Why Syphilis Testing Matters During Pregnancy
Why is syphilis testing at ANC important and what are the risks of untreated syphilis in pregnancy?
18/08/2026
What Is Syphilis and How Is It Spread?
Syphilis is a bacterial infection caused by Treponema pallidum. It is transmitted through sexual contact and from an infected mother to her baby during pregnancy or delivery. In its early stages, syphilis may cause a painless sore (chancre) and then a skin rash — but these symptoms often resolve on their own, leading many people to believe the infection has gone. In fact, the bacteria remain in the body and can cause serious damage to the heart, brain, and other organs over time.
In Rwanda, national surveillance data show that syphilis remains a concern among pregnant women, with rates of reactive syphilis tests varying by region. Because symptoms are unreliable and the consequences of transmission to the baby are severe, routine testing at every first ANC visit is a national policy.
The Risk of Syphilis in Pregnancy
Untreated syphilis during pregnancy carries devastating consequences for the baby. According to WHO, untreated maternal syphilis results in stillbirth in approximately 25% of cases. Among live-born babies with congenital syphilis, significant proportions have severe complications including low birth weight, pneumonia, liver disease, bone malformation, deafness, blindness, and neurological damage including intellectual disability.
Globally, congenital syphilis causes an estimated 300,000 stillbirths and neonatal deaths each year — the overwhelming majority of which are preventable with routine antenatal screening and treatment. The tragedy of congenital syphilis is that it is almost entirely avoidable.
The Test — Simple, Rapid, and Accurate
The syphilis test offered at ANC is called the RPR (Rapid Plasma Reagin) test or, in many Rwandan health facilities, a rapid point-of-care test. A small blood sample is taken from a finger prick or venous blood draw. Results are available within minutes. A reactive (positive) result indicates exposure to syphilis bacteria and requires follow-up with a confirmatory test (TPHA or TPPA).
In the context of pregnancy, a reactive screening test is typically treated immediately without waiting for the confirmatory result — because the risk of delaying treatment to the baby far outweighs the small risk of treating unnecessarily.
Treatment — One Injection Changes Everything
The treatment for syphilis in pregnancy is benzathine penicillin G — a single intramuscular injection for early syphilis, or three weekly injections for late syphilis. This treatment is highly effective, inexpensive, and free at all government health facilities in Rwanda.
Treatment is given immediately on the same visit as the positive result is obtained, without waiting for partner testing or confirmatory results. Partners must also be tested and treated for the treatment to be fully effective — reinfection from an untreated partner defeats the purpose. Both partners must complete treatment before resuming sexual intercourse.
Your Baby After a Syphilis Diagnosis
If you tested positive for syphilis during pregnancy and were treated appropriately, your baby has an excellent chance of being born healthy. Babies born to mothers treated before 20 weeks have the best outcomes — the earlier the treatment, the less exposure the baby has had.
After birth, your baby will be examined and tested for signs of congenital syphilis. If congenital syphilis is confirmed or suspected, your baby will receive a course of penicillin injections. Follow all recommendations from your health provider regarding your baby's follow-up appointments and any further testing. With appropriate treatment, most babies born to treated mothers develop normally.
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