Gestational and congenital syphilis remain a public health challenge in Brazil, despite well-established prevention and treatment protocols. Vertical transmission of syphilis can lead to severe and preventable neonatal outcomes. This study aimed to analyze the clinical-epidemiological situation of gestational and congenital syphilis between 2022 and 2024, describing the profile of pregnant women, treatment adherence, and associated fetal outcomes.

Retrospective, cross-sectional, descriptive censitary study based on compulsory notification system records. All pregnant women diagnosed with syphilis and all congenital syphilis cases notified between January 2022 and April 2024 were included. Variables analyzed included sociodemographic characteristics, performance and timing of diagnosis, treatment of pregnant women and partners, and neonatal outcomes. Statistical analysis used descriptive statistics with frequencies, proportions, and measures of central tendency.

A total of 119 pregnant women with syphilis were included. Most were aged 24–29 years (39.3%), lived in urban areas (55.5%), and had completed high school (34.5%). Adequate treatment adherence was 88.2% among pregnant women, whereas only 17.6% of partners were correctly treated. Regarding timing of diagnosis, 53.3% of pregnant women were diagnosed in the first trimester. Neonatal outcomes included 55 newborns testing negative and 49 positive for congenital syphilis, plus 15 cases of spontaneous abortion.

The study identified the epidemiological profile of affected pregnant women, the main factors associated with infection, and fetal outcomes, clarifying critical points in prevention of vertical transmission. Despite good treatment adherence among pregnant women, low partner treatment coverage remains a major challenge. The proposed objectives were fully achieved, providing relevant data to guide public health strategies and actions in prenatal care.