Background If disease burden were directly correlated with priority on the global health agenda, then congenital syphilis would have a high position. But even though congenital syphilis adversely affects around 650,000 pregnancies and newborns annually and is relatively simple to diagnose and treat, it is largely absent from high-level discussions of reproductive and child health and is not a major programmatic focus at prominent global health organisations. We sought to examine explanations for the low prioritisation of congenital syphilis and use our findings to inform framing strategies to improve the placement of congenital syphilis on the global health agenda.

Methods First, we reviewed published literature on congenital syphilis to construct a basic narrative, identify trends, and identify important stakeholders. Second, we conducted semi-structured interviews with stakeholders involved with or important to congenital syphilis control to understand the prioritisation of congenital syphilis and attempts to promote it. Third, we surveyed influential representatives of global health institutions to assess their perspectives on the position of congenital syphilis on the global health agenda. Finally, we analysed the data to track changes in priority given to congenital syphilis over time. We then developed political strategies based on these data.

Results Based on our literature review and key informant interviews, we develop framing strategies, identify potential political allies, and suggest pathways advocates can use to increase the prominence of congenital syphilis on the global health agenda.

Conclusions Although it is an important cause of stillbirth and neonatal death, congenital syphilis is largely invisible on the global health agenda. Past efforts to raise awareness have had limited impact. Future efforts toward elimination of congenital syphilis could benefit greatly from increased attention to framing strategies and alliances with related issues in global health.