Background: The prevalence of syphilis in pregnancy varies across the globe and among different age groups within the same country. In sub-Saharan Africa, syphilis prevalence among pregnant women has been found to range from 2.5 to 18% among antenatal clinic attendees, with the highest prevalence in the age group 35–49 years. Also, it is higher in the rural than urban clinics.

Objectives: To determine trends in syphilis prevalence using the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) test among pregnant women attending the public antenatal clinics in Gaborone, Botswana (2004–2008).

Study design: Cross-sectional study using routinely collected antenatal data.

Results: The overall syphilis prevalence amongst pregnant women in Gaborone, Botswana decreased from 2.96% (95% CI, 2.55–3.37) in 2004 to 1.15% (95% CI, 0.89–1.41) in 2008 (p < 0.001). The age specific prevalence per total number of reactive VDRL/RPR was highest amongst pregnant women aged 26 to 30 years (p < 0.001) and lowest for those aged 16 to 20 years (p < 0.025) during the period 2004–2008. However, there were variations in syphilis prevalence rates within and between the clinics.

Conclusion: Syphilis sero-positivity in pregnancy in Gaborone, Botswana has been declining for the last five years, but was more prevalent amongst pregnant women aged 26 to 30 years with the lowest prevalence among those aged 16 to 20 years during the period 2004 to 2008. This decline may be attributed to a number of factors and, in particular, the adoption of the syndromic approach for management of sexually transmitted infections in the country.