Introduction To analyse congenital syphilis (CS) between 2007 and 2014, and case profile in 2014 in the state of São Paulo (SSP).

Methods Ecological descriptive study; sources: SINAN (cases) and Fundação Seade (live births-LB population).

Results 24 684 cases of syphilis in pregnancy (PS) and 12 479 of CS reported in the period. PS detection rate and CS incidence rate increased 2.8 times (3.5 to 9.9/1,000 LB) and 2.4 times (2.0 to 4.8/1,000 LB) in 2010 and 2014, respectively. There were 132 infant deaths and 1051 stillbirths and miscarriages by syphilis, about 9.5% (1,183) of total cases. In 2014, 29% (870/2,989) of CS cases did not complete clinical and laboratory protocol (no long bone x-ray or CSF) and 17% (499/2,989) did not comply with treatment protocol. About 20% (612/2,989) of mothers were ≤19 years old, 75% (2,244/2,989) underwent antenatal care (AN) and of these, 71% (1,597/2,244) were diagnosed with syphilis. Although most mothers had access to AN diagnosis of syphilis during pregnancy, the vertical transmission chain was not interrupted. It is emphasised that 55% (1,632/2,989) of the mother’s treatment was considered inadequate, because the sexual partner was not treated (74%, 2,203/2,989).

Conclusion Albeit preventable, CS remains a public health problem with failures, especially during AN. Early diagnosis and treatment up to the 20th week of pregnancy can reduce fetal loss and prevent infant deaths. The case definition is sensitive considering the treatment of sexual partner in the mother’s treatment classification. The public health challenge is to increase coverage and quality of AN, expand diagnosis and treatment of women and sexual partners in primary care services, and prevent STDs, especially in vulnerable women. To identify determinants of transmission and foster interventions, CS cases have been investigated using specific protocols and discussed in regional and municipal committees. The SSP proposed using Mother and Child Mortality Committees to discuss the cases, given they have already been established and are operating regularly.