Syphilis, a sexually transmitted infection caused by the spirochete Treponema pallidum, remains a major challenge for global public health, particularly regarding maternal and child health. While its primary transmission occurs through unprotected sexual contact and often remains silent due to asymptomatic cases, vertical transmission can lead to fetal death in over 40% of cases. In Paraná, Brazil, syphilis rates have been rising due to barriers in healthcare access and service quality, compromising detection and management. This study aimed to analyze syphilis cases in pregnant women across Paraná’s macro-regions (2019–2023) and assess the effectiveness of health services in prevention, diagnosis, counseling, and treatment.

A quantitative and descriptive study analyzed the distribution and profile of gestational syphilis cases in Paraná between 2019 and 2023. Data were obtained from the National System of Notifiable Diseases (SINAN) for syphilis cases and from DataSUS (live births) to estimate the total number of pregnant women, acknowledging the potential margin of error since not all pregnancies result in registered births. No additional filters were applied to provide a comprehensive and accurate reflection of the disease’s notification patterns.

Between 2019 and 2023, Paraná reported 17,333 cases of gestational syphilis and 722,209 live births. There was a continuous increase except for 2020, when a slight decline was noted in the North and Northeast macro-regions, likely due to the COVID-19 pandemic’s isolation measures and its impact on health services. The East and West macro-regions had the highest incidence rates, with the West reaching 34.83 per 1,000 live births in 2023. These findings reveal weaknesses in primary care, inefficiencies in prenatal coverage, and deficiencies in the diagnosis and treatment of pregnant women and their partners.

The data confirm an alarming increase in gestational syphilis cases in Paraná between 2019 and 2023, particularly in the East and West macro-regions. The brief decline observed in 2020 reflects the pandemic’s health impact. The upward trend underscores the urgent need to strengthen screening, early diagnosis, and treatment for pregnant women and their partners. Effective public policies must expand access to quality prenatal care and reinforce primary healthcare services to reduce incidence and prevent vertical transmission.