Why is congenital syphilis still a problem?
The leading factor responsible for the continued high incidence of congenital syphilis globally is the lack of adequate antenatal care (19). In different settings syphilis in pregnancy has been associated with poverty, HIV infection, substance abuse, and underutilization of the health system. Individual risk factors for syphilis described in different populations include age (younger age is associated with incidence, older age is associated with prevalence), history of stillbirth, being illiterate or female, having multiple casual sex partners, having a self-perceived high risk of acquiring an STI, and being HIV-positive (10, 20). Congenital syphilis is more likely to occur where mothers have poor antenatal care, that is when they have late, few or no antenatal visits. It is also more likely to occur when the mother has primary syphilis or an illness of unknown duration, higher plasma non-treponemal test titres (Venereal Disease Research Laboratory (VDRL) test titres of >1:16) at treat
