The latest data on congenital syphilis in South Africa reveals that in 2023, 198 babies out of every 100 000 live births had been infected by their mothers.

Syphilis is a sexually transmitted infection that can cause serious problems if not treated – and it can pass from a pregnant woman to her unborn baby. This is called congenital syphilis.

In 2023, South Africa reported 1 739 congenital syphilis cases, which is ‘well above the global target of 50 per 100 000 live births’, said the National Institute for Communicable Diseases (NICD) when it released the Public Health Bulletin South Africa’s Congenital Syphilis Report to the media recently.

The study found that KZN, Gauteng, Western Cape and Eastern Cape recorded the highest clinical notifications, accounting for 89.9% of all notifications, with KZN alone accounting for 46% of clinical notifications.

Some good news from the report is that fewer babies under two had positive blood tests for syphilis in the third quarter of 2023, at a national level. This could mean fewer babies were exposed to syphilis or that more pregnant women were diagnosed with the infection, leading to treatment for both mother and child.

“In the absence of treatment, 50–90% of pregnant women with syphilis will transmit the infection to their unborn child, resulting in adverse pregnancy or birth outcomes such as stillbirths, preterm or low birthweight deliveries and associated complications, early neonatal deaths and congenital infections. Pregnant women living with HIV and co-infected with syphilis are more likely to transmit HIV to their unborn babies compared to pregnant women living with HIV but without syphilis,” reads the report.

The NICD said that around 30–40% of all infants who acquire syphilis while in-utero die shortly before or after birth. According to the World Health Organisation (WHO), congenital syphilis is the second leading cause of preventable stillbirth globally, preceded only by malaria.

How to prevent congenital syphilis

• Practice safe sex by ensuring condoms are used.
• If you think you may have syphilis, seek immediate treatment, even if you don’t have symptoms or your symptoms seem to have gone away. This is because many people with syphilis do not have symptoms or do not notice them.
• If pregnant, attend antenatal classes, ideally before 20 weeks.
• If you know a pregnant woman, especially one without a support system, encourage her to go to her nearest clinic for advice and support.
• Your antenatal class should ensure you are tested for both HIV and syphilis. If this does not happen, speak up.
• If diagnosed with syphilis, pregnant women can be treated with benzathine penicillin, which will significantly reduce the chance of their child being born with syphilis. Treatment should ideally be before the second trimester, advises the WHO.
• The National Department of Health recommends that the screening be repeated frequently during pregnancy if the initial result is negative. The mom-to-be should also be tested during her labour/delivery admission.

Improved reporting rate

According to the report, South Africa has been screening for antenatal syphilis since the late 1990s. It has been a notifiable medical condition since 2017 and healthcare workers are required to report cases within seven days.

Additionally, according to the NICD, rapid diagnostic tests are used to monitor infection in children under two.

The report showed an increase in the number of healthcare facilities reporting cases, which suggests improved reporting overall. Case reports were submitted by 116 facilities in 40 districts between 2017 and 2020, compared with 165 facilities in 47 districts in 2023.

Symptoms of congenital syphilis in babies

According to the WHO, babies born with syphilis can experience:

• rashes
• inflammation in the organs
• anaemia
• bone and joint problems
• neurological conditions, including blindness, deafness, meningitis
• developmental delays
• seizures.

Some of these symptoms may only be noticed later in life.

Click here to read the full Congenital Syphilis Report.