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[Unpublished] 1991. 13 p. (WHO/VDT/91.455)The epidemiology, determining factors, prevention, detection, treatment, and programmatic aspects of maternal and congenital syphilis are discussed. Syphilis can be an acute or chronic infection, but is entirely curable; yet, it is one of the most damaging of all STDs to the fetus. Prevalence in maternal serum ranges from about 0.03% in the UK to 13-16% in some African urban areas. The adverse effects of untreated maternal syphilis to the fetus include abortion, intrauterine death, prematurity, congenital syphilis, and tardive infection. The infant is at greater risk if his mother's syphilis infection is acute; he may escape infection if her syphilis is chronic. Common barriers to effective control of syphilis in developing countries are late prenatal care, lack of screening or treatment, and, especially, failure to find a new infection after earlier prenatal screening. To prevent syphilis in pregnancy, the most important program approaches are health education and promotion of prenatal screening, adequate treatment, partner tracing, and treatment. Both in developing and Westernized settings, it is highly cost-effective to screen and treat maternal syphilis. In developing countries, the VDRL or rapid plasma reagin (RPR) card tests are adequate for screening. Programs should include the management techniques of training, evaluation, regular reporting, quality control of testing, and surveillance of maternal syphilis rates. All these systems can be linked to HIV testing and surveillance programs.