Worldwide, the World Health Organization estimates that maternal syphilis is responsible for 460 000 stillbirths or abortions, 270 000 cases of congenital syphilis, and 270 000 low birthweight or premature babies.¹ The vast majority of these cases are seen in developing countries, but congenital syphilis also occurs in affluent nations. Established control methods are based on antenatal screening in the first trimester supported by treatment and partner notification. High risk patients are then followed up in the third trimester; treatment and partner notification are undertaken where necessary. These control methods are highly cost effective but are dependent on well structured healthcare pathways.^2,3 A recent paper by Cross et al provides insight into the problems of managing syphilis in pregnancy across diverse clinical settings in a London teaching hospital.⁴ The authors report outcomes for 70 women with positive syphilis serology, and found that of 42 women at intermediate risk of transmitting infectious syphilis …