Syphilis by Vertical Transmission in Brazil: Trends 2014–2023 and Perspectives for Elimination by 2030

Congenital syphilis remains a serious public health problem in Brazil, with major impacts on neonatal morbidity and mortality, including miscarriages, stillbirths, and infant deaths. Despite control efforts, the country recorded, in 2023, around 86,111 cases of syphilis in pregnant women and 25,002 cases of congenital syphilis, resulting in 196 deaths attributed to the disease. Without proper diagnosis and treatment, vertical transmission rates can reach up to 80%. This study analyzed recent trends and evaluated national indicators to inform strategies toward elimination of vertical transmission by 2030, in line with global targets. This is an ecological time-series study using data from the Notifiable Diseases Information System (SINAN) and information from the Syphilis Epidemiological Bulletin (Ministry of Health) for the period 2014–2023. Indicators examined included the detection rate of syphilis in pregnant women (cases per 1,000 live births), incidence of congenital syphilis, prenatal care coverage and performance of complementary tests in exposed newborns, and the number of deaths associated with the disease. Analyses showed that the detection rate of syphilis in pregnant women had an average annual increase of about 11%, indicating expanded prenatal testing, while the incidence of congenital syphilis remained stable, with important regional disparities: in 2022, the national incidence was 10.3 cases per 1,000 live births, reaching up to 39.2/1,000 in some states in the North and Northeast. There was a reduction in the absolute number of congenital syphilis cases in 2023 compared to 2022 (a decrease of 1,511 cases), attributed to recent efforts, including distribution of rapid tests and protocols for early treatment. Moreover, 94.4% of children diagnosed with congenital syphilis in 2023 underwent cerebrospinal fluid examination, and 74.4% of cases were adequately treated with penicillin, indicating advances in neonatal care. However, persistent regional inequalities and difficulties in linking infected pregnant women to health services compromise the achievement of the elimination target by 2030. It is concluded that, despite increased detection and improvements in care, the persistence of high congenital syphilis rates reveals important failures in the network of care for women and children.