Abstract: 【Abstract】 Objective To systematically evaluate the methodological quality and reporting quality of guidelines for the management of syphilis in pregnancy in China and other countries, to assess similarities and differences in their recommendations, and to provide references for developing high-quality, context-appropriate guidelines in China. Methods Guidelines were retrieved from Chinese and English databases and official websites of relevant organizations from inception to July 2025. The Appraisal of Guidelines for Research and Evaluation Ⅱ （AGREE Ⅱ） instrument was used to assess the methodological quality of the included guidelines, and the Reporting Items for Practice Guidelines in Healthcare （RIGHT） checklist to evaluate their reporting compliance. Domain standardized scores were calculated, and guidelines were classified according to their comprehensive quality. Core recommendations were synthesized and compared. Results A total of 10 guidelines were included. The AGREE Ⅱ instrument-based assessment showed that the “clarity of presentation” domain had the highest score （87.78% ± 11.58%）, while the “rigour of development” domain had the lowest score （56.25% ± 23.86%）. The RIGHT checklist-based assessment showed that the “background” domain had the highest score （75.63% ± 18.15%）, whereas the “review and quality assurance” domain had the lowest score （43.75% ± 30.19%）. Comprehensive quality assessment revealed that 4 guidelines were classified as high quality, 5 as moderate quality, and 1 as low quality. Comparison of recommendations showed that 9 guidelines strongly recommended syphilis screening for pregnant women at the first antenatal visit or as early as possible, and all the guidelines mentioning treatment recommended benzathine penicillin as a first-line treatment. However, recommendations on screening frequency and non-penicillin alternatives varied across guidelines. Conclusions Current guidelines for the management of syphilis in pregnancy exhibit similarities and differences in both quality and content. Most guidelines require improvements in methodological rigor and reporting completeness. Differences in recommendations reflect a general lack of high-quality evidence in this field.

Key words: Syphilis, Pregnancy complications, infectious, Guidelines, Mother-to-child transmission, AGREE Ⅱ, RIGHT checklist