Congenital syphilis needs urgent public health attention

Key Points:

• In 2024, the CDC reported nearly 4,000 new congenital syphilis cases in infants, the highest since the 1950s, with 5%-10% resulting in stillbirth or early death and many survivors facing lifelong disabilities.
• The surge is linked to weakened syphilis control since the 2008 Great Recession and cuts to local public health programs, with many pregnant women either not tested or untreated due to barriers like lack of insurance, poor access, and fear of immigration enforcement.
• Effective prevention requires early, universal prenatal care with easy access, expanded Medicaid coverage, and integrated services in community settings; medical providers must be held accountable for screening and prompt treatment with injectable penicillin.
• Public health agencies need sufficient staff and resources for case investigation and partner services, along with real-time monitoring systems and “sentinel event” reviews to identify and fix system failures in congenital syphilis prevention.
• Rapid point-of-care syphilis tests should be widely deployed in emergency and community settings, and maternal health services must integrate substance use treatment to address overlapping epidemics, while punitive policies that deter prenatal care must end.