Diagnosis and management of congenital syphilis: Avoiding missed opportunities

Congenital syphilis can result in pregnancy loss and substantial morbidity in newborns. The current epidemic of congenital syphilis in Canada (especially Western Canada) is a preventable public health emergency. Rates indicate a lack of control of syphilis within the community and insufficient public health resources to prevent spread that predate the COVID-19 pandemic. Risk factors include lack of prenatal care, methamphetamine and other substance use, and unstable housing. The cornerstone of prevention is identification, treatment, and follow-up during pregnancy, including of partners. Clinicians caring for newborns need to consider aspects of maternal treatment, reinfection risk, the results of paired maternal and infant syphilis serology, and infant clinical assessment. A complete risk assessment will guide effective management and follow-up of infants exposed in utero to syphilis.