Management of detected syphilis in pregnancy adheres to guideline recommendations, but the crisis of congenital syphilis persists

Background: Infectious syphilis among women of reproductive age continues to rise in many countries including Australia, with a resultant increase in congenital syphilis. In response, new guidelines for management of syphilis in pregnancy were published in Queensland, Australia in 2018. Aims: This study evaluates the management of women diagnosed with syphilis in pregnancy in South-East Queensland (SEQ) after release of this guideline. Materials and Methods: This retrospective review of notification data identified women in SEQ who had a positive syphilis serology during pregnancy, without evidence of adequate treatment prior to the pregnancy, between January 2019 and December 2021 inclusive. Maternal demographics and pregnancy details including syphilis staging, testing and management were extracted, with management assessed against the 2018 Queensland syphilis in pregnancy guideline. Results: Of the 42 women identified, 79% were diagnosed in the first or second trimester, 69% had early-stage syphilis at the time of diagnosis and 86% were asymptomatic at the time of diagnosis. All, including the eight (19%) Aboriginal and/or Torres Strait Islander women identified, completed stage-appropriate treatment with penicillin, 83% completed treatment four weeks prior to delivery and 60% achieved a four-fold reduction in rapid plasma reagin at time of delivery. Conclusions: Our findings suggest compliance with syphilis in pregnancy management recommendations has improved in SEQ since release of the 2018 guidelines. However, congenital syphilis rates continue to rise; further initiatives addressing barriers to timely testing and management of syphilis in pregnancy are urgently needed at both healthcare system levels and for individual women.