Prevention Of Congenital Syphilis Research Articles

Incidência de sífilis congênita e sua prevalência em gestantes em um município do noroeste do Paraná

The prevalence of syphilis in pregnant women in Nova Esperanca PR Brazil, between 2013 and 2014 and the occurrence of congenital syphilis reported during the same period in the town are investigated by a descriptive and retrospective analysis. Data were retrieved from pregnant women´s clinical charts in which were included Venereal Disease Research Laboratory tests during the prenatal follow-up and compulsory reports for congenital syphilis from the town´s epidemiological sector. Thirty-six cases of pregnancy syphilis and five cases of congenital were registered. All patients had a prenatal follow-up and only one patient was diagnosed with pregnancy syphilis at birth. Results demonstrate a rise in the prevalence of congenital syphilis in Nova Esperanca between 2013 and 2014. Assessment of all pregnant women with syphilis during the prenatal period showed that 13.9% failed to have a satisfactory treatment and the etiological agent caused fetal infection. Comparison of results of current study with data for Brazil revealed a detection rate of 7.5 cases of pregnancy syphilis for every 1000 live births, whereas a rate of 4.8 cases per 1000 live cases of congenital syphilis occurred during the same year. Results reveal weak points in the care and prevention of syphilis. Health professionals should actively participate in the disease´s prevention and follow-up.

Educational intervention in Primary Care for the prevention of congenital syphilis.

ABSTRACTObjectives:to evaluate the efficiency of educational interventions related to the knowledge of health care professionals of Primary Care and to verify the impact on the vertical transmission rates of congenital syphilis. Method:a quasi-experimental study conducted in the city of Londrina, Paraná, between 2013 and 2015. An educational intervention on diagnosis, treatment and notification was carried out with 102 professionals with knowledge measurement before and after the intervention. Incidence and mortality data from congenital syphilis were taken from the system for notifiable diseases (SINAN) and the Mortality Information System (SIM). Excel tabulation and statistical analysis was done in the Statistical Package for Social Sciences, version 2.1. A descriptive and inferential analysis was performed. Results:the mean number of correct responses increased from 53% to 74.3% after the intervention (p < 0.01). The adherence to professional training was 92.6%. There was a significant reduction in the vertical transmission rate of syphilis from 75% in 2013 to 40.2% in 2015. In 2014 and 2015 there were no records of infant mortality from this condition. Conclusion:the educational intervention significantly increased the knowledge of health professionals about syphilis and collaborated to reduce the rate of vertical transmission of the disease.

Access of pregnant women to technologies for the prevention and control of congenital syphilis in Fortaleza-Ceará, Brazil

To evaluate access to technologies for prevention and control of Congenital Syphilis (CS) by pregnant women. Multi-case study that analyzed prenatal care to pregnant women with syphilis, which aimed at identifying the aspects that hinder their access to soft, soft-hard and hard health technologies that may contribute to the prevention of SC. The field research was done from April to September 2011 at four Health Units of two Regional Executive Divisions in Fortaleza City. Data was collected through observation and interviews with the health professionals and coordinators of the different units, the Statistic Medical Attendance Service professionals, health agents and pregnant women. Soft technologies include active search for pregnant women and home visits; light-hard technologies correspond to counseling, and hard technologies to the gathering of biological material for the serological diagnosis of syphilis and the treatment of pregnant woman and their sexual partners. The analysis consisted in contextualizing and interpreting the meanings of the answers obtained considering access as the main focus. Professionals have difficulty dealing with the subjective issues that involve sexually transmitted infections, and the units have problems in organizational aspects, continuity of care delivery and physical structure, which compromise the access of pregnant women to the technologies for prevention and control of CS. Pregnant women with syphilis do not have access to different technologies for prevention and control of CS, a situation that makes early diagnosis of syphilis unfeasible and possibly contributes to poor syphilis indicators in Fortaleza.

Assessment in the primary care of the State of São Paulo, Brazil: incipient actions in sexual and reproductive health.

ABSTRACTOBJECTIVE The objective of this study is to assess performance in sexual and reproductive health of primary health care services of the Brazilian Unified Health System, in the State of São Paulo, Brazil.METHODS An evaluative framework was built for sexual and reproductive health with the categorization of 99 indicators in three domains: sexual and reproductive health promotion (25), sexually transmitted infections/AIDS prevention and care (43), and reproductive health care (31). This framework was applied to assess the services responses to the questionnaire of Quality Evaluation of Primary Health Care in the Municipalities of São Paulo State (QualiAB), in 2010. Percentages were calculated for positive responses to indicators and performance in the sexual and reproductive health dimension, according to domains, and their contribution to the overall score in sexual and reproductive health (Friedman), relative participation (Dunn), and correlation (Spearman) was verified.RESULTS Overall, 2,735 services participated in the study. They were located in 586 municipalities (distributed throughout the 17 regional health departments of São Paulo), of which 70.6% had fewer than 100,000 inhabitants. The overall average performance of these services for sexual and reproductive health is 56.8%. The actions are characterized by: prenatal with adequate beginning and exams, better organization for immediate rather than for late postnatal care, and selective reproductive planning for some contraceptives; prevention based on specific protection, limitations in the prevention of congenital syphilis, in the treatment of sexually transmitted infections, and in the screening of cervical and breast cancer; specific educational activities, with a restricted vulnerability approach, focus on sexuality over reproduction. The domain of reproductive health has greater participation in the overall score, followed by prevention/care and promotion. The three domains are correlated; the domain of prevention/care has the highest correlation with the other ones.CONCLUSIONS The implementation of sexual and reproductive health in primary health care in the services studied is incipient. The revision of the purpose of the work, the dissemination of technologies, and the investing in permanent education are needed. The evaluative framework built can be used by the sexual and reproductive health program services and management in primary health care, thereby contributing to their actions.

The amount of penicillin needed to prevent mother-to-child transmission of syphilis.

Syphilis is unique among sexually transmitted diseases in that it remains curable (with minimal reports of resistance) with a single dose of penicillin, formulated for this purpose as long-acting benzathine penicillin.1,2 Pregnant women with untreated syphilis experience adverse birth outcomes in over half of untreated pregnancies. These outcomes include stillbirth, organ deformities, prematurity and neonatal death.3 The World Health Organization (WHO) estimates that 930 000 pregnant women have probable active syphilis (transmissible during pregnancy) annually which results in approximately 350 000 adverse birth outcomes per year.4 Most maternal syphilis cases and adverse pregnancy outcomes occur in low- and middle-income countries, and more than half occur in sub-Saharan African countries.4 WHO estimates that global syphilis prevalence is 0.5% (95% uncertainty interval, UI: 0.4–0.6%) which corresponds to a global incidence of 5.6 million (95% UI: 4–8 million) syphilis cases per year among people aged 15–49 years.5 From these estimates, it is possible to calculate the amount of penicillin needed for syphilis treatment on a global scale. However, the difference between the global needs and what is currently produced is not possible to quantify as there is no global monitoring of availability. In May 2016, benzathine penicillin was recognized by the 69th World Health Assembly as an essential medicine that has been in short supply for several years. These shortages have affected treatment and prevention of congenital syphilis.6 A lack of benzathine penicillin can result in pregnant women with syphilis receiving ineffective or no treatment.7–10 Benzathine penicillin is a generic injectable with very few global manufacturers and is therefore at high risk for inventory stock out and shortages at the point-of-care. WHO has received reports of stock outs of benzathine penicillin from antenatal care representatives and providers in high morbidity countries from three WHO regions.11 Shortages during 2015 and 2016 at the manufacture and supply levels have been reported in the region of the Americas.12–14 An estimated 5.6 million doses of 2.4 million units of benzathine penicillin are needed annually to treat all syphilis cases.5 Of these, 930 000 doses are needed to treat pregnant women with syphilis early in pregnancy to prevent all cases of congenital syphilis.4 These separate estimates indicate an acute need for expanded access to benzathine penicillin in countries with high rates of adult syphilis and ongoing improvements in syphilis screening during antenatal care. WHO advocates use of these estimates in discussions at the manufacture and distribution levels to ensure a reliable supply of benzathine penicillin in all countries with cases of adult syphilis. Global demand for this formulation of penicillin has not been consistently and adequately quantified. Many people with syphilis do not develop pathognomic signs or symptoms and do not receive a diagnosis because they are unaware of infection or are unable to access health care and/or diagnostic tests. Therefore, these estimates of penicillin requirements are greater than the number of adults who will have been diagnosed with syphilis. These estimates do not include the treatment of congenital syphilis in infants as such regimens require different doses of aqueous, procaine, or benzathine penicillin formulations.1,2 As a result of increasing need and reported shortages, and in response to the directives from the 69th World Health Assembly, WHO, in partnership with other stakeholders, is doing a market analysis that will include evaluation of production, demand, supply and procurement practices at manufacture, country and regional levels. Results of this analysis will be used to further refine estimates of benzathine penicillin demand, improve availability and develop interventions to improve supply management and procurement. WHO’s plan for the elimination of mother-to-child transmission of HIV and syphilis includes targets of 95% of pregnant women receiving antenatal care and receiving syphilis testing during antenatal care, and 95% of women diagnosed with syphilis during pregnancy being treated.15 Elimination targets for syphilis are achievable given that benzathine penicillin, the only recommended treatment for syphilis occurring in pregnant women, can cure maternal syphilis and prevent adverse birth outcomes related to congenital syphilis if provided early in pregnancy.1,2 Countries seeking to expand and improve prenatal care, reduce adverse pregnancy outcomes, and achieve congenital syphilis elimination targets must have access to a secure supply of benzathine penicillin. Equally, manufacturers need a reasonable global needs estimate as part of the business case required to justify any changes to their manufacturing processes. These WHO estimates of penicillin needs can be used along with estimates of demand to adapt manufacturing practices to expand access to benzathine penicillin.

Estimating Benzathine Penicillin Need for the Treatment of Pregnant Women Diagnosed with Syphilis during Antenatal Care in High-Morbidity Countries.

BackgroundCongenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis.MethodsProportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis.ResultsUsing current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases.ConclusionPenicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment of maternal syphilis are important for congenital syphilis prevention, and will be increasingly critical in the future as more countries move toward elimination targets.

Манифестный врожденный сифилис у ребенка, родившегося от матери с нейрофи- броматозом (клинический случай)

The value of observation is the presence of bright rare clinical manifestations of congenital syphilis in the child and secondary syphilis combined with neurofibromatosis mother. It highlights the issue completion prevention of congenital syphilis in relation to certain contingent of women.

Congenital syphilis: injury panorama at a teaching Hospital

Establish the profile of women with syphilis in pregnancy as well as aspects of prenatal care, and the incidence and prevalence of congenital syphilis in that specific population. Documental study at a teaching maternity in Fortaleza, Ceará, Brazil. The population consisted of 787 women with syphilis diagnosed at the childbirth or curettage in the period from 2007 to 2012. The prevalence rate in pregnant women was 2.7%. In relation to health care of pregnant women, 57.82% had prenatal care. However, most (59.47%) of the diagnosis of maternal syphilis was held at childbirth or curettage and only 9.89% had proper treatment in the follow-up. Regarding the management of newborns, the data show that the majority (62.20%) had signs and symptoms of congenital syphilis; among them, 93.30% had proper treatment, although 66.85% did not undergo X-Ray (XR) of long bones. Reducing the cases of congenital syphilis depends on the quality of the prenatal care provided to those women, through training and professional involvement to fulfill the recommendations of health policies for combating syphilis.&nbsp

P07.19 Added value of a novel dual treponemal/nontreponemal rapid diagnostic test for syphilis among pregnant women

Introduction In resource-limited settings, syphilis rapid diagnostic tests (RDTs) aide in the prevention of congenital syphilis. However, most syphilis RDTs detect only treponemal antibodies which persist after treatment. Consequently, treatment may be provided unnecessarily to pregnant women with past infection. We estimated the potential reduction of over-treatment by comparing a new RDT detecting both treponemal and non-treponemal antibodies, with a treponemal RDT (T-RDT). Methods A prospective descriptive study among pregnant women in antenatal care was conducted in Deou, Burkina Faso. The women were included if they were eligible for routine syphilis screening and provided informed consent. DPP Screen and Confirm assay (Chembio) and T-RDT (SD Bioline) were performed on whole blood specimens by a trained laboratory technician. Plasma was tested in an international reference laboratory by T. Pallidum Particle Agglutination (TPPA) and quantitative Rapid Plasma Reagin, (RPR). Presumptive active syphilis was defined as both TPPA and RPR were reactive. Results A total of 242 pregnant women were included: 91 (37.6%) had a presumptive active syphilis and one-in-five (19.8%) had high RPR titres ≥1:8. The DPP did not reduce the number of incorrectly treated cases (over-treatment) compared to the T-RDT (0.0% vs. 2.5%; p = 0.218). In addition, the DPP led to a higher proportion of under-treatment compared to the T-RDT (18.2% vs. 0.8%; p Conclusion This study was the first evaluation of DPP in pregnant women. DPP showed no added value in reducing the proportion of women unnecessarily treated. Conversely, it underestimated women needing treatment. Our study population may not have been representative as the surprising high seroprevalence may suggest presence of other treponemal infections in the area. Accordingly, additional studies are required to evaluate the potential benefits of DPP. Disclosure of interest statement Medecins Sans Frontieres funded this study. Epicentre receives core funding from Medecins Sans Frontieres. No pharmaceutical grants were received in the development of this study. The authors have declared that no competing interests exist.

Prevenção da sífilis congênita em Fortaleza, Ceará: uma avaliação de estrutura e processo

Objetivo: Avaliar a estrutura e o processo de trabalho dos profissionais de saúde para desenvolver as ações de prevenção e controle da sífilis congênita em Fortaleza, Ceará. Métodos: Pesquisa avaliativa desenvolvida de julho a outubro de 2011 em 89 unidades primárias. Foram avaliados os componentes de estrutura física, materiais e insumos, recursos humanos e estrutura organizacional e as unidades foram classificadas como satisfatórias e insatisfatórias. Resultados: Na classificação geral, descobriu-se que somente 47,2% das unidades foram consideradas insatisfatórias. A sala de coleta de sangue estava presente em 68,5%, profissional capacitado para atender casos de sífilis em 21,3% e apenas 16,9% das unidades aplicavam a penicilina benzatina em gestantes. Conclusão: No geral, as unidades primárias de saúde não se encontravam em condições estruturais e processuais para contribuir para o controle da sífilis congênita.

Sífilis na gravidez

Syphilis is caused by the Treponema pallidum and its mode of transmission is sexual, blood borne or from mother-to-child (vertical) throughout the pregnancy. According to the guidance of the Ministry of Health, serological screening and treatment are routinely offered to all pregnant women attending antenatal care, nevertheless rates of maternal morbidity, congenital infection and perinatal mortality remain high and the disease still represents a challenge for public health. The persistence of the high prevalence of congenital syphilis despite the targeted prevention programs is unsettling. This review aims to contribute to the spread of the current knowledge in our country and the elaboration of measures which can reduce vertical transmission and mother and child morbimortality. The prevalence of syphilis in pregnant women in Brazil is 1.6%. The Southeast region has the highest rate of congenital syphilis notification and the State of Rio de Janeiro has the highest incidence per live births (9.8/1,000), according to data of the Ministry of Health. The cost of preventing congenital syphilis, testing and therapy included, is lower than U$ 1.50 per person and the risk of mother-to-child transmission during pregnancy ranges from 70-100% in cases of recent syphilis to 30-40% in late syphilis. This review presents a discussion about the diagnosis and early treatment of syphilis in pregnancy, which can prevent unfavourable pregnancy outcomes for both mother and child when properly administered. A better understanding of the condition allows the search for improvement in public policies, collaborating to the reduction of the prevalence of syphilis and its complications in Brazil.

Knowledge of healthcare professionals regarding the vertical transmission of syphilis in Fortaleza -CE, Brazil

The aim of this study was to investigate the knowledge of family health strategy professionals regarding the prevention and control of the vertical transmission of syphilis. This cross-sectional study was carried out in Fortaleza, Ceará, Brazil, from August to October 2009. A questionnaire was used, with its correct answers being in line with the recommendations of the Ministry of Health. Univariate analysis was carried out, with frequency distribution, mean and standard deviation. A total of 269 professionals participated, 44.7% had 6 to 10 years of experience in the FHS, and 60% of the questions regarding their knowledge were answered correctly: 75.8% were aware of the request period of the Venereal Disease Research Laboratory (VDRL) test; 78.1% of the alternative drug for the treatment for pregnant women allergic to penicillin, 55.1% of the request period for VDRL for cure and control, and 50.2% of the conduct with a sexual partner. It was concluded that healthcare professionals are unaware of the appropriate actions for the prevention and control of congenital syphilis.

Correlates of syphilis seropositivity and risk for syphilis-associated adverse pregnancy outcomes among women attending antenatal care clinics in the Democratic Republic of Congo

Screening and treatment for syphilis among pregnant women is the primary means of prevention of congenital syphilis. Sentinel surveillance for syphilis can inform these prevention efforts. We reviewed antenatal syphilis screening results to assess trends and to identify correlates of seropositivity among women attending antenatal care clinics in the Democratic Republic of Congo during 2011. Syphilis seropositivity among the 17,669 women attending the antenatal care clinics during 2011 was 4.2% (range 0.4%-16.9%). Syphilis seropositivity was significantly higher among women attending rural clinics (5.0%) as compared to urban clinics (3.0%) and those tested in antenatal care clinics in the provinces of Equateur (7.6%) and Orientale (7.7%) as compared to other provinces (p < 0.001). Based on the antenatal care syphilis seroprevalence and national pregnancy estimates, we estimate that approximately 128,591 pregnant women countrywide would have tested seropositive for syphilis during 2011. Over 85,000 adverse pregnancy outcomes would have resulted from these maternal infections, assuming prenatal syphilis diagnosis and treatment were not available. The prevalence of syphilis was highest in rural areas, but exceeded 1% in every area, indicating a need to assure screening and treatment throughout Democratic Republic of Congo. These sentinel surveillance estimates can be used to guide national congenital syphilis prevention efforts.

S14.1 Testing For Syphilis in Pregnancy and Associated Adverse Outcomes in Mozambique

BackgroundAntenatal syphilis screening and treatment is an effective intervention to reduce perinatal, infant, and maternal morbidity and mortality. Prenatal syphilis screening increased in Manica and Sofala Provinces from < 5%...

P3.351 Congenital Syphilis Prevention In Honduras

<h3>Introduction</h3> Honduras is a Central American country whose priority is the elimination of congenital syphilis in 2015. <h3>Objective</h3> To prevent transplacental transmission of syphilis from mother to daughter/son during the gestational period. <h3>Materials and Methods</h3> Descriptive retrospective analysis from January 2008 to December 2012 in 117 health units without a laboratory from the Preventive Program transmission of syphilis from mother to daughter/son that detects syphilis during pregnancy in attending antenatal women, using rapid tests for free and voluntary screening. <h3>Results</h3> Year 2008 4.950 pregnant women were screened, 10 of them were reactive, with a prevalence of 0.2%, in 2009 7.285 pregnant women were screened of which 17 were reactive with a prevalence of 0.2%, in the year 2010 5.310 pregnant women were screened, 5 out were reactive with a prevalence of 0.09%, in 2011 8.343 pregnant women were screened of which 20 were reactive with prevalence of 0.2% and 2012 9.320 women were screened of which 14 were reactive with a prevalence of 0.1%. <h3>Conclusions</h3> During the five years 66 pregnant women were screened with syphilis, all received treatment with their partners and were followed until delivery, of which 57 (86%) of the children born were free of congenital syphilis, 7 pregnant women have not yet reached the time birth and 1 pregnant woman did not return for follow-up service. Screening for syphilis during pregnancy is key to preventing transplacental transmission of syphilis mother daughter/son The free screening with rapid tests for syphilis in pregnant women in places that do not have clinical laboratories, improved the access and permitted the early capture, and were provided with timely treatment with their sexual partner. Rapid tests for syphilis are essential tool for early diagnosis of congenital syphilis prevention.

G03(P) Craniotabes: Time For an Old Physical Sign to Be Put to Use?

AimsCraniotabes describes softness of the infant’s cranial bones, causing a ‘ping pong ball’ effect after minimal pressure is applied. Exact causes of this phenomenon are not clear. This paper aimed...

Congenital Syphilis in the 21st Century

While the prevalence of congenital syphilis continues to be low throughout most of the developed world, there has been a slight resurgence of the disease in several European countries, including Spain. In this context, we need to become more familiar with the signs and symptoms of this disease and consider its diagnosis in patients with only mild clinical manifestations. A definitive diagnosis may be difficult or even impossible in patients whose diagnostic tests reveal low positive titers or inconsistent results. The cornerstone of congenital syphilis control is prenatal screening and the treatment of infected mothers with penicillin, an effective and economical intervention. Based on a review of the literature supplemented by data from our own clinical experience, this article provides a detailed description of the clinical manifestations of congenital syphilis as well as the various diagnostic methods and treatments available.

Epidemiological Surveillance of Congenital Syphilis in Spain, 2000–2010

The characteristics of 67 confirmed congenital syphilis cases reported to the surveillance system in Spain (2000-2010) were analyzed. The incidence rates ranged from 0.00 to 2.23 per 100,000 live births. Median age at diagnosis was 4 days. Hepatosplenomegaly was the most common clinical finding, although almost 60% of the cases were asymptomatic. Missed opportunities for congenital syphilis prevention through antenatal care were identified.

Syphilis: still a major cause of infant mortality

www.thelancet.com/infection Vol 12 April 2012 269 1 Mabey D, Peeling RW. Syphilis, still a major cause of infant mortality. Lancet Infect Dis 2011; 11: 654–55. 2 Hawkes S, Matin N, Broutet N, Low N. Eff ectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 2011; 11: 684–91. 3 Walker DG, Walker GJ. Forgotten but not gone: the continuing scourge of congenital syphilis. Lancet Infect Dis 2002; 2: 432–36. 4 Walker GJA. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database Syst Rev 2001; 3: CD001143. 5 Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives saved tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health 2011; 11 (suppl 3): S9. 6 Walker DG, Walker GJA. Prevention of congenital syphilis—time for action. Bull World Health Organ 2004; 82: 401. 7 Walker GJA, Walker DG. Congenital syphilis: a continuing but neglected problem. Semin Fetal Neonatal Med 2007; 12: 198–206. makers might have chosen to give little attention to the scourge of congenital syphilis in part because of two Cochrane systematic reviews, which they incorrectly claimed showed “no good evidence that the treatment of syphilis in pregnant women improved pregnancy outcome”. However, the systematic review, authored by one of us, concluded that “...there is no doubt that penicillin is eff ective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis”. The second review mentioned by Mabey and Peeling states that “detection and appropriate, timely penicillin treatment is a highly eff ective intervention to reduce adverse syphilis-related pregnancy outcomes”. To misinterpret the fi ndings of systematic reviews and place responsibility on them for the failure to adequately control congenital syphilis diverts attention away from organisations such as WHO, which should be working with governments and other partners to increase eff orts to tackle congenital syphilis. Unfortunately, babies in countries as diverse as Australia, Belarus, China, and Haiti continue to be born with congenital syphilis. This situation should be unacceptable. That antenatal screening and treatment can work is well known, and yet there has been limited success over the past decade in controlling, let alone eliminating, congenital syphilis. As we have argued previously on several occasions, the time has come to be more ambitious, resourceful, and innovative in preventing this tragedy. Business as usual is not an option.

Sífilis congénita en el siglo xxi

While the prevalence of congenital syphilis continues to be low throughout most of the developed world, there has been a slight resurgence of the disease in several European countries, including Spain. In this context, we need to become more familiar with the signs and symptoms of this disease and consider its diagnosis in patients with only mild clinical manifestations. A definitive diagnosis may be difficult or even impossible in patients whose diagnostic tests reveal low positive titers or inconsistent results. The cornerstone of congenital syphilis control is prenatal screening and the treatment of infected mothers with penicillin, an effective and economical intervention. Based on a review of the literature supplemented by data from our own clinical experience, this article provides a detailed description of the clinical manifestations of congenital syphilis as well as the various diagnostic methods and treatments available.