Congenital syphilis prevention has become one of the most urgent yet overlooked challenges in American public health, as cases among newborns surge to levels not seen in nearly seventy years. For physicians who have spent careers fighting preventable disease, the current trajectory is deeply alarming, especially because the tools to stop it already exist.

A Crisis Reaching Historic Levels

The numbers paint a sobering picture of a problem spiraling out of control.

In 2024, the Centers for Disease Control and Prevention reported nearly 4,000 new cases of syphilis in babies, the highest figure since the mid-1950s. The human toll behind these statistics is devastating. Typically, between 5% and 10% of reported cases result in stillbirth or death shortly after delivery, while many surviving infants are left with lifelong disability or developmental delay.

This is not a disease that has to claim young lives. That’s precisely what makes its resurgence so troubling.

How We Got Here

The rise in congenital syphilis didn’t happen overnight, it reflects years of eroding public health infrastructure.

The national loss of syphilis control can be traced back to the Great Recession and the defunding of local public health programs beginning in 2008. As these critical systems were stripped of resources, the safety net designed to catch and treat infections weakened considerably.

In many ways, congenital syphilis serves as a sentinel event, a clear warning sign that a local public health program has failed in its fundamental mission.

The Root of the Problem

Understanding why babies are being born with syphilis is key to solving the crisis.

According to CDC evaluations, most cases stem from two preventable failures: pregnant women not being tested, and those who test positive not receiving treatment. The barriers to care are numerous and often interconnected.

Many pregnant women miss out on prenatal care due to factors such as:

• Lack of insurance or poor access to services
• Fear of immigration detention
• Co-occurring conditions like substance use disorders or mental health challenges

Even more concerning, the problem persists among those who do receive prenatal care. Studies show that only about 80% of these women are actually tested for syphilis, revealing significant gaps even within the system.

Making Prenatal Care Early, Easy, and Universal

The first line of defense is ensuring every pregnant person can access care without obstacles.

Public health systems must prioritize prenatal care that is early, accessible, and universal. This means offering same-week entry into prenatal care, walk-in and telehealth options, and clinics with evening and weekend hours to accommodate different schedules and needs.

Rather than cutting public insurance programs, the approach should be the opposite. Medicaid should be expanded, with presumptive eligibility during pregnancy, zero-cost visits, laboratory testing, and even transportation support. Critically, prenatal services should be brought to where people already are, including:

• Women, Infants and Children (WIC) program sites
• Substance-use clinics
• Jails and reentry programs
• Homeless shelters

Holding the System Accountable

Mandates alone aren’t enough if they aren’t enforced.

While nearly all states have legislated requirements for syphilis screening during pregnancy, often calling for up to three tests, compliance remains inconsistent. Public health authorities need to hold medical providers and health systems accountable when screening fails to happen.

For those who don’t comply, measures such as public reporting of testing failures and potential medical-legal action could help drive change. Just as importantly, technology should be leveraged to support providers. Electronic health record systems should include reminder prompts, hard-stop order sets, monitoring dashboards, and standing nursing protocols to ensure screening doesn’t fall through the cracks.

Treat Immediately, Don’t Wait

When a test comes back positive, time is everything.

Because syphilis treatment is both safe and highly effective, providers should follow national and expert recommendations to treat immediately upon an initial positive screening, without waiting for a referral or additional testing. Delays can be the difference between a healthy birth and a tragic outcome.

Making this possible requires that same-day injectable benzathine penicillin G be readily available in clinics and at any testing location. Without immediate access to treatment, even a timely diagnosis loses much of its value.

The Penicillin Supply Challenge

Unfortunately, ensuring access to this life-saving medication has proven difficult.

Over the past decade, injectable penicillin availability has been plagued by shortages, stock-outs, and recalls. This unreliable supply represents a serious obstacle to effective treatment.

To address this, government agencies must guarantee a dependable penicillin supply through measures like state and regional rotating stockpiles, rapid redistribution systems, and clear allocation protocols. Additionally, expanding who can administer the injection, to include trained nurses and pharmacists within state scope-of-practice rules, would help ensure treatment reaches patients quickly. Clinics also need logistical and reimbursement support to keep penicillin on hand.

Investing in Public Health Capacity

Sustainable progress depends on rebuilding the workforce and infrastructure behind prevention.

For lasting impact, Congress must fund the CDC to provide technical assistance to local communities. Congenital syphilis prevention relies heavily on public health staff and outreach efforts. States, counties, and cities need an adequate number of disease intervention specialists to handle rapid case investigation, partner services, and linkage to care.

Programs should also set and regularly report on clear performance targets, such as the percentage of pregnant women tested, the time between a positive test and treatment, and the percentage adequately treated before delivery.

Learning From Every Case

Accountability extends to examining failures in real time.

Local healthcare organizations need real-time monitoring tools, including dashboards tracking pregnancy-associated syphilis, treatment timeliness, and missed screenings. For every single case, maternal-child clinical care teams should conduct a “sentinel event” review, similar to maternal mortality reviews, to pinpoint exactly where the system broke down and fix it.

This kind of rigorous, case-by-case analysis transforms each failure into a learning opportunity that can prevent future tragedies.

The Promise of Rapid Testing

New technology offers a powerful opportunity to close screening gaps.

Thanks to recent advances, there are now three FDA-approved rapid point-of-care tests that are inexpensive and deliver results in under 15 minutes. These tests should be deployed widely in settings like emergency departments, urgent care centers, shelters, correctional facilities, and mobile clinics.

The potential impact is enormous. Emergency departments could establish “pregnancy and syphilis fast track” pathways for those without prenatal care. One study found that using rapid syphilis testing among pregnant women in an emergency department boosted screening rates from just 2% to 56%, a dramatic improvement.

Yet the limited deployment of these tests reflects an absence of will, leadership, and adequate reimbursement. Without strong patient advocacy and public health-minded leadership, promising new technology rolls out slowly and incompletely.

Connecting Maternal Health and Addiction Treatment

In many communities, substance use and congenital syphilis are deeply intertwined.

In some areas, methamphetamine or opioids are major drivers of the crisis. Where this is the case, prenatal services should be paired with opioid use disorder treatment, harm reduction programs, and case management. Care must be nonjudgmental and easily accessible to keep people engaged rather than driving them away.

A particularly damaging barrier is fear of punishment. In some places, women who might test positive for substances avoid prenatal care altogether out of fear of legal consequences. These punitive policies need to end if we hope to reach the most vulnerable patients.

What Success Looks Like

The good news is that meaningful, measurable progress is entirely achievable.

A jurisdiction that takes these steps seriously can demonstrate real results, including:

• More than 95% of pregnant patients screened early and rescreened when indicated
• Treatment occurring within days, rather than weeks, of a positive test
• Proper follow-up and partner treatment
• Zero cases where a mother tested positive but wasn’t adequately treated before delivery

These benchmarks aren’t aspirational fantasies, they represent what’s possible when systems function as intended.

The Bottom Line

The path to effective congenital syphilis prevention is well understood, the playbook exists, the treatments work, and the technology is available. What’s been missing is consistent execution, adequate capacity, and above all, the political will to act.

Part of the challenge is that the victims of this crisis are among the most voiceless. Babies who die have no way to advocate for themselves, and the families devastated by congenital syphilis are often too stigmatized to speak up. That’s why physicians and everyone who cares about children’s health must raise their voices and demand attention from public health leaders.

Ultimately, strengthening maternal-child health systems and rebuilding public health capacity benefits everyone. It saves lives, prevents needless suffering, and lowers healthcare costs in the long run. The question is no longer whether we know how to solve this crisis, but whether we have the resolve to finally do so.

This article touches on pregnancy loss, infant death, and serious health challenges, which can be difficult subjects. If you or someone you know has been affected by these issues, support is available, and reaching out to a healthcare provider or counselor can help.