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Congenital syphilis in neonates: Persistent diagnostic and treatment challenges in resource-limited settings

Anjali Joshi1, Jeetinder Joshi2, Pothapregada Sriram3

  • 1Senior Resident, Department of Neonatology, AIIMS Bilaspur, Bilaspur, Himachal Pradesh, India.

Tropical Doctor
|May 29, 2026
PubMed

Insights

Congenital syphilis (CS) persists in low- and middle-income countries due to failures in antenatal screening and treatment. This study highlights recurring issues in preventing CS, emphasizing the need for improved interventions.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Neonatal Care

Background:

  • Congenital syphilis (CS) remains a significant global health challenge, particularly in low- and middle-income countries (LMICs).
  • Existing guidelines for CS prevention are often not fully implemented, leading to persistent transmission and delayed diagnoses.
  • Previous reports from India have highlighted symptomatic infants with delayed diagnoses due to inadequate antenatal screening.

Purpose of the Study:

  • To prospectively identify and characterize neonates born to mothers with reactive syphilis serology in northern India.
  • To evaluate the effectiveness of antenatal screening and maternal treatment in preventing congenital syphilis.
  • To map failures in the congenital syphilis prevention cascade in a tertiary care setting.

Main Methods:

  • Prospective identification of five neonates born to mothers with reactive syphilis serology at a tertiary care center in northern India (September 2024-January 2026).
  • Assessment of maternal syphilis treatment adequacy.
  • Neonatal RPR testing and classification of CS probability based on CDC criteria.
  • Evaluation of treatment challenges, including penicillin availability.

Main Results:

  • All five neonates were asymptomatic at birth, despite reactive maternal serology.
  • Adequate maternal treatment was confirmed in only two of the five cases.
  • Only one neonate had a reactive neonatal RPR test.
  • Based on CDC criteria, one neonate was highly probable CS, three were possible CS, and one was less likely CS.
  • Limited availability of aqueous crystalline penicillin led to the use of benzathine penicillin for all infants.

Conclusions:

  • Failures in the congenital syphilis prevention cascade, including antenatal screening and adequate maternal treatment, continue to impact LMICs.
  • Even asymptomatic neonates born to mothers with reactive syphilis require careful evaluation and management.
  • Challenges in penicillin availability and adherence to treatment protocols complicate CS management in resource-limited settings.
  • Systemic improvements are needed to address recurring failures in preventing congenital syphilis.

Keywords:
AsiaCongenital diseasedisease controldisease prevention

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