Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2010, Article ID 312798, 6 pages doi:10.1155/2010/312798 Review Article A Road Map for the Global Elimination of Congenital Syphilis Mary L. Kamb,1 Lori M. Newman,1, 2 Patricia L. Riley,3 Jennifer Mark,1 Sarah J. Hawkes,4 Tasneem Malik,1 and Nathalie Broutet2 1 Division of STD Prevention (DSTDP), International Activities Unit, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, NE, MS E-02, Atlanta, GA 30333, USA 2 Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland 3 Division of Global HIV/AIDS, CDC, Atlanta, GA, USA 4 University College London, London, UK Correspondence should be addressed to Mary L. Kamb, mkamb@cdc.gov Received 2 December 2009; Accepted 21 May 2010 Academic Editor: Sean Blackwell Copyright © 2010 Mary L. Kamb et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Congenital syphilis is the oldest recognized congenital infection, and continues to account for extensive global perinatal morbidity and mortality today. Serious adverse pregnancy outcomes caused by maternal syphilis infection are prevented with screening early in pregnancy and prompt treatment of women testing positive. Intramuscular penicillin, an inexpensive antibiotic on the essential medicine list of nations all over the world, eﬀectively cures infection and prevents congenital syphilis. In fact, at a cost of $11–15 per disability adjusted life year (DALY) averted, maternal syphilis screening and treatment is among the most cost-eﬀective public health interventions in existence. Yet implementation of this basic public health intervention is sporadic in countries with highest congenital syphilis burden. We discuss the global burden of this devastating disease, current progress and ongoing challenges for its elimination in countries with highest prevalence, and next steps in ensuring a world free of preventable perinatal deaths caused by syphilis. 1. Introduction Mother-to-child transmission of syphilis, that is, congenital syphilis, has been documented since the 15th century [1], yet continues today to cause substantial perinatal morbidity. If left untreated, maternal syphilis infection will, in up to 80% of pregnancies, lead to severely adverse pregnancy outcomes including stillbirth, premature birth, neonatal death, or congenital infection in the newborn [2]. In light of continuing perinatal mortality caused by syphilis and the high cost-eﬀectiveness of antenatal screening and treatment as an intervention package [3], in 2007 the World Health Organization (WHO) launched a global initiative for the elimination of congenital syphilis. In subsequent analyses, WHO has estimated that, were ten countries with high antenatal syphilis burden allowed to focus eﬀorts in strengthening existing maternal and child health (MCH) systems infrastructure to ensure universal maternal syphilis screening coupled with prompt treatment, an investment of only $3 to 4 million dollars per year over ﬁve years could substantially reduce this global perinatal scourge. In addition to these resources, elimination of congenital syphilis requires a combined commitment of governments and other partners in order to mount an eﬀective and sustained response. The global elimination of congenital syphilis can greatly support current global eﬀorts, including those outlined in the Millennium Development Goals of reducing child mortality, improving maternal health, and combating HIV, malaria and other infectious diseases. 2. Global Burden of Congenital Syphilis Globally just over 2 million pregnant women test positive for syphilis each year, comprising 1.5 percent of all pregnancies worldwide [9, 10]. Treponema pallidum, the bacteria causing syphilis, is able to traverse the placenta early in pregnancy and lead to fetal exposure; however, fetal compromise is generally not manifested until later in the second or third trimesters with maturation of the fetal immune system [2]. Cohort studies have been consistent in ﬁnding that