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To evaluate the maternal-fetal management and follow-up of infants at risk for congenital syphilis.Monocentric retrospective cohort study at the Félix Guyon Hospital, Saint-Denis, La Réunion between January 2008 and December 2014. Management of 38 pregnancies (35 women, 39 fetuses) with a positive syphilis serology was evaluated according to the Centers for Disease Control and Prevention (CDC) guidelines.A total of 68% (n = 26) of pregnancies were screened before 16 weeks of gestation, and 26% (n = 10) had appropriate treatment. Adverse outcomes were noted in 45% of pregnancies. Neonatal serology was not performed in 7 live-born neonates (19%) and 33 infants were classifiable according to the four CDC scenarios. In the infants, adequate complementary evaluation and appropriate treatment were noted in 42% (n = 13) and 55% (n = 17) of cases, respectively. Rate of infant follow-up was 76% (n = 16). No treatment failure was observed in infants.Reinforcement of public health policies and a better sensitization, training and collaboration among perinatal caregivers are warranted given the gaps revealed in our study.