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Systematically review the literature to identify what components of an antenatal syphilis screening programme work effectively.

Electronic databases were searched to identify studies between 1974 and 2009 that reported on effectiveness of syphilis screening and on the effectiveness of antenatal interventions in relation to three outcomes: increased uptake of syphilis screening, increased treatment rates and reduction in adverse pregnancy. Data on study design and population, components of the intervention and control groups, outcomes and the risk of bias were extracted from included studies.

In all, ten articles (out of 787) were included in the final. Taken together these studies looked at 41,049 women and the outcomes of interventions such as introducing point of care testing and same day treatments. Although the effects of such interventions varied between the studies, the trend was towards an increased uptake of screening and decrease in adverse outcomes such as perinatal deaths, stillbirth and congenital syphilis.

Adverse effects of maternal syphilis such as perinatal deaths and stillbirths can be reduced by 50% through interventions to improve the coverage and effectiveness of antenatal screening programmes. Investing in such screening programmes would have beneficial effects for maternal and neonatal health.

Syphilis is the cause of many stillbirths, newborn deaths and birth defects in low and middle-income countries; this systematic review demonstrates how simple and effective interventions can lead to significant improvements in maternal and child health. As mentioned in the accompanying commentary, although proven cost-effective measures for prevention are available, the lack of recognition of the problem is a major barrier to solving this issue.  This is the case for many birth defects; the PHG Foundation will next week launch a new tool to help these countries develop simple, cost-effective health services (see Born Healthy).