GESTATIONAL syphilis exposed gaps in prenatal care, from missed education to delayed diagnosis and partner treatment.
A qualitative study of 20 women diagnosed with gestational syphilis in Rio de Janeiro, Brazil, found that individual, social, and programmatic vulnerabilities shaped how patients experienced prenatal care, diagnosis, and treatment. Although most cases were identified during pregnancy, some were only detected during childbirth or postpartum, raising concerns about missed opportunities for prevention of congenital syphilis.
The women were notified through two Family Clinics in the Santa Cruz neighborhood and interviewed at home between August 2023 and March 2024. Most participants were Black or mixed race, had low educational attainment, were unemployed, and had low income, reflecting a concentration of social vulnerability among those affected by gestational syphilis.
Diagnosis Often Arrived Without Understanding
Participants described receiving a diagnosis of gestational syphilis with fear, confusion, and limited prior knowledge of the infection. Several women reported that they did not know what syphilis was before being diagnosed, and some only understood the condition after speaking with clinicians or seeking information independently.
This lack of knowledge represents an important individual vulnerability because comprehension of diagnosis, transmission, and fetal risk is central to treatment adherence. The findings suggest that testing alone is insufficient when not paired with clear, repeated, and accessible counseling.
Prenatal Care Gaps Extended Beyond Testing
Prenatal care was often perceived as minimal or fragmented. Some women described care as “normal” despite receiving treatment for gestational syphilis, while others reported that appointments centered on medication administration and blood testing without adequate explanation of transmission, fetal risk, prevention, or follow-up.
Programmatic vulnerabilities were also evident when syphilis was detected late or only after neonatal complications had occurred. One participant reported that her child was already in intensive care with syphilis by the time the infection was identified at the hospital.
Partner treatment remained another major barrier. While 12 women said their partners received treatment, eight reported that partners did not agree to take the medication, underscoring the need for prenatal care models that engage sexual partners and address gendered barriers to prevention.
The study reinforces that reducing gestational syphilis requires more than screening. Stronger health education, continuous follow-up, culturally sensitive care, better service organization, and partner involvement are essential to prevent vertical transmission and improve maternal and neonatal outcomes.
Reference
Sarefino AO et al. Gestational syphilis and prenatal care: a study in light of individual, social, and programmatic vulnerabilities. Rev Esc Enferm USP. 2026;60:e20250270.
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