Current evidence on the diagnosis and treatment of congenital syphilis

Abstract

Congenital syphilis is a vertical infection caused by Treponema pallidum, associated with outcomes such as miscarriage, prematurity, stillbirth, low birth weight, and clinical manifestations during the neonatal period. This study aimed to review the diagnostic and therapeutic approaches to congenital syphilis. A narrative literature review was conducted using articles published between 2014 and 2024, retrieved from PubMed, SciELO, LILACS, and Google Scholar, based on the descriptors “congenital syphilis,” “diagnosis,” “treatment,” and “newborn.” Articles in Portuguese, English, or Spanish, available in full text and relevant to the topic, were included. Diagnosis involves clinical evaluation and specific tests, including treponemal and non-treponemal assays, cerebrospinal fluid analysis, imaging, and radiographic examinations. Treatment depends on the clinical presentation of the newborn, including intravenous crystalline penicillin or intramuscular procaine penicillin for ten days in symptomatic cases, and a single dose of intramuscular benzathine penicillin in asymptomatic cases with guaranteed follow-up. Prevention of vertical transmission requires serological screening during the first and third trimesters and at delivery, adherence to clinical protocols, and partner management. Although clinical guidelines exist, operational barriers persist and hinder effective control of the infection.