Congenital syphilis, the neonatal infection caused by vertical transmission of the spirochete Treponema pallidum subsp pallidum is increasing globally. Congenital syphilis is entirely preventable through antenatal administration of Penicillin, but <70% of untreated pregnancies will result in an adverse birth outcome. Globally, gestational syphilis is the second leading infectious cause of stillbirth after malaria. Congenital syphilis may be apparent between birth and 12 weeks of age as a classical syndrome of rash, hepatosplenomegaly, jaundice, snuffles, thrombocytopenia and pseudoparesis but crucially up to two-thirds of infants are asymptomatic at birth.1 Identification of asymptomatic congenital syphilis requires a high index of suspicion by clinicians and a robust system of antenatal screening and reporting.

In the UK, syphilis rates hit record levels in 2022,2 with a 15% increase between …