International Journal of Infectious Diseases最新文献

{"title":"Comparative effectiveness of three benzathine penicillin G-based regimens in people with HIV who presented with early syphilis.","authors":"Kai-Hsiang Chen, Hsin-Yun Sun, Kuan-Yin Lin, Yu-Shan Huang, Sung-Hsi Huang, Wang-Da Liu, Yi-Chia Huang, Tzong-Yow Wu, Yu-Chung Chuang, Aristine Cheng, Li-Hsin Su, Chien-Ching Hung","doi":"10.1016/j.ijid.2026.109069","DOIUrl":"10.1016/j.ijid.2026.109069","url":null,"abstract":"<p><strong>Objectives: </strong>To compare 12-month serologic responses to three benzathine penicillin G (BPG)-based regimens among people with HIV (PWH) and early syphilis.</p><p><strong>Methods: </strong>We retrospectively included syphilis episodes treated with BPG, BPG plus 7-day doxycycline (BPG/doxycycline), or BPG/doxycycline plus single-dose ceftriaxone during 2018-2024. Episodes with baseline rapid plasma reagin (RPR) titers <1:4 or exposure to other Treponema pallidum-active antibiotics were excluded. Serologic response was defined as a ≥ 4-fold RPR decline at 12 months. Intention-to-treat (ITT) with last-observation-carried-forward and per-protocol analyses were performed.</p><p><strong>Results: </strong>Among 1077 episodes in 762 PWH, 453 received BPG, 570 BPG/doxycycline, and 54 BPG/doxycycline/ceftriaxone. ITT response rates were 74.6%, 83.2%, and 88.9%, respectively (P < 0.001); per-protocol rates were 74.4%, 83.4%, and 89.8% (P < 0.001). Higher baseline RPR titers and doxycycline-containing regimens were independently associated with response. In analyses directly comparing BPG/doxycycline with and without ceftriaxone, adding ceftriaxone to BPG/doxycycline was not significantly associated with a higher serologic response.</p><p><strong>Conclusions: </strong>BPG/doxycycline was associated with a higher likelihood of 12-month serologic response. The incremental association of ceftriaxone remained uncertain because of the small number of ceftriaxone-treated episodes.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109069"},"PeriodicalIF":4.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probable sexual transmission of dengue virus serotype 1 from a male traveler to his female partner: A case report.","authors":"Jingjing Yang, Jinshen Wang, Jieru Pan, Shuai Zhang, Desi Zheng, En Lin, Jinzhang Wang, Shenggen Wu, Xiaoyang Zhang","doi":"10.1016/j.ijid.2026.108807","DOIUrl":"10.1016/j.ijid.2026.108807","url":null,"abstract":"<p><strong>Background: </strong>Dengue is primarily transmitted by Aedes mosquitoes, whereas sexual transmission has rarely been reported. We describe a probable case of male-to-female sexual transmission of dengue virus serotype 1 (DENV-1) in southeastern China.</p><p><strong>Case presentation: </strong>A 41-year-old woman developed fever and myalgia on March 11, 2026, and tested positive for DENV-1 RNA and NS1 antigen, with negative anti-DENV IgM and IgG, consistent with early acute infection. Her husband had developed dengue in Timor-Leste on February 18, returned to China on March 4, and had unprotected sexual intercourse with her on March 5-7. At investigation, DENV RNA was undetectable in his blood but remained detectable in semen. Local vector-borne transmission appeared less likely because no substantial dengue activity was identified, the Breteau Index was 2, no adult Aedes mosquitoes were captured, and mean daily temperatures during the relevant period were low.</p><p><strong>Conclusion: </strong>Taken together, the epidemiologic timeline, laboratory findings, and limited support for local mosquito-borne transmission were most consistent with probable sexual transmission of DENV-1.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108807"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for tuberculosis in prisons: efficacy of a breath-based diagnostic approach in a high prevalence setting.","authors":"Luis Gómez Paciello, Leonardo Jara, Marlene Salina, Lidia Candia, Lucas Zeballos, Diego Palacios, Gladys Molinas, Belén Benitez, Larissa Gill, Marilia Martinez, Maria Bordon, Adrian Prieto, Sofia Berton, Arturo Battaglia, Cynthia Meza, Sarita Aguirre, Claudia Piñanez, Felipe Gonzalez, Geronimo Ortellado, Pilar Muñoz, Maria Teresa Tortola, Nelleke Koedoot, Maria Joao Novais, Joao Neves, Mariana Vieira, Claudio Silva, Dulce Torres, Pauli Bles, Ana Aguiar, Raquel Duarte, Adrian Sanchez-Montalvá, Juan Espinosa-Pereiro, Cecile Magis-Escurra","doi":"10.1016/j.ijid.2026.108959","DOIUrl":"10.1016/j.ijid.2026.108959","url":null,"abstract":"<p><strong>Objectives: </strong>Tuberculosis (TB) remains a major health threat in prisons, where overcrowding and limited access to care facilitate transmission. We evaluated the diagnostic accuracy and feasibility of the AeoNose for TB screening in Paraguayan prisons.</p><p><strong>Methods: </strong>In this cross-sectional diagnostic study, people deprived of liberty and prison staff underwent symptom screening, chest X-ray with CAD4TB (v6), and AeoNose breath sampling. Individuals with presumptive TB underwent GeneXpert and mycobacterial culture. Breath signals were analyzed using a convolutional neural network. Two subsets were evaluated: all participants with valid samples and the same population excluding prior TB. Five-fold cross-validation was applied.</p><p><strong>Results: </strong>Of 3752 individuals screened, 2993 had valid samples. TB prevalence was 6.7%. In subset 1 (188 TB cases) and subset 2 (142 TB cases), mean AUC was 0.634 (SD 0.040) and 0.624 (0.054). Sensitivity and specificity were 0.670 (95% CI: 0.592-0.737) and 0.537 (0.518-0.555), and 0.711 (0.630-0.793) and 0.505 (0.491-0.519).</p><p><strong>Conclusion: </strong>Under real-world prison conditions, AeoNose did not meet WHO criteria for a TB triage test. However, large-scale breath-based screening using portable devices was feasible, supporting further development of non-invasive screening approaches.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108959"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Methodological issues of paper about the 2025 measles outbreak in Mexico.","authors":"Luis Omar Colombo-Mendoza, Julieta Del Carmen Villalobos-Espinosa, Elías Beltrán-Naturi","doi":"10.1016/j.ijid.2026.108890","DOIUrl":"10.1016/j.ijid.2026.108890","url":null,"abstract":"","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108890"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interferon-gamma release assays versus tuberculin skin test for latent tuberculosis infection positivity among healthcare workers and first responders: a systematic review and meta-analysis.","authors":"Hamoud Alahmari, Lisa Hanson, Peter G Kelley, Jo Spong, Adriana Milazzo, George Mnatzaganian","doi":"10.1016/j.ijid.2026.108949","DOIUrl":"10.1016/j.ijid.2026.108949","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate latent tuberculosis infection (LTBI) positivity among hospital healthcare workers (HCWs) and first responders.</p><p><strong>Methods: </strong>Four databases were searched for observational studies published from 2000 onward. Studies reporting LTBI positivity using interferon-gamma release assays (IGRAs) or tuberculin skin tests (TSTs) were included. Pooled proportions were estimated using Freeman-Tukey double arcsine transformation. Meta-regression used logit-transformed proportions with restricted maximum likelihood random-effects models. Estimates were stratified by diagnostic method and World Health Organization TB incidence region.</p><p><strong>Results: </strong>Of 34,835 records identified, 95 studies from 41 countries comprising 63,988 participants were included. The pooled IGRA and TST positivity proportions were 22% (95% CI: 17-28%) and 38% (95% CI: 31-44%), respectively. Among studies reporting both tests in the same populations, pooled positivity was 46% lower with IGRA than TST. The pooled IGRA and TST conversion proportions were 8% (95% CI: 6-12%) and 12% (95% CI: 7-18%), respectively. Unlike IGRA positivity, TST positivity was significantly associated with higher Bacillus Calmette-Guérin (BCG) vaccination rates.</p><p><strong>Conclusion: </strong>LTBI remains common among HCWs, with estimates varying considerably by diagnostic method. Higher TST positivity, together with its association with BCG vaccination, suggests greater specificity of IGRA for LTBI screening in BCG-vaccinated populations.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108949"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent comparison of severity of influenza and coronavirus disease 2019 among hospitalized patients in Hong Kong: a target trial emulation on observational health care data.","authors":"Celine Sze Ling Chui, Jack Chi-Him Lau, Min Fan, Brian Pui-Chun Chan, Wang-Chun Kwok, Chun-Ka Wong, Kelvin Kai-Wang To","doi":"10.1016/j.ijid.2026.108958","DOIUrl":"10.1016/j.ijid.2026.108958","url":null,"abstract":"<p><strong>Objectives: </strong>Influenza virus (IV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are significant causes of hospitalization. Earlier studies showed more severe disease for SARS-CoV-2 infections, but many were compared with historical influenza cohorts and were conducted before the milder Omicron variant emerged. We aimed to compare the severity of SARS-CoV-2 infection with a concurrent cohort of IV infection among hospitalized patients after the emergence of the Omicron variant in Hong Kong SAR, China.</p><p><strong>Methods: </strong>This is a target trial emulation study based on the public electronic health database in Hong Kong SAR, China. Adults aged ≥18 years who were hospitalized with laboratory-confirmed SARS-CoV-2 or IV infection between January 1, 2023, and January 31, 2024, were included. Pooled logistic regression was used to explore the risk of the composite outcome (30-day mortality, mechanical ventilation, intensive care unit [ICU] admission).</p><p><strong>Results: </strong>A total of 47,956 cases were identified, including 32,523 SARS-CoV-2 mono-infections, 15,103 IV mono-infections, and 330 SARS-CoV-2/IV co-infections. Overall, the risks of composite outcome (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.06-1.23), 30-day mortality (HR, 1.20; 95% CI 1.09-1.32), and ICU admission (HR, 1.21; 95% CI 1.06-1.38) were higher for SARS-CoV-2 than IV infection. Subgroup analysis showed that male patients with SARS-CoV-2 were at higher risk of the composite outcome (HR, 1.19; 95% CI 1.08-1.31), 30-day mortality (HR, 1.26; 95% CI 1.11-1.44), and ICU admission (HR, 1.2; 95% CI 1.02-1.4) than male patients with IV. Post hoc analysis showed that SARS-CoV-2/IV co-infection was associated with an increased risk of 30-day mortality than SARS-CoV-2 mono-infection (HR, 2.11; 95% CI 1.58-2.81) or influenza mono-infection (HR, 3.45; 95% CI 2.19-5.42).</p><p><strong>Conclusion: </strong>SARS-CoV-2 Omicron infection was associated with more severe outcomes than IV mono-infection, and co-infection was more severe than mono-infection among hospitalized patients. Our findings have important implications for health care policies, including vaccine recommendations for SARS-CoV-2.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108958"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lowering the cough threshold to one week reduces tuberculosis diagnostic delay: A real-world implementation study from Shenzhen, China.","authors":"Chuangyue Hong, Mingzhen Li, Xiaoling Che, Zhipeng Zhuo, Weiguo Tan, Zhiguang Zhao","doi":"10.1016/j.ijid.2026.108971","DOIUrl":"10.1016/j.ijid.2026.108971","url":null,"abstract":"<p><strong>Objectives: </strong>Passive case finding in low TB incidence areas, using a cough threshold of 2 weeks or more, can miss early or subclinical cases, resulting in diagnostic delays. Our study explored whether setting the cough threshold to at least one week could minimize diagnostic delays and boost TB detection rates in Shenzhen, a highly mobile, low-incidence city in China.</p><p><strong>Methods: </strong>A quasi-experimental study was conducted in the general hospital's respiratory clinics from June 2021 to September 2025. It used historical and concurrent control groups with coughs lasting 2 weeks or more. The intervention group included patients with coughs of at least 1 week. Key outcomes measured were total diagnostic delay, patient delay, health system delay, and bacteriological positivity. Propensity score matching (1:1) adjusted for variables like age, sex, birthplace, residence, occupation, and hospital level. Analyses involved conditional logistic regression and Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>Out of 56,695 screened individuals, 5742 were diagnosed with pulmonary TB. After matching, 191 intervention patients were compared with 191 historical and 191 concurrent controls. The intervention significantly reduced median total diagnostic delay (16.1 vs. 27.4 and 27.7 days; P < 0.001) and health system delay (3.0 vs. 6.4 and 9.4 days; P < 0.001), but not patient delay (13.0 vs. 15.0 days; P = 0.694 and 0.849). It decreased the odds of bacteriological positivity compared to historical (adjusted OR: 0.41; P < 0.001) and concurrent controls (adjusted OR: 0.28; P < 0.001), increased the odds of prolonged patient delay (>30 days) (adjusted OR: 5.11-5.56; P < 0.001), and reduced prolonged health system delay (>14 days) (adjusted OR: 0.10-0.14; P < 0.001).</p><p><strong>Conclusions: </strong>Reducing the cough screening threshold from ≥2 weeks to ≥1 week in a low-incidence, high-mobility urban area significantly decreased diagnostic delays, especially within the health system, and identified earlier-stage disease without extra resources. This cost-free policy can be easily implemented in similar regions to help achieve End TB goals.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108971"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A sensitive and rapid detection method for the Stx2 gene of Escherichia coli O157:H7, based on the combination of colorimetric loop-mediated isothermal amplification (cLAMP) with CNN deep learning model.","authors":"Yuliawati, Tina Rostinawati, Desriani, Yuni Elsa Hadisaputri, Heri Saepuloh, Tati Ariyanti, Sri Suryatmiati Prihandani, Kahfi Heryandi Suradiradja, Gono Semiadi, Wirdateti, Abu Khalid Rivai","doi":"10.1016/j.ijid.2026.108950","DOIUrl":"10.1016/j.ijid.2026.108950","url":null,"abstract":"<p><strong>Objectives: </strong>Escherichia coli producing Shiga toxin has been reported as a major problem in foodborne and clinical settings, primarily because the organism produces Shiga toxin type 2 (stx2). Therefore, this study aimed to establish a sensitive, rapid detection method for the stx2 gene of E. coli O157:H7 by combining a cLAMP method with a convolutional neural network (CNN) deep learning model.</p><p><strong>Result: </strong>The cLAMP conditions were optimized by varying the incubation temperature and reaction time. A positive reaction led to a visible color change from pink to yellow. Subsequently, the assay was evaluated for specificity and sensitivity. The optimal cLAMP incubation time and temperature were 60°C for 25 minutes. The method indicated high sensitivity and specificity, with an LOD of 14.7 fg. The cLAMP was combined with CNN deep learning. The model was trained through transfer learning and assessed on the test dataset based on precision, accuracy, F1-score, and recall. The results showed that a rapid and sensitive cLAMP assay combined with CNN deep learning was successfully developed.</p><p><strong>Conclusion: </strong>A combination of cLAMP and CNN using the MobileNetV2 architecture offers the highest specificity, sensitivity, and accuracy among the evaluated architectures. This combination has the potential for point-of-care testing (POCT).</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108950"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of severe mpox in Mbarara City, southwestern Uganda, October 2024-May 2025.","authors":"Justine Wobusobozi, Richard Migisha, Aminah Namwabira, Martha D Nalweyiso, Michael Mutegeki, Irene Kyamwine, Benon Kwesiga, Lilian Bulage, Alex Riolexus Ario","doi":"10.1016/j.ijid.2026.108965","DOIUrl":"10.1016/j.ijid.2026.108965","url":null,"abstract":"<p><strong>Background: </strong>In October 2024, Mbarara City, Uganda, experienced sustained mpox transmission, with Nyamityobora Ward being disproportionately affected. Data on factors associated with severe disease were limited. We determined the prevalence and factors associated with severe mpox in Nyamityobora Ward during October 2024-May 2025.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using active case finding among suspected mpox cases in Nyamityobora Ward from April to May 2025. Disease severity was assessed using an adapted Mpox Severity Scoring System (MPSSS) and dichotomized as severe versus non-severe. Modified Poisson regression was used to identify associated factors.</p><p><strong>Results: </strong>Of 106 mpox cases identified, 62 (59%) had severe disease. The median age was 29 years and 55% were female. HIV co-infection (adjusted prevalence ratio [aPR] 1.8, 95% CI: 1.2-2.7), delayed care-seeking >5 days (aPR 1.5, 95% CI: 1.1-2.1) and sex work (aPR 1.4, 95% CI: 1.0-2.0; P = 0.045) were independently associated with severe mpox.</p><p><strong>Conclusion: </strong>Severe mpox was common and strongly associated with HIV co-infection, delayed care-seeking and sex work. Integrating mpox screening into HIV services and promoting early care-seeking and implementing targeted interventions for sex workers may reduce severe outcomes during outbreaks.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108965"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal syphilis, preventable stillbirth, and treatment protection: a global systematic meta-analysis.","authors":"Daniel Mugabi, Theoneste Hakizimana, Prosper Akankwasa, Jackson Kakooza, John Yahweh, George Bina Sande, Adam Abdrahim Suliman Ebaid, Catherine R Lewis, Emmanuel Okurut, Musa Kasujja","doi":"10.1016/j.ijid.2026.108945","DOIUrl":"10.1016/j.ijid.2026.108945","url":null,"abstract":"<p><strong>Objectives: </strong>Maternal syphilis remains a major cause of adverse pregnancy outcomes, with stillbirth among the most severe. We aimed to estimate the global prevalence of stillbirth among pregnancies complicated by syphilis and to evaluate associated determinants.</p><p><strong>Methods: </strong>This systematic review and meta-analysis searched four databases for studies reporting stillbirth among pregnant women with confirmed maternal syphilis. Random-effects meta-analysis was performed on logit-transformed prevalence estimates. Heterogeneity was assessed using I² and τ² statistics. Subgroup analyses explored geographic region and treatment adequacy; treatment-stratified estimates were prioritized because treatment exposure differed substantially across studies. Risk of bias was also assessed.</p><p><strong>Results: </strong>Eleven studies met the inclusion criteria. The pooled prevalence of stillbirth was 5.02% (95% confidence interval 2.44-10.06%) with substantial heterogeneity (I² = 90.67%). Stillbirth prevalence was highest in sub-Saharan Africa (10.93%) and lowest in Asia (1.57%; P < .001), although regional estimates were potentially confounded by differences in treatment coverage. Treatment-stratified prevalence was 11.69% in studies with low or absent treatment coverage and 2.81% in studies with moderate-to-high coverage (Q = 22.1, P < .001). In one included study, adequate treatment was associated with 84% lower adjusted odds of stillbirth (adjusted odds ratio = 0.16); this relative effect should not be interpreted as a 16% breakthrough rate. No significant publication bias was detected.</p><p><strong>Conclusions: </strong>Maternal syphilis remains a significant but preventable cause of stillbirth. Treatment adequacy, rather than geography alone, was the most clinically important source of variation. Early diagnosis and timely, stage-appropriate therapy substantially reduce stillbirth. Strengthening antenatal screening and ensuring prompt treatment are critical to achieving global elimination of congenital syphilis-related mortality.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"108945"},"PeriodicalIF":4.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}