Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2026
Antenatal Syphilis Treatment Adequacy and Neonatal Outcomes: A Retrospective Cohort Study.
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Tripathy Priyadarshini, Lurie Erin, Narang Vahinie, Chandrasekaran Nirmala
Аннотация
OBJECTIVES: To describe the timing and adequacy of antenatal syphilis treatment and neonatal outcomes in a population experiencing structural vulnerability.
METHODS: This retrospective cohort study included pregnant individuals with confirmed syphilis who received multidisciplinary prenatal care through a specialized perinatal addictions program and delivered at a tertiary academic hospital in Ontario, Canada, between July 2021 and July 2025. Adequate treatment was defined as a single dose of benzathine penicillin G for early syphilis or 3 weekly doses for late latent syphilis or syphilis of unknown duration, with the final dose completed at least 30 days before delivery. The primary outcome was congenital syphilis. Secondary outcomes included gestational age at delivery, birth weight, neonatal intensive care unit admission, neonatal death, and mode of delivery.
RESULTS: Fourteen pregnancies met the inclusion criteria, with a median maternal age of 32 years. Most infections were latent (86%). Diagnosis occurred before 20 weeks in 7%, between 20 and 28 weeks in 43%, and after 28 weeks in 50%. All participants received penicillin; treatment was adequate in 9 (64%) and inadequate in 5 (36%). One neonate (7%) was diagnosed with congenital syphilis in the setting of late presentation and incomplete maternal therapy. Most births were term (86%), the median birth weight was 2950 g, and neonatal intensive care unit admission occurred in 2 cases (14%). One neonatal death was unrelated to syphilis.
CONCLUSIONS: Congenital syphilis occurred only in the setting of late diagnosis and incomplete maternal treatment. Early screening, repeat testing in individuals at ongoing risk, and multidisciplinary care models that address structural barriers are critical to prevention.
METHODS: This retrospective cohort study included pregnant individuals with confirmed syphilis who received multidisciplinary prenatal care through a specialized perinatal addictions program and delivered at a tertiary academic hospital in Ontario, Canada, between July 2021 and July 2025. Adequate treatment was defined as a single dose of benzathine penicillin G for early syphilis or 3 weekly doses for late latent syphilis or syphilis of unknown duration, with the final dose completed at least 30 days before delivery. The primary outcome was congenital syphilis. Secondary outcomes included gestational age at delivery, birth weight, neonatal intensive care unit admission, neonatal death, and mode of delivery.
RESULTS: Fourteen pregnancies met the inclusion criteria, with a median maternal age of 32 years. Most infections were latent (86%). Diagnosis occurred before 20 weeks in 7%, between 20 and 28 weeks in 43%, and after 28 weeks in 50%. All participants received penicillin; treatment was adequate in 9 (64%) and inadequate in 5 (36%). One neonate (7%) was diagnosed with congenital syphilis in the setting of late presentation and incomplete maternal therapy. Most births were term (86%), the median birth weight was 2950 g, and neonatal intensive care unit admission occurred in 2 cases (14%). One neonatal death was unrelated to syphilis.
CONCLUSIONS: Congenital syphilis occurred only in the setting of late diagnosis and incomplete maternal treatment. Early screening, repeat testing in individuals at ongoing risk, and multidisciplinary care models that address structural barriers are critical to prevention.