Neurosyphilis and Complications in Pregnancy: Clinical Impact and Diagnostic Challenges

This study aims to analyze complications of neurosyphilis in pregnant women and discuss strategies to prevent vertical transmission and reduce severe neonatal outcomes. Studies indexed in PubMed, Scopus, and LILACS from 2010 to 2023 were reviewed. Indexing terms included “neurosyphilis,” “pregnancy,” “vertical transmission,” “diagnosis,” and “treatment.” Single case reports and studies not focused on neurosyphilis in pregnancy were excluded. A total of 150 studies were reviewed, of which 25 met inclusion criteria. Selection covered original articles, reviews, and guidelines on neurosyphilis and pregnancy. Two independent reviewers screened studies and assessed eligibility. A meta-analysis quantified treatment effectiveness and frequency of neonatal complications. Neurosyphilis in pregnant women is often asymptomatic or presents with mild neurologic symptoms, complicating early diagnosis. Lumbar puncture, the proposed diagnostic method, is rarely performed due to pregnancy-related risks. Insufficient prenatal screening favors underdiagnosis and increases the likelihood of vertical transmission. Penicillin therapy proved effective in most studies; however, strict monitoring is essential to ensure infection clearance and avoid fetal complications. The prevalence of neonatal complications, such as hydrocephalus and hearing loss, remains high in inadequately treated cases. Neurosyphilis in pregnancy remains a major diagnostic and management challenge due to paucity of overt symptoms and the complexity of confirmatory testing during gestation. Penicillin is the most effective strategy to prevent vertical transmission and severe complications. Broader prenatal screening policies are essential to ensure timely detection and treatment of pregnant women with syphilis, aiming to prevent neurosyphilis and congenital syphilis.