Congenital syphilis poses a persistent threat to neonatal health despite being a preventable and treatable disease. This comprehensive review examines the clinical presentations, diagnostic approaches, and evaluation strategies for congenital syphilis. Clinical manifestations can range from asymptomatic to severe, affecting multiple organ systems. Diagnosis relies on serological testing, including non-treponemal and treponemal tests, with careful interpretation in neonates due to passive transfer of maternal antibodies. Imaging studies and lumbar puncture may be warranted in certain cases. Treatment with penicillin remains the cornerstone, with regimens varying based on age and clinical severity. Close follow-up and serological monitoring are essential to assess treatment response and prevent long-term sequelae. Despite challenges, early detection, and comprehensive management can signicantly reduce the burden of congenital syphilis.