The morbidity and mortality associated with congenital syphilis are preventable; screening in pregnancy enables treatment of the mother, fetus and sexual partners. Maternal syphilis leads to stillbirth, prematurity, clinical congenital syphilis and infant death, with the highest transmission rates and most deaths occurring in early syphilis. A recent study in Russia showed that 26% of infants with congenital syphilis had fatal outcomes,¹ while 51% of all stillbirths in Tanzania were attributed to syphilis.² While maternal screening and treatment of syphilis are extremely cost-effective health interventions even when the prevalence of infection is very low,^3,4 many countries do not have universal antenatal screening. In a survey of 22 countries in sub-Saharan Africa, 17 had antenatal screening, but although 73% of pregnant women had antenatal care, only 38% were screened for syphilis.⁵

Globally, the World Health Organization (WHO) estimates that around 360 000 fetal and perinatal deaths occur annually due to syphilis and a further 270 000 babies suffer serious and permanent effects.⁶ A study conducted in four countries (Argentina, Cuba, Saudi Arabia and Thailand) participating in the WHO antenatal care trial estimated an overall prevalence of 0.9% with a range of 0.1% …