DESPITE syphilis being a treatable sexually transmitted disease — which untreated pregnant mothers pass on to their infants as congenital syphilis, South Africa has reported 1,739 congenital syphilis cases translating to a rate of 198 per 100,000 live births — well above the global target of 50 per 100,000 live births.

This is according to a recent report by the National Institute for Communicable Diseases (NICD) titled – Congenital Syphilis in South Africa: 2023 Annual Surveillance Report.

Congenital syphilis is a severe, disabling, and often life-threatening infection seen in infants whose mothers were infected with syphilis caused by treponema pallidum and not fully treated during pregnancy. The infection can pass through the placenta to the unborn infant during pregnancy or natural birth.

The NICD revealed that KwaZulu-Natal, Gauteng, Western Cape, and Eastern Cape recorded the highest clinical notifications, accounting for 89.9%. KZN alone accounts for 46% of clinical notifications — with the eThekwini metro having the highest cases.

“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,” the NICD said in the report.

Congenital syphilis symptoms can manifest early in a newborn (within three months) or late (after two years).

“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. Screening and testing pregnant women for syphilis remains the cornerstone of the elimination of the mother-to-child transmissions (MTCTs) plan,” revealed the report.

To improve case detection, treatment, and reporting, it was highlighted that there is a need to train and re-train healthcare providers at primary care facilities, district, regional, and tertiary hospitals on the clinical signs and symptoms of maternal and congenital syphilis, and the notification procedures.

The mother-to-child transmissions plan was launched by the World Health Organization in 2007, and it requires that countries ensure that 95% of pregnant women attend antenatal care, ideally before 20 weeks, and that 95% of those who attend antenatal care are screened and tested for syphilis, and that 95% of pregnant women who have syphilis are treated with benzathine penicillin.

“Countries will be considered to have eliminated congenital syphilis when they have a case rate that is less than 50 cases per 100,000 live births in the presence of a robust surveillance system.

“South Africa has been screening for antenatal syphilis since the late 1990s and has included congenital syphilis on the national Notifiable Medical Conditions (NMC) platform since 2017 to monitor progress toward eliminating mother-to-child transmission.

“Healthcare workers are required to report congenital syphilis cases within seven days, with additional surveillance through (rapid plasma reagin) RPR-positive results in children under two,” the NICD said in the report.

The rapid plasma reagin test is a type of rapid diagnostic test that looks for non-specific antibodies in the blood of the patient that may indicate an infection by syphilis.

“In July 2023, a combined case notification and investigation form was introduced for more efficient case reporting and classification. This report presents trends in congenital syphilis notifications and RPR-positive results for 2023,” said the NICD.