Congenital syphilis (CS), a vertical infection caused by Treponema pallidum, is associated with stillbirth, prematurity, low birth weight, and early neonatal death. Despite being preventable through timely prenatal diagnosis and treatment, its rates remain high in Brazil, especially in the Northern region, where factors such as low education, poverty, and limited access to healthcare hinder control efforts. This study aimed to analyze CS incidence indicators between 2020 and 2023 in a Northern Brazilian state, identifying temporal patterns and factors contributing to disease persistence.

Descriptive study using secondary data from the Notifiable Diseases Information System (SINAN), Ministry of Health documents, World Health Organization reports, and scientific publications from SciELO and PubMed. Confirmed cases from 2020–2023 were included. Indicators analyzed included annual case counts and incidence rates per 1,000 live births. Descriptive statistics and trend graphs were used to illustrate case evolution and compare national and international targets for vertical transmission elimination.

A total of 1,625 CS cases were reported between 2020 and 2023. The highest number occurred in 2020 (427 cases), followed by 2023 (412), 2022 (397), and 2021 (389), showing no clear downward trend. The national incidence rate in 2022 was 10.3 per 1,000 live births, exceeding the PAHO target (< 0.5/1,000). Additional data showed high neonatal mortality, late prenatal initiation, and failures in testing. Studies suggest a link between CS and adverse socioeconomic conditions, as well as the COVID-19 pandemic’s impact on prenatal care coverage and quality.

The findings highlight the persistence of CS as a public health problem. The continued high incidence reinforces the need to expand testing, improve prenatal care quality, ensure timely treatment of pregnant women and partners, and address structural inequalities. CS elimination requires intersectoral action, active surveillance, and greater equity in maternal–child healthcare.