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www.jogh.org • doi: 10.7189/jogh.09.020312 1 December 2019 • Vol. 9 No. 2 • 020312 Syphilis continues to affect a large number of pregnant women, causing substantial perinatal morbidity and mortality. It was estimated that approximately 1.36 million pregnant women globally were infected with syphilis, resulting in at least 520 000 adverse pregnancy outcomes caused by mother-to-child transmission (MTCT) of the infection [1]. As one of the adverse pregnancy outcomes of MTCT of syphilis, congenital syphilis can be prevented by screening and treatment of infected pregnant women. In light of continuing mortality caused by maternal syphilis and the high cost-effectiveness of antenatal screening and treatment for syphilis as an intervention strategy, the WHO launched the global initiative for the elimination of congenital syphilis in 2007 [2]. Since then, Cuba become the first country to be officially validated by the WHO for the successful elimination of congenital syphilis in 2015, followed by another 10 countries and territories by the end of 2018, including Belarus, Moldova and Thailand in 2016; Anguilla, Antigua & Barbuda, Bermuda, Cayman Islands, Montserrat, St. Christopher & Nevis in 2017 and Malaysia in 2018. In addition, more countries have had their validation plans in place or committed to applying for the validation by a target date. These achievements are primarily owing to integrating interventions of maternal syphilis into the existing elimination of MTCT of HIV. However, maternal syphilis in these countries which have achieved the elimination account for only a small part of the global burden of the disease. Many countries, particularly those with high burden of syphilis among pregnant women as well as those with high rate of the infection among high-risk groups, still face many challenges towards achieving the elimination of congenital syphilis. These challenges could be related to policy and resource, social environment, health system, programme implementation, and others in many resource-limited settings (Box 1). Turning off the tap: sustaining elimination of congenital syphilis through the programme targeting high-risk groups