Congenital syphilis is a systemic infection caused by vertical transmission of the spirochete Treponema pallidum , which occurs predominantly via the transplacental route when the bacterium present in the bloodstream of an infected pregnant woman reaches the fetus during pregnancy. Less frequently, infection may occur during childbirth through direct contact with active syphilitic lesions in the birth canal (vertical transmission). To assess morbidity and mortality due to congenital syphilis in Brazil between 2020 and 2025. Ecological epidemiological study using DATASUS data for Brazil. Records with ICD-10 code A50 (congenital syphilis) from 2020 to 2025 were included. Variables analyzed included age group, race/skin color, schooling, prenatal care, timing of maternal syphilis diagnosis, partner treatment, and month of initiation of maternal treatment. From 2020 to 2025, 114,826 cases of congenital syphilis were confirmed in Brazil, 94.45% in newborns less than 7 days old. Most cases occurred in mixed-race children (60,950), followed by white (28,044), Black (5,207), Asian (286), and Indigenous (302). Maternal schooling was recorded as ignored in 114,649 records. Regarding prenatal care, 82.17% of mothers received follow-up and 12.42% did not. Maternal syphilis was diagnosed mainly during prenatal care (66,549), followed by childbirth/curettage (35,916), after delivery (6,644), and not recorded in 5,717 cases. In 56,651 cases, partners were not treated; 21,826 partners were treated, and in 36,349 cases this information was not recorded. The months with the highest number of maternal treatment initiations were October (5,163), September (5,147), and July (5,038). Despite expanded prenatal coverage, failures persist in diagnosis, treatment, and quality of notifications. This scenario highlights the urgent need for intersectoral measures aimed at improving prenatal care, training health professionals, expanding access to rapid testing and treatment, and strengthening health education for the population. Reducing congenital syphilis morbidity and mortality requires a coordinated and continuous response within the Brazilian Unified Health System (SUS), with a focus on equity, prevention, and health surveillance, thereby contributing to a decrease in preventable infant mortality in the country.
Flores et al. (2026) studied this question.