Congenital syphilis is one of the preventable diseases caused by the gram-negative bacteria Treponema pallidum; yet, it imposes a serious global health and economic burden, with more than half of the cases resulting in serious adverse outcomes, including infant mortality. Mother-to-child transmission (MTCT) of
syphilis is estimated at 3.6 million adjusted life years (DALYs) and around $309 million in medical costs. In 2006, an estimated 9.7 million children of age less than five years died in developing countries; almost four million were
neonatal deaths. There were 3.2 million
stillbirths globally, among whom 95% were in the developing countries. In sub-Saharan Africa, there is an estimated 2.7% (0.1%-10.3%) of pregnant women infected with
syphilis, representing more than 900,000 pregnancies at risk each year. There were many non-specific and specific diagnostic tests used in the past, which required laboratory equipment and electricity, but there are many newer tests available now that provide rapid results with high sensitivity and specificity, e.g., the immunochromatographic strip (ICS) and rapid
syphilis tests (RST). Early
syphilis can be completely eliminated with a single injection of
penicillin, which is readily available, cheap, and highly effective, and treating pregnant women with
penicillin is 98% effective at preventing
congenital syphilis. Targeting women at a high risk of having syphilis makes universal screening in antenatal programs the most efficacious way to prevent
syphilis-associated morbidity and mortality. The potential for a program to prevent
congenital syphilis in the perinatal, neonatal, and postnatal periods is evident. While considering resource allocation to child survival programs in areas where the prevalence of
syphilis is high, officials need to include antenatal
syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system. In countries like Zambia and other resource-limited settings, a same-day test and treatment with
penicillin should be prioritized to achieve the goal of eliminating
congenital syphilis. Eliminating MTCT of
syphilis through screening and treatment in
antenatal care (ANC) is highly cost-effective in a wide range of settings, especially in countries with a high prevalence.