The 2022 sentinel survey reported a concerning increase in syphilis cases among pregnant women and congenital syphilis in newborns, despite the availability of preventive measures, effective treatment, and established clinical guidelines. This study aimed to identify implementation barriers in the management of syphilis among pregnant women and their newborns, and to propose potential strategies to address these challenges. A quantitative descriptive design was used. Fourteen purposively selected healthcare workers, primarily midwives, including two operational managers and one district clinical manager, from two primary healthcare clinics in two districts of Free State Province, participated in the study. Data were collected using a structured questionnaire. All participants reported being knowledgeable about syphilis and experienced in managing affected patients. Although treatment guidelines were reportedly accessible, most midwives continued to rely on the Maternity Care Guidelines (2016) rather than the updated Comprehensive STI Clinical Management Guidelines (2021-2025), citing a lack of regular training on the revised guidelines. The Rapid Plasma Reagin (RPR) mono test was used for screening by 64% of participants. However, adherence to recommended diagnostic protocols was inconsistent, particularly regarding confirmatory testing, such as the TPHA test. Routine screening for HIV and other sexually transmitted infections was commonly performed. Notably, 64% of midwives reported not testing newborns for syphilis after delivery; 35.7% tested and treated only symptomatic infants with Bicillin. Referral and follow-up of affected infants were reported by 50% of participants. Although midwives demonstrated adequate knowledge, this did not consistently translate into practice . Implementation barriers, including incomplete guideline adherence, insufficient training, limited resources, and inconsistent clinical practices, contribute to ongoing gaps in the management of maternal and congenital syphilis. Strengthened training, improved resource allocation, and standardized guideline implementation are essential to improve outcomes.

Tabane is a dedicated paediatrician specialising in infectious diseases and public health. She is committed to improving child health outcomes through clinical practice, research, and leadership. Since 2020, she has served as Head of the Department of Paediatrics and Child Health, guiding the department’s vision and mentoring emerging professionals. Her research focuses on paediatric infectious diseases, particularly HIV. Prof. Tabane serves on the National Advisory Committee on Morbidity and Mortality of Children to the Minister of Health and holds several leadership roles at the University of the Free State, including membership of the Senate and key institutional committees.