Prevention of congenital syphilis--time for action.

Abstract

While congenital syphilis is largely under control in affluent parts of the world, syphilis during pregnancy continues to be a tragic and substantial problem in many developing countries. Estimates indicate that around a million pregnancies are affected annually (1). The situation in sub-Saharan Africa re-mains the worst, with rates of syphilis infection among pregnant women over 10% and reinfection during pregnancy a common occurrence (2). Yet, as the articles in this issue of the Bulletin em-phasize, inadequate attention has been given to this significant public health problem in spite of the fact that, as Schmidt states (pp. 402–409), “we have had the tools to prevent [congenital syphilis] for decades” and they are “inex-pensive, simple and highly cost-effective”.Studies in Africa have shown that, if special efforts are made, the traditional approach of antenatal screening and treatment of infected women repre-sents value for money and is at least as cost-effective as antiretroviral therapies to prevent mother-to-child transmis-sion of human immunodeficiency virus (HIV) (1, 3). Schmidt argues, however, that the inability to control congenital syphilis is principally due to “interna-tional and national underappreciation of the burden of congenital syphilis, with resultant insufficient political will to prevent and maintain effective antenatal screening programmes”. Hawkes et al. (pp. 417–423) highlight the need to view syphilis control through the perspectives of multiple stakeholders in order to identify opportunities for improving the formulation and imple-mentation of national policies. Thus, political will and commitment among health policy-makers to recognize and tackle congenital syphilis is crucial but, in general, screening and treatment are poorly implemented in many countries (4). Accordingly, several of the papers published in this issue of the Bulletin highlight the need to strengthen the tra-ditional approach to control congenital