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• Gestational syphilis was higher in younger women with newborns with lower birth weight. • Rapid plasma reagin titers in maternal/cord blood are good predictors of congenital syphilis. • A congenital syphilis rate of 38.0% was confirmed in 71 newborns, with data available. • Attention to treatment failure/reinfection in women will reduce congenital syphilis. The objective of this study was to explore the factors and outcomes associated with gestational syphilis in Peru. Women from the miscarriage, vaginal delivery, and C-section wards from a large maternity hospital in Lima with or without syphilis diagnosis were enrolled and their pregnancy outcomes compared. Maternal syphilis status using maternal blood and child serostatus using cord blood were determined by rapid plasma reagin (RPR) and rapid syphilis tests. The newborns' clinical records were used to determine congenital syphilis. A total of 340 women were enrolled, 197 were positive and 143 were negative for RPR/rapid syphilis tests. Antibody titers in sera from cord and maternal blood were comparable with RPR titers and were highly correlated (rho = 0.82, P <0.001). Young age (P = 0.009) and lower birth weight (P = 0.029) were associated with gestational syphilis. Of the women with gestational syphilis, 76% had received proper treatment. Mothers of all newborns with congenital syphilis also received appropriate treatment. Treatment of their sexual partners was not documented. Syphilis during pregnancy remains a major cause of the fetal loss and devastating effects of congenital syphilis in newborns. [ABSTRACT FROM AUTHOR]