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Antenatal Syphilis Treatment Adequacy and Neonatal Outcomes: A Retrospective Cohort Study
Priyadarshini Tripathy1, Erin Lurie2, Vahinie Narang3
1Department of Maternal-Fetal Medicine, St. Michael's Hospital, Toronto, ON.
Insights
Congenital syphilis in a vulnerable population was linked to late maternal diagnosis and incomplete treatment. Early screening and multidisciplinary care are vital for preventing this infection.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Public Health
Background:
- Syphilis in pregnancy poses significant risks to both mother and neonate.
- Structurally vulnerable populations often face barriers to adequate prenatal care and timely syphilis treatment.
Purpose of the Study:
- To evaluate the timing and adequacy of antenatal syphilis treatment.
- To assess neonatal outcomes in a vulnerable pregnant population receiving specialized care.
Main Methods:
- Retrospective cohort study of pregnant individuals with syphilis in Ontario, Canada (July 2021-July 2025).
- Defined adequate treatment based on penicillin regimen and completion timing relative to delivery.
- Assessed primary outcome of congenital syphilis and secondary outcomes including neonatal health indicators.
Main Results:
- Most syphilis infections (86%) were latent, with diagnosis often occurring late in pregnancy (50% after 28 weeks).
- Adequate maternal treatment was achieved in 64% of cases; inadequate treatment occurred in 36%.
- One case of congenital syphilis (7%) was observed, associated with late maternal diagnosis and incomplete treatment.
Conclusions:
- Congenital syphilis in this cohort was exclusively linked to delayed diagnosis and insufficient maternal treatment.
- Emphasizes the critical need for early syphilis screening and re-testing for high-risk individuals.
- Highlights the importance of multidisciplinary care models addressing structural barriers to optimize prevention.
Objectives:
To describe the timing and adequacy of antenatal syphilis treatment and neonatal outcomes in a population experiencing structural vulnerability.
Methods:
This retrospective cohort study included pregnant individuals with confirmed syphilis who received multidisciplinary prenatal care through a specialized perinatal addictions program and delivered at a tertiary academic hospital in Ontario, Canada, between July 2021 and July 2025. Adequate treatment was defined as a single dose of benzathine penicillin G for early syphilis or 3 weekly doses for late latent syphilis or syphilis of unknown duration, with the final dose completed at least 30 days before delivery. The primary outcome was congenital syphilis. Secondary outcomes included gestational age at delivery, birth weight, neonatal intensive care unit admission, neonatal death, and mode of delivery.
Results:
Fourteen pregnancies met the inclusion criteria, with a median maternal age of 32 years. Most infections were latent (86%). Diagnosis occurred before 20 weeks in 7%, between 20 and 28 weeks in 43%, and after 28 weeks in 50%. All participants received penicillin; treatment was adequate in 9 (64%) and inadequate in 5 (36%). One neonate (7%) was diagnosed with congenital syphilis in the setting of late presentation and incomplete maternal therapy. Most births were term (86%), the median birth weight was 2950 g, and neonatal intensive care unit admission occurred in 2 cases (14%). One neonatal death was unrelated to syphilis.
Conclusions:
Congenital syphilis occurred only in the setting of late diagnosis and incomplete maternal treatment. Early screening, repeat testing in individuals at ongoing risk, and multidisciplinary care models that address structural barriers are critical to prevention.
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