Syphilis Prevalence Among Pregnant Women in Low-Middle Income Countries

Abstract

Introduction: Congenital syphilis remains a preventable cause of perinatal mortality. This review updates prevalence estimates of maternal syphilis in low-middle income countries (LMICs) post-2015. Methods: A systematic review of 47 cross-sectional and surveillance studies (2016–2025) from Africa, Southeast Asia, and Latin America. Pooled prevalence using random-effects models. Results: Overall maternal syphilis prevalence was 2.8% (95% CI: 2.1–3.6%). Highest rates in Southern Africa (4.9%) and parts of Brazil (4.2%). Only 52% of seropositive women received adequate treatment (≥2.4 MU benzathine penicillin before delivery). Discussion: Prevalence remains above WHO elimination target (≤0.5%). Barriers include inadequate antenatal screening infrastructure and penicillin stockouts. Heterogeneity in diagnostic tests (RPR vs. treponemal assays) complicated comparisons. Conclusions: Strengthening point-of-care testing and ensuring penicillin supply chains are critical to reduce congenital syphilis in LMICs.