{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:03:24Z","timestamp":1789985004259,"version":"4.0.1"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Dis. Rep.","Infectious Disease Reports"],"abstract":"<jats:p>Background: Congenital syphilis remains a significant cause of adverse birth outcomes despite effective screening and treatment. Data on its epidemiology in Saudi Arabia are limited. This study aims to describe the incidence, clinical characteristics, and outcomes of congenital syphilis at a tertiary pediatric center in Riyadh, Saudi Arabia, and to identify gaps in antenatal care and prevention. Methods: We conducted a retrospective chart review of all infants diagnosed with congenital syphilis (aged 0\u201324 months) and pregnant women with positive syphilis serology who presented to our center between January 2021 and December 2025. Cases were classified as highly probable, possible, less likely, or unlikely based on Center for Disease Control (CDC) and European criteria. Incidence rates were calculated per 1000 live births. Results: Over the five-year study period, there were 11,722 live births and 12 cases of probable or possible congenital syphilis, yielding an incidence rate of 1 per 1000 live births. An additional two cases were classified as less likely due to successful prevention of mother-to-child transmission. The majority of cases (n = 7) were attributed to inadequate maternal treatment. Three cases of abortion and intrauterine fetal demise were identified, probably due to untreated maternal syphilis. Most infants were asymptomatic at birth; however, one patient presented with hepatosplenomegaly, cytopenia, and cholestasis, while two had abnormal long bone findings. No cases of neurosyphilis were identified. Five infants were born to mothers with suspected false-positive serology but were managed as possible cases due to incomplete follow-up. Favorable neurodevelopmental outcomes were observed in all patients who completed follow-up (n = 5). Conclusions: We report congenital syphilis incidence rates that align with the global upward trend. We also identified multiple missed opportunities for screening and early treatment\u2014findings that can inform future guidelines and enhance awareness among healthcare providers and the public.<\/jats:p>","DOI":"10.3390\/idr18050107","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:03:47Z","timestamp":1789977827000},"page":"107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Re-Emergence of the Great Mimicker: Congenital Syphilis in a Low Prevalence Setting"],"prefix":"10.3390","volume":"18","author":[{"given":"Rabab","family":"AlGhaithi","sequence":"first","affiliation":[{"name":"Pediatric Infectious Disease, King Fahad Medical City, Riyadh 11525, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Shawg","family":"AlSalamah","sequence":"additional","affiliation":[{"name":"General Pediatrics, King Fahad Medical City, Riyadh 11525, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/pd.6135","article-title":"Fetal and neonatal abnormalities due to congenital syphilis: A literature review","volume":"42","author":"David","year":"2022","journal-title":"Prenat. Diagn."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1093\/cid\/ciaf504","article-title":"State-of-the-Art Review: Congenital Syphilis in the Modern Era: Current Strategies and Future Directions","volume":"81","author":"Flores","year":"2026","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1002\/ijgo.70511","article-title":"Syphilis in pregnancy: A practical guide for prenatal care providers","volume":"171","author":"Desjardins","year":"2025","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_4","unstructured":"(2026, March 08). STI Treatment Guidelines, Available online: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/default.htm."},{"key":"ref_5","unstructured":"World Health Organization (2026, February 27). Mother-to-Child Transmission of Syphilis. Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/stis\/prevention\/mother-to-child-transmission-of-syphilis."},{"key":"ref_6","unstructured":"Saudi Arabia Ministry of Health (2026, March 08). Women\u2019s Health: The First List of the Pregnant Woman to the Health Centre, Available online: https:\/\/www.moh.gov.sa\/en\/healthawareness\/educationalcontent\/wh\/pages\/first-visit-pregnant-woman-health-center.aspx."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sankaran, D., Partridge, E., and Lakshminrusimha, S. (2023). Congenital Syphilis-An Illustrative Review. Children, 10.","DOI":"10.3390\/children10081310"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"104558","DOI":"10.1016\/j.bjid.2025.104558","article-title":"Risk factors associated with syphilis among patients at a sexual health center in Brazil: A retrospective study","volume":"29","author":"Marques","year":"2025","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wang, J., Zhu, M., and Smith, R.D. (2025). Prevalence, incidence and risk factors of syphilis among men who have sex with men in China from 2013 to 2025: A systematic review and meta-analysis. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-12176-8"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Korenromp, E.L., Rowley, J., Alonso, M., Mello, M.B., Wijesooriya, N.S., Mahian\u00e9, S.G., Ishikawa, N., Le, L.V., Newman-Owiredu, M., and Nagelkerke, N. (2019). Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0219613"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e0012622","DOI":"10.1128\/cmr.00126-22","article-title":"Congenital Syphilis: A Review of Global Epidemiology","volume":"36","author":"Gilmour","year":"2023","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5","DOI":"10.26719\/emhj.23.100","article-title":"Oman eliminates mother-to-child transmission of HIV and syphilis","volume":"30","author":"Elgalib","year":"2024","journal-title":"East. Mediterr. Health J."},{"key":"ref_13","unstructured":"(2026, February 27). Congenital Syphilis, Available online: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/congenital-syphilis.htm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/jdv.16946","article-title":"2020 European guideline on the management of syphilis","volume":"35","author":"Janier","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"262","DOI":"10.5144\/0256-4947.2004.262","article-title":"Antenatal screening for syphilis at a tertiary care hospital in Riyadh","volume":"24","author":"Shakoor","year":"2004","journal-title":"Ann. Saudi Med."},{"key":"ref_16","first-page":"293","article-title":"Serological tests for syphilis in Saudi Arabia","volume":"62","author":"Hossain","year":"1986","journal-title":"Genitourin. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.5214\/ans.0972.7531.220206","article-title":"Infectious disease screening among stem cell transplant donors: An Institutional experience in Saudi Arabia","volume":"22","author":"Alsuhaibani","year":"2015","journal-title":"Ann. Neurosci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3257549","DOI":"10.1155\/ijm\/3257549","article-title":"Blood Donor Serological Screening in Makkah, Saudi Arabia: A 7-Year Retrospective Study on Transfusion-Transmitted Infections","volume":"2025","author":"Halawani","year":"2025","journal-title":"Int. J. Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5144\/0256-4947.2021.8","article-title":"Seropositivity of syphilis among individuals screened in a tertiary hospital in the Eastern Province of Saudi Arabia","volume":"41","author":"Wanni","year":"2021","journal-title":"Ann. Saudi Med."},{"key":"ref_20","first-page":"10","article-title":"Temporal Trends in Syphilis Epidemiology in the UAE: A Five-Year Retrospective Analysis (2018\u20132022)","volume":"1","author":"Poor","year":"2024","journal-title":"Int. J. Sex. Transm. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1093\/cid\/cix371","article-title":"Risk of Congenital Syphilis (CS) Following Treatment of Maternal Syphilis: Results of a CS Control Program in China","volume":"65","author":"Hong","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1097\/OLQ.0000000000000846","article-title":"Congenital Syphilis Prevention: Strategies, Evidence, and Future Directions","volume":"45","author":"Plotzker","year":"2018","journal-title":"Sex. Transm. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.15537\/smj.2021.42.9.20200789","article-title":"The outcome of prevention of mother-to-child transmission of HIV infection at King Abdulaziz University Hospital, Western Region of Saudi Arabia: A Descriptive Study","volume":"42","author":"Ahmed","year":"2021","journal-title":"Saudi Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e312","DOI":"10.1097\/INF.0000000000003943","article-title":"Prevalence of Common Respiratory Viruses in Children at a Tertiary Care Hospital in Saudi Arabia","volume":"42","author":"Saleh","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.15585\/mmwr.mm7246e1","article-title":"Vital Signs: Missed Opportunities for Preventing Congenital Syphilis\u2014United States, 2022","volume":"72","author":"McDonald","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/5\/107\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:32:38Z","timestamp":1789983158000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/5\/107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["idr18050107"],"URL":"https:\/\/doi.org\/10.3390\/idr18050107","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}