Despite being a preventable infection, rates of congenital syphilis-the transmission of syphilis from mother to child during pregnancy-are quietly increasing in France, according to a new analysis of data from 2012 to 2019. The study, focusing on cases within France, reveals concerning disparities, especially in overseas regions where infection rates are substantially higher. These findings are prompting public health officials to re-evaluate screening protocols and prevention strategies to protect newborns from this serious condition.
Rates of congenital syphilis – syphilis passed from a mother to her baby during pregnancy – are quietly rising in France, according to a recent analysis of data from 2012 to 2019. While the overall number of cases remains limited, the incidence increased from 1.6 to 2.4 cases per 100,000 live births during that period, raising concerns among public health officials. This increase highlights the importance of continued surveillance and preventative measures to protect newborns from this preventable infection.
The study revealed significant geographic disparities, with rates substantially higher in French overseas regions (DROM), ranging from 13 to 16.7 cases per 100,000 live births. Guyane, in particular, showed a notably elevated incidence. In response, authorities in Guyane have implemented rapid diagnostic tests for both HIV and syphilis to improve early detection and treatment.
The study details characteristics of reported cases.
The majority of infants diagnosed with congenital syphilis (82%) received a diagnosis before one month of age. Nearly half of these infants exhibited symptoms, and 35% were born prematurely. Mothers of affected infants were often young – 58% were under 25 years old – and faced socioeconomic challenges, with 30% lacking health insurance. A concerning 12% of mothers did not receive any prenatal care. All cases identified in the study involved infants born in France.
One in five cases was identified in the DROM regions and the Île-de-France (Paris region). Approximately one-third of infants were born prematurely. Treatment was initiated on the day of diagnosis in most cases, with a median duration of ten days. However, the potential severity of congenital syphilis underscores the need for robust prevention efforts; without screening and treatment, the infection can lead to a 40% stillbirth rate and a 20% neonatal mortality rate. In this study, 4% of affected infants died.
12% of mothers did not receive prenatal care
The fact that congenital syphilis cases are being diagnosed despite mandatory syphilis screening during the first trimester of pregnancy raises questions about gaps in care. The data showed that 12% of mothers did not receive any prenatal care, 30% lacked health insurance, and more than 30% did not attend the recommended number of prenatal visits. Access to supplemental health insurance was limited, with only 19% of affected mothers utilizing it. Among mothers who were screened, 44% received testing late in their pregnancy – during the third trimester or at the time of delivery.
Another contributing factor is that 15% of mothers were already pregnant when they arrived in France, limiting opportunities for preventing mother-to-child transmission. Efforts are needed to meet the World Health Organization’s goal of reducing congenital syphilis to less than one case per 100,000 live births by 2030.
Concerning findings
While the available data is not exhaustive, “the results of this study are concerning,” the authors wrote, particularly if the goal of eliminating mother-to-child transmission is to be maintained. Some cases continue to slip through the cracks, prompting Santé Publique France to consider making congenital syphilis a reportable condition. The study also points to “missed opportunities for prenatal screening and the need to adapt prevention strategies.”
Beyond healthcare professionals – who are urged to verify that syphilis serology is included in the medical records of pregnant women at multiple points during pregnancy, delivery, and postpartum – broader societal mobilization is needed. Strategies such as community-based screening outside of traditional healthcare settings and the use of rapid diagnostic tests have proven effective. These efforts should be targeted toward vulnerable populations, including young women, migrants, and those facing socioeconomic hardship, with sustained commitment.
