Congenital Syphilis Elimination in Latin America: A Systematic Analysis of Policy and Progress

Syphilis in pregnancy and congenital syphilis (CS) remain major public health challenges in Latin America despite long-standing elimination initiatives. CS incidence continues to rise, although diagnosis and treatment are available, reflecting persistent programmatic gaps. A systematic assessment of strengths, weaknesses, opportunities, and threats (SWOT) can help refine strategies and accelerate progress toward the elimination of mother-to-child transmission (EMTCT) of syphilis.

We performed a qualitative SWOT analysis of public health policies addressing syphilis in pregnancy and CS in Latin American countries. Data sources included Pan-American Health Organization databases, global monitoring databases, national data, peer-reviewed literature, and programmatic reports. Evidence was synthesized using a standardized matrix to classify internal and external factors affecting syphilis control.

Regional strengths include political commitment, national guidelines aligned with Pan-American Health Organization/World Health Organization recommendations, high antenatal care coverage, use of rapid and HIV/syphilis tests, and established surveillance systems. Key weaknesses include late antenatal care initiation, gaps in timely testing and treatment, regulatory barriers to point-of-care testing and penicillin administration, benzathine penicillin shortages, data quality limitations, fragmented governance and care, and weak partner management. Opportunities include strengthening the EMTCT agenda via program integration, digital health expansion, regional collaboration, and innovative diagnostic strategies. Threats include rising syphilis incidence, competing public health emergencies, political and economic instability, poverty, exclusion and stigma, and loss-to-follow-up during and after pregnancy due to population mobility.

Despite political commitment, Latin America remains far from achieving EMTCT of syphilis. Strengthening integrated services, supply chains, data systems, and partner management is needed to improve outcomes.