Serologic response to VDRL in infants with congenital syphilis: ceftriaxone vs. penicillin.

Congenital syphilis (CS) can occur despite timely identification and adequate treatment of maternal syphilis (breakthrough CS). We examined associations between maternal characteristics and prevalence of breakthrough CS. Having primary/secondary syphilis, a higher maximum nontreponemal titer, and treatment initiation closer to delivery were associated with a higher prevalence of breakthrough CS.

ABSTRACT Neonatal IgM antibodies reflect an in utero immune response to Treponema pallidum and may offer added diagnostic value. This study evaluated the test performance of treponemal IgM levels measured by the research-use-only (RUO) Dual Path Platform (DPP) Syphilis TnT point-of-care (POC) assay for congenital syphilis (CS) risk stratification. Conducted from May 2023 to May 2025, this study tested neonatal serum samples from infants born to mothers with syphilis using the DPP Syphilis TnT RUO POC assay, which reports treponemal and nontreponemal IgM levels as relative light units (RLU). Neonates were classified as confirmed proven or highly probable CS , possible CS , or CS less likely per guidelines; 23 neonates without maternal syphilis served as controls. Treponemal IgM levels were compared across categories using nonparametric tests and ordinal logistic regression. Diagnostic performance used prespecified cutoffs, with agreement assessed against neonatal rapid plasma reagin (RPR). Twenty-two maternal-neonatal dyads were included. Mean treponemal IgM levels rose with CS severity, peaking in the high-risk group ( possible or confirmed proven/highly probable CS: 29.9 ± 20.6 RLU) versus CS less likely (17.5 ± 20.8 RLU) and controls (3.5 ± 0.8 RLU; P < 0.05). Higher IgM levels independently linked to elevated CS risk (OR 1.10 per 1 RLU; P = 0.0025). At ≥10 RLU cutoff, treponemal IgM detected 88.9% of high-risk neonates, with 76% agreement to neonatal RPR. The DPP Syphilis TnT RUO POC assay’s treponemal IgM levels discriminated CS risk categories effectively and may supplement current algorithms to improve neonatal CS stratification. IMPORTANCE Congenital syphilis (CS) continues to rise in the United States and globally, yet diagnosis at birth remains difficult because no single laboratory test definitively confirms infection in newborns. Clinical decisions often rely on maternal history and indirect serologic comparisons, which can result in both missed cases and unnecessary treatment of low-risk infants. IgM antibodies are produced by the fetus in response to infection in utero and therefore represent a biologically meaningful marker of congenital infection. This study evaluates the diagnostic potential of the Dual Path Platform Syphilis TnT research-use-only point-of-care assay to detect treponemal IgM in at-risk neonates. We demonstrate that IgM levels increase across CS less likely , possible CS , and confirmed proven or highly probable CS categories and are independently associated with disease risk. These findings provide early evidence that neonatal IgM testing may improve risk stratification and support more precise clinical decision-making in CS management.

BackgroundIn recent years, gestational and congenital syphilis have re-emerged as significant public health concerns in Hungary. Although national surveillance data are available for syphilis, they do not include gestational cases, and recent studies describing the epidemiological and clinical characteristics of gestational and congenital syphilis remain limited. The aim of the study was to analyze 10 years of data to evaluate the clinical characteristics and outcomes of gestational and congenital syphilis and to identify gaps in prenatal screening and care.MethodsWe conducted a cross-sectional, single-center study at the National STD Centre in Budapest, analyzing data from pregnant women diagnosed with syphilis and their newborns between 2015 and 2025. Maternal epidemiological and clinical data were collected, and neonatal clinical and laboratory data were evaluated where available.ResultsA total of 180 pregnant women with 185 pregnancies were included. Diagnosis was made in the second or third trimester in 139 cases, and 110 cases were classified as early latent syphilis. 173 women were asymptomatic at the time of diagnosis. Penicillin was administered in 176 out of 185 (95%) cases, and an adequate serological response, defined as a ≥4-fold decline in RPR titer, was observed in 176/185 (95%). Neonatal data were available for 106 newborns. 10 (9%, 95% CI: 5-17%) neonates met the diagnostic criteria for congenital syphilis, including nine probable and one confirmed case. Clinical manifestations ranged from asymptomatic infection to severe multisystem involvement. All neonates with congenital syphilis (n = 10), as well as those whose mothers had not received adequate treatment (n = 10), in total 20/106 neonates (19%; 95% CI: 12-27%) were treated with penicillin.ConclusionGestational and congenital syphilis remain significant public health concerns in Hungary. The high proportion of late diagnoses highlights the need for repeated antenatal screening and interdisciplinary collaboration to prevent congenital infection.

Incidence and characteristics of congenital syphilis cases in Catalonia, 2010-2024: Underestimation of disease burden and perspectives for elimination.

Introduction: Brazilian public health faces constant challenges to meet demographic and social changes, and despite current policies, rates of sexually transmitted infections, such as syphilis, especially in pregnant women and newborns, are still high. Primary Health Care is recognized as the best way to act on maternal and child health, with prenatal care being essential for the diagnosis and follow-up of pregnant women. Objective: To analyze the social and epidemiological profile of pregnant women and newborns with syphilis in the Southeast region of Brazil between 2019 and 2022. Methods: This is a descriptive and cross-sectional research, with data from Brazilian Epidemiological Indicators and the 2023 Epidemiological Bulletin of the Brazilian Ministry of Health. Results: According to the results, the Southeast region concentrates almost 50% of the cases of gestational and congenital syphilis in Brazil. Although many pregnant women receive prenatal care and are diagnosed in the first trimester, a significant proportion still receive incomplete treatment, which negatively affects the newborn. Conclusion: Syphilis continues to be a serious public health issue, especially in the Southeast, with alarming growth rates. Therefore, it is essential to implement public policies that improve the quality of prenatal care, ensuring continuous follow-up during pregnancy and in the postpartum period for effective diagnosis and treatment of syphilis.

Background: Syphilis rates are rising globally, with increases in congenital syphilis in South America particularly concerning. The characterization of contemporary South American Treponema pallidum (Tp) strains is crucial to syphilis vaccine development, yet few genomic epidemiology studies have focused on this region. Here, we performed whole genome sequencing of Tp from Buenos Aires, Argentina, as well as deep sequencing of the hypervariable tprK locus, which is critical to Tp immune evasion. Methods: People with primary, secondary, or congenital syphilis were enrolled at two clinics in Buenos Aires between October 2018 and January 2023, including individuals associated with intra-household transmission. Tp DNA from swabs was quantified by tp0574 qPCR, and whole-genome sequencing was performed on samples with sufficient treponemal burden. Tp reads were assembled to the SS14 strain reference genome, recombinant regions masked, and a core genome phylogeny was generated. Full-length tprK was sequenced using PacBio reads. Findings: Tp genomes were recovered from 96 samples from 70 individuals in Buenos Aires and primarily belonged to globally dominant SS14 sublineage-1 and Nichols sublineage-8, as did Tp recovered from contemporary samples from Brazil (n=8). Peruvian samples (n=3) all belonged to sublineage-1. Two individuals from Buenos Aires had co-infections with Nichols- and SS14-lineage strains. Macrolide resistance via A2058G mutation occurred in 27/70 (39%) samples. Across 56 samples, tprK allelic diversity was significantly increased in secondary syphilis, oral lesions, and SS14-lineage strains compared to primary syphilis, anogenital lesions, and Nichols-lineage strains, respectively. Increased tprK diversity in SS14-lineage strains is driven by an enhanced repertoire of V7-specific donor sequences. Using multiple approaches, tprK sequences from intra-household transmission events were more similar than unrelated samples with identical core genomes. Interpretation: Tp circulating in South America is closely related to dominant global sublineages. Increased tprK diversity in the SS14 lineage may influence Tp's ability to escape host adaptive immunity. We confirmed that tprK profiling is a promising tool to elucidate syphilis transmission networks. This study underscores the utility of genomics to yield insights into Tp pathogenesis.

An initial evaluation found that doxy-PEP has a population-level effect on syphilis among cisgender men and transgender women who have sex with men. Whether doxy-PEP's impact is generalizable across the U.S. and will affect syphilis incidence among cisgender women and pregnant people - populations who seldom receive doxy-PEP - and congenital syphilis (CS) is unknown. We used public health surveillance data from January 2017-June 2025 to conduct an interrupted time series analysis of monthly syphilis diagnoses (all stages) overall and by gender before and after doxy-PEP implementation in March 2023 in King County, WA. We estimated the observed and counterfactual number of syphilis cases post-implementation to calculate absolute and relative differences in cases. In the post-implementation period, the absolute difference in total syphilis cases was -3031 (95%CI:-4295, -1768) with a relative difference of -52.3% (95%CI:-74.1%, -30.5%). Among cisgender men, the absolute difference in cases was -2248 (95%CI:-3321, -1175) for a relative difference of -53.1% (95%CI:-78.5%, -27.8%) in the post-implementation period. Cisgender women experienced an absolute difference of -755 cases (95%CI:-939, -572) and a relative difference of -46.9% (95%CI:-58.3, -35.5%) after doxy-PEP implementation. Among transgender and nonbinary people, the absolute difference in syphilis cases was -56 (95%CI:-90, -23), a relative difference of -33.1% (95%CI:-53.3, -13.6%), in the post-implementation period. Syphilis cases among pregnant persons rose from 13 in 2017 to 48 in 2024 while CS cases increased from 0 in 2017 to 23 in 2024. After the implementation of doxy-PEP, syphilis diagnoses declined dramatically, including among cisgender women. This decline has not affected syphilis in pregnant persons or CS.

Syphilis remains a persistent global public health problem. Given that low-cost diagnostics and highly effective therapies have been available for decades, the current epidemic is driven by structural weaknesses in health systems, stigma, absence of political will and failures to integrate new technologies into routine care. At the Shanghai 2025 Syphilis Meeting, experts highlighted the evolving landscape of syphilis diagnostics. The presentations offered an overview of our changing understanding of seronegative primary disease, reinfection patterns, and asymptomatic mucosal shedding as well as the limitations of diagnostics for neurosyphilis and novel approaches that have shown promising performance. One presentation provided new insights into congenital syphilis by demonstrating significant changes seen on fetal ultrasound and compelling data suggesting a role for new point-of-care IgM tests for risk stratification of exposed newborns. Self-testing was highlighted as an emerging strategy that leverages community engagement, decentralization, and digital technologies to reach populations historically excluded from facility-based services. Finally, a global systems-level overview offered a summary of implementation barriers for diagnostic assays, the need for sustainable adoption of point-of-care tests, and the policy deficits that impede progress. The presentations collectively illustrated the complex interplay between technology, systems design, behavioral dynamics, and policy in shaping the global response to syphilis. The path forward requires an approach that integrates novel diagnostic and digital technologies with programs designed to strengthen health systems as well as community partnerships. Such cross-disciplinary frameworks have the potential to reduce diagnostic inequities and accelerate progress toward the elimination of syphilis worldwide.

We estimated potential congenital syphilis (CS) cases averted using the national disease surveillance data and AtlasPlus data. Nationally, over 60% of potential CS cases were averted during 2010-2023, with state variations. Despite an increase in the number of averted cases, the percentage of potential cases averted has declined over time.

Despite similarities in healthcare system organization, the incidence of congenital syphilis remains stable in Russia, whereas a marked decline has been achieved in China. The question remains which systemic factors constitute key barriers in Russia. This study seeks to identify and quantitatively assess specific gaps in screening, monitoring, and treatment of syphilis among pregnant women in Russia that hinder effective adoption of successful Chinese practices. The work aimed to perform a comparative analysis of syphilis incidence among pregnant women in Russia and China. A retrospective analysis was conducted using data from the Russian Federal State Statistics Service, the Chinese Center for Disease Control and Prevention, and scientific publications (2013–2023). In China, a decline in syphilis incidence among pregnant women has been observed due to mandatory trimester-based screening (coverage 99%) and a comprehensive program for the prevention of mother-to-child transmission. The incidence of congenital syphilis decreased from 91.6 to 18.4 cases per 100,000 live births (between 2011 and 2018). In Russia, the incidence remains consistently high (13.1–17.6 per 100,000 population in 2020–2023), with more than 30% of women entering antenatal care in the second or third trimester. Data on treatment coverage are lacking. Reducing the burden of congenital syphilis in Russia may be facilitated by standardization of screening protocols and implementation of monitoring systems ensuring early antenatal registration. The success of the Chinese model is driven by comprehensive screening and integration of services within the national healthcare system, which is comparable to that of the Russian Federation.

Congenital syphilis (CS) is highly preventable through prenatal screening and treatment. However, populations disproportionately impacted by prenatal syphilis often face barriers to access, in part due to housing instability and substance use. This study assessed Pregnancy Connections, a pilot program designed to prevent CS by offering comprehensive, patient-centered prenatal care, with added support and comprehensive case management services, for patients experiencing unstable housing and/or substance use. This qualitative study involved interviews with three groups: program staff (n=13), patients (n=10), and individuals eligible for the prenatal program but not enrolled (n=14). Interviews were transcribed and analyzed to identify program successes, challenges, and lessons learned. Key successes included the provision of respectful and responsive care, reduced barriers to care, improved collaboration and coordination, and improved patient outcomes. The main challenges included difficulties in care coordination within the health center and with external services, suboptimal patient engagement, and limited program outreach and awareness. Lessons learned for future implementation highlighted the critical need for services and outreach for this vulnerable and often stigmatized population. Additionally, thoughtful referral systems and incentives, clinic champions, and organizational support were key. Identifying and developing effective interventions is essential to address this critical public health issue. Providing respectful, patient-centered prenatal care with added support for populations at elevated risk of syphilis is a promising approach.

To the Editors: Rising maternal syphilis infections have led to a surge in congenital syphilis (CS), which causes severe and permanent health issues leading to substantial social and economic burdens compared with adult infection.1,2 However, the immunopathogenesis of CS, especially the role of neonatal immunity, remains unclear. Here, we report a case of a preterm infant with CS following incomplete maternal treatment, providing a unique opportunity to observe fetal–neonatal immune responses to active Treponema pallidum infection. A female neonate was born at 27 weeks gestation (1024 g). Maternal syphilis screening at 8 weeks gestation was negative. However, seroconversion was confirmed at 26 weeks and 5 days following fetal ascites detection: rapid plasma reagin (56 units) and T. pallidum hemagglutination assay titers (259, cutoff index). Maternal amoxicillin treatment was initiated, but spontaneous delivery occurred 2 days later. At birth, she presented respiratory failure, hepatosplenomegaly, ascites, skeletal abnormalities, anemia and thrombocytopenia. Serological tests confirmed CS diagnosis (rapid plasma reagin: 76.8, T. pallidum hemagglutination assay: 28.7, cutoff index; fluorescent treponemal antibody-absorption immunoglobulin [Ig]M, 1:1,280). Administration of intravenous penicillin G improved CS symptoms. After surgical ligation for patent ductus arteriosus and initiation of home oxygen therapy for bronchopulmonary dysplasia, she was discharged from the hospital on day 114. Time course analysis of peripheral blood lymphocyte subsets revealed a polarization of T helper (Th)2 cells at birth, followed by gradual increase in Th1 cells, T follicular helper cells, memory B cells and regulatory T cells (Fig. 1A). Cytokine profiling revealed elevated interleukin (IL)-12, IL-8, IL-10 and IL-21 levels; however, pro-inflammatory or Th1 cytokines were not elevated: IL-1β, IL-2, IL-6, tumor necrosis factor-alpha and interferon-gamma (Fig. 1B).FIGURE 1.: Temporal progression of the peripheral immunophenotype. A: Immune cell analyses in peripheral blood on days of life 0, 3, 7 and 11 using a LSRFortessa flow cytometer (Becton Dickinson, Franklin Lakes, NJ) and FlowJo software (version 10.6.2; Becton Dickinson). The proportions of Th1 cells (CCR6−CXCR3+), Th2 cells (CCR6−CXCR3−) within memory Th cells (CD4+CD45RO+); Treg cells (CD127dimCD25+) within Th cells (CD4+); Tfh cells (CD45RO+CXCR5+) within Th cells (CD4+) and memory B cells (CD19+CD27+IgD+) within B cells (CD19+) were assessed. B: Cytokine profiles in peripheral blood were evaluated on days of life 0, 1, 7 and 11 using a BD Cytometric Bead Array (Becton Dickinson). Tfh indicates T follicular helper; Treg, regulatory T cells.At primary infection sites in adult syphilis, pro-inflammatory cytokines, Th1-mediated immunity and humoral responses, which are all critical for bacterial clearance, are induced.3 As observed in the present case, infants with CS present with systemic infection at birth, resembling that of adult secondary syphilis.1,2 However, despite detectable humoral immune responses, pro-inflammatory cytokine production and Th1-mediated immunity were markedly reduced at birth, with T-cell differentiation skewed toward a Th2 phenotype. Th2 polarization and attenuated pro-inflammatory cytokine production and Th1-mediated immunity indicated developmentally distinct characteristics of the neonatal immunoregulatory immune system, which are essential for fetal–maternal tolerance.4 A previous report suggested that preterm infants with CS exhibit pro-inflammatory cytokine production and Th1 responses at birth, indicating that they possess pathogen clearance mechanisms similar to those in adults5; however, the infant was born to a mother who had completed syphilis treatment. Therefore, the reported immune profile may not represent the immune status during active T. pallidum infection and likely differs from that observed in our case, where maternal treatment was incomplete. Accordingly, the Th1 response in our case gradually developed following the initiation of antimicrobial treatment. These findings suggest that developmentally distinct features of the neonatal immune system contribute to impaired clearance of T. pallidum, leading to the severity of CS symptoms. Study limitations include the single-case design. Future research with larger cohorts is necessary to further elucidate the immunopathogenic features of CS.

Congenital syphilis has increased in prevalence since 2001, especially in low- and middle-income countries, constituting a public health problem. To analyze the economic burden and epidemiological characterization of congenital syphilis in a tertiary public hospital in Monterrey. Children under 2 years of age born to mothers with positive VDRL (Venereal Disease Research Laboratory) or TP-PA (particle agglutination for Treponema pallidum), from January 2017 to December 2024, in a public tertiary hospital were included. They were classified according to Centers for Disease Control and Prevention scenarios. Maternal and infant clinical and demographic variables, clinical outcomes, hospitalization costs and type of federal health coverage were collected. A total of 321 patients were analyzed, and the median hospital stay was 4 days with median costs of $1533.15 USD. Higher costs were observed in proven congenital syphilis ($4221.58 USD) compared to other clinical scenarios. A statistical difference was reported between the costs of the three periods of federal health coverage ($370.88 vs. $2801.38 vs. $1,532.82 USD; p < 0.001). 48% of the cases were diagnosed after birth. The results reflect the high economic burden and increasing trends of congenital syphilis, with mostly late diagnosis.

The incidence of congenital syphilis (CS) in Canada increased from 2.1 to 14.5 reported confirmed cases/100,000 live births from 2017 to 2023 (from 8 to 53 cases). We aimed to document prenatal characteristics and contributing factors to CS among mothers or birthing parents (M/BP) of infants with CS in Canada. Participants of the Canadian Paediatric Surveillance Program, which includes both paediatricians and paediatric subspecialists, were invited to report on CS cases meeting the study case definition between June 2021 and May 2023. A detailed questionnaire was completed by the reporting clinician. We used descriptive statistics in the assessment of prenatal risk factors among cases, including data on healthcare access, diagnosis, and treatment as well as on socio-demographic, socio-economic and socio-behavioural determinants. During the 24-month study period, 245 live-born cases of CS were reported, including 81 (33.1%) confirmed and 164 (66.9%) probable cases from seven provinces and territories. Substance use in pregnancy was reported in 65% of cases. Only half of M/BP had at least 1 prenatal care visit during their pregnancy, while only one-quarter had ≥ 1 prenatal care visit in each trimester. In a quarter of cases, no syphilis screening was performed during pregnancy. Prenatal syphilis treatment was not initiated among 20% who screened positive. In this country-wide assessment, we identified substantial failures in the delivery of adequate prenatal care to M/BP of live-born infants diagnosed with CS. Public health action, such as community outreach to ensure prenatal care for all pregnant people, with specific attention to the prenatal healthcare needs and engagement in the care of those who use substances, is pressing.

Syphilis remains a global public health concern, with maternal infection posing a substantial risk for congenital syphilis, a preventable condition associated with severe morbidity and mortality. Penicillin, particularly benzathine penicillin G, remains the cornerstone of treatment and the only therapy with proven efficacy in preventing vertical transmission during pregnancy. However, recurrent global shortages, limited manufacturing capacity, mislabeling of penicillin allergy, and the absence of validated alternative regimens for pregnant women and neonates threaten progress toward elimination goals. This review summarizes current evidence on the treatment of syphilis in pregnancy and congenital syphilis, highlighting the established maternal and neonatal regimens, diagnostic and therapeutic challenges, and clinical consequences of delayed or inadequate treatment. We examine the scope and drivers of benzathine penicillin G shortages, the overestimation of penicillin allergy and its impact on care, and the role of neonatal management when maternal therapy is suboptimal. Emerging data on alternative antimicrobial agents, including cephalosporins, tetracyclines, lipoglycopeptides, and novel compounds are discussed considering recent advances in Treponema pallidum culture and susceptibility testing. While several non-penicillin agents show promise for non-pregnant populations, robust evidence supporting their use during pregnancy and for the prevention of congenital syphilis is lacking. Addressing these gaps through coordinated supply chain strategies, guideline harmonization, and targeted clinical research is essential to ensure resilient and equitable syphilis control and advance global efforts toward the elimination of congenital syphilis.

The neglected role of partner treatment in congenital syphilis control in Brazil: nationwide evidence from 2007 to 2023

Rates of congenital syphilis in the US have surged over the past decade, despite most states having long-standing mandates requiring clinicians to offer syphilis screening early in pregnancy. Gaps in screening coverage remain, and first-trimester screening alone may miss cases. Several professional bodies now recommend repeat screening in the third trimester and at delivery. Evidence on the impact of expanded prenatal syphilis screening mandates on case detection is limited. To evaluate the effectiveness of expanding prenatal syphilis screening mandates on syphilis case detection during pregnancy. Birth certificate data from 33 US states between 2012 and 2022 were analyzed using a staggered difference-in-differences design. Maternal syphilis case detection in 4 states that enacted mandates for third-trimester and delivery screening (Arizona, Georgia, Louisiana, and Michigan) were compared with 29 control states without such mandates during this period. The new mandates required all pregnant people be offered third-trimester screening. Three of the states further required that individuals at high risk of syphilis infection be offered screening again at delivery, and 1 state required universal delivery screening. To ascertain whether expanded mandates were associated with changes in screening coverage, inpatient discharge records from 1 mandate expansion state (Georgia) were analyzed. Data were analyzed from December 2024 to September 2025. Passage of a universal syphilis screening mandate in the third trimester and a high-risk or universal mandate at delivery between 2012 and 2022. Maternal syphilis case detection (cases per 100 000 live births) and the share of deliveries receiving syphilis screening. The study sample included 16.3 million live births and 20 961 reported syphilis cases between 2012 and 2022 in 4 mandate expansion states and 29 control states. Expanded screening mandates were associated with a 26% (95% CI, 3-53) increase in maternal syphilis case detection in the first quarter after enactment. The increase in case detection attenuated thereafter and was no longer significant within 1 year (11%; 95% CI, -17 to 48; P = .48). In this study, expanded prenatal syphilis screening mandates may improve syphilis case detection in the near-term but are unlikely to have sustained impact without complementary efforts, such as those that facilitate clinician adherence and ensure patient access to and completion of treatment.

Congenital syphilis remains a preventable cause of fetal and neonatal morbidity and mortality, despite the availability of inexpensive diagnostics and effective treatment. We aimed to evaluate the maternal and congenital syphilis burden at the Instituto Nacional Materno Perinatal, Peru's national referral center for maternal and perinatal care. We conducted a retrospective analysis of aggregated, de-identified surveillance data from January 2023 to December 2025. Maternal prevalence and congenital syphilis incidence were calculated and compared with World Health Organization (WHO) elimination benchmarks. Among 59,568 pregnant women screened, maternal syphilis prevalence ranged between 1·0% and 1·2% of all women screened. Across 36,094 live births, congenital syphilis incidence ranged between 191 and 259 per 100,000 live births, consistently exceeding the WHO target of 50 per 100,000 live births. More than half of maternal infections were diagnosed at outside facilities before referral. Reported treatment coverage exceeded 90% among mothers and 100% among infants in all years. The prevalence of congenital syphilis exceeded WHO elimination benchmarks despite stable maternal prevalence, highlighting gaps in timely diagnosis and linkage between diagnosis and treatment.

Congenital syphilis remains a public health issue in Mexico. Timely screening during pregnancy is key to its prevention. To evaluate the implementation of the dual HIV/Syphilis rapid test in pregnant women at the General Zone Hospital with Family Medicine No. 2 and its feasibility to meet the national goal of performing three tests per pregnancy. A total of 8672 tests (2020 - 2024) were analyzed using MATLAB to identify trends by age, trimester, and test number. Linear regressions were applied, using the root mean square error as a measure of confidence, to project the fulfillment of the goal. Most pregnant women (74%) underwent only one test, mainly in the first trimester. An increase in second and third tests was observed in 2024. Projections suggest the goal may be reached between 2029 and 2030. The dual HIV/Syphilis screening strategy at this hospital shows significant progress toward universal testing during pregnancy. The trend suggests comprehensive care for all pregnant women, contributing to the reduction of congenital syphilis and improved maternal-neonatal health. Strengthening early detection, follow-up, and sexual health education remains essential.