The sound of silence: missing the opportunity to save lives at birth

The adverse impact of syphilis on child health has been known for over 500 years, yet the World Health Organization (WHO) only targeted congenital syphilis for elimination in 2007.1 Syphilis in pregnancy is not rare. Far more pregnant women have syphilis than human immunodeficiency virus (HIV) infection: 1.9 million (2008) and 1.49 million (2010), respectively.2 The fraction of pregnant women with syphilis that is detected and treated is unknown, but estimates suggest that it is less than 10%.3 Whereas untreated maternal HIV infection is transmitted to infants in about one third of the cases, untreated maternal syphilis nearly always results in an adverse pregnancy outcome. For these reasons, syphilis is as important an infection during pregnancy as infection with HIV. It therefore makes sense to build on global efforts to prevent and treat HIV infection during pregnancy to strengthen the fight against maternal syphilis.