Congenital syphilis is a major public health concern in Brazil, reflecting failures in early diagnosis and prenatal care. This study aimed to analyze the epidemiological profile of congenital syphilis in the country, considering sociodemographic, clinical, and care-related variables, including maternal age and education, prenatal care attendance, newborn sex, case classification, clinical outcome, and temporal and geographic distribution.

Observational, ecological, and quantitative study using data from DATASUS. Statistical analysis was performed in Microsoft Excel using ANOVA and Tukey tests, with p < 0.05 and a 95% confidence interval.

The state of Rio Grande do Sul accounted for 56.6% of all notifications. Most cases (67.1%) occurred among individuals identified as white (p = 0.0019). Approximately 95.9% of mothers had received prenatal care (p = 0.0256). Cases were most frequent among mothers with completed secondary education (20.4%; p = 0.014). Regarding final case classification (p = 0.0238), 91.3% were classified as recent congenital syphilis, 5.7% as stillbirth or miscarriage due to syphilis, and only 0.1% as late congenital syphilis. Regarding case outcomes (p = 0.0215), 95.2% of newborns were recorded as alive. Temporal analysis (p < 0.001) revealed an 87.67% increase in the mean number of cases between 2014 and 2017, with Santa Catarina showing the greatest proportional growth (147.1%). A decline in reported cases was observed from 2023 onward, with a 55.76% decrease in 2024 compared to the previous year; Rio Grande do Sul showed the largest proportional reduction (58.93%). No significant sex-based differences were found (p = 0.1382).

The study showed that Rio Grande do Sul had the highest number of congenital syphilis cases, predominantly among white individuals. Despite the decline since 2023, there remains a need for deeper epidemiological profiling to improve healthcare strategies and ensure more effective interventions.