In 2024, the Centers for Disease Control and Prevention reported nearly 4,000 new cases of syphilis in babies, the highest case number since the mid-1950s. Typically about 5%-10% of those reported cases are stillbirths or die soon after delivery. Many surviving babies are left with lifelong disability or developmental delay.
The increase reflects the national loss of syphilis control that began with the Great Recession and the defunding of local public health programs in 2008. As a physician and former public health official, I have never been more concerned about those rates of congenital syphilis.
Congenital syphilis is a sentinel event demonstrating failure of the local public health program.
Evaluations by the CDC have shown that most cases of congenital syphilis are due to pregnant women not being tested and, among those who test positive for syphilis, not getting treated. Some pregnant women miss out on prenatal care because of lack of insurance, poor access, fear of immigration detention, or other medical conditions like substance use or mental health problems, but even among those who receive prenatal care, only about 80% are tested.
To control congenital syphilis, the U.S. needs to treat it as a preventable outcome of missed screening, missed treatment, and missed follow-up. The playbook is well known. What’s been missing is consistent execution and capacity.
