Confronting Challenges and Applying Solutions for the WHO Global Initiative to Eliminate Congenital Syphilis as a Public Health Problem

Background:
Congenital syphilis (CS) remains a serious public health problem globally, affecting an estimated 2 million pregnancies and accounting for more than 750,000 perinatal deaths each year.

Objective:
To describe the framework and key objectives of the WHO Initiative, launched in October 2007, To Eliminate Congenital Syphilis as a Public Health Problem; and to identify key challenges and potential solutions for the new global effort.

Method:
Data are from review of the published literature, discussions from two WHO Technical Consultations (2004, 2007), other smaller expert consultation meetings and the WHO report The Global Elimination of Congenital Syphilis: Rationale and Strategy for Action.

Result:
Despite widely available and affordable screening tests and treatment, most pregnant women worldwide are not screened for syphilis. Inadequate screening and delayed treatment stems from a variety of causes, but important factors are lack of awareness of global CS burden, misunderstandings about its severity, insufficient resources, fragmented implementation plans and limited use of new rapid test technologies by local programs. The new WHO Global Initiative addresses the importance of advocacy, leadership and the development of an investment case for CS elimination. It also addresses implementation of early maternal syphilis screening as an integrated part of existing maternal, infant and child health services rather than another vertical program, and development of practical program monitoring and impact measures.

Conclusion:
Congenital syphilis is preventable; maternal syphilis screening and treatment is inexpensive and can be highly cost effective; and CS elimination should be a priority for national health policy strategies throughout the world.

Implications:
The WHO focus on elimination of congenital syphilis can help increase global awareness of the problem, help identify resources and galvanize action against this old disease that -- despite existing interventions -- continues to cause global perinatal mortality equivalent to HIV.