Failing To Prevent the Preventable: The Resurgence of Congenital Syphilis

Skylar, a 32-year-old from Arkansas, found out she was pregnant with her first child in November. A month later, routine first-trimester blood tests delivered news she never saw coming. Her doctor called to say she had tested positive on an RPR test — a syphilis screening that detects antibodies the body produces in response to infection — and a confirmation test left no doubt.“I felt healthy and was in shock this was happening,” she tells the New York Sun.Skylar had no symptoms, which is common. In its early stages, syphilis in women can cause painless sores on the genitals, vagina, or cervix that go unnoticed, followed by a rash, flu-like fatigue, or swollen lymph nodes, signs easily mistaken for something else, or missed entirely.Many women, like Skylar, have no symptoms at all, which is precisely what makes the disease so dangerous during pregnancy. And she is far from alone in navigating this health hurdle while expecting.Cases of newborn syphilis increased for the twelfth consecutiveyear in 2024, with nearly 4,000 cases reported nationwide — and compared to 2015, congenital syphilis is nearly 700 percent higher. The infection travels from mother to fetus through the placenta. When it goes undetected and untreated, it kills — causing stillbirth, miscarriage, or neonatal death, and leaving survivors at risk of blindness, deafness, developmental delays, and skeletal abnormalities.Provisional 2024 data record approximately 285 stillbirths and infant deaths linked to congenital syphilis in the United States — consistent with a more than 600 percent increase since 2015, when just 495 cases were reported overall.These are not abstractions. These are babies born into a country with the medical knowledge, the infrastructure, and the treatment necessary to save them — who were not saved.Associate Professor of Public Health Sciences at Penn State University, Casey Pinto, tells the New York Sun that the divergence between declining adult syphilis rates and rising congenital cases is not a paradox; it is a mirror held up to who the system actually serves.“The average American with a full-time job and healthcare who may have contracted syphilis has much easier access to healthcare, screening, and subsequent treatment,” Dr. Pinto says, describing scenarios where abuse, poverty, or Medicaid enrollment delays push women deep into pregnancy before they ever see a provider.The logic, Dr. Pinto explains, is straightforward: The less syphilis circulating in a community, the lower the odds that someone who falls through the cracks of the health care system will ever encounter it.Cascade of FailuresThe cruelest dimension of this crisis is how thoroughly preventable it has always been. A single course of penicillin administered during pregnancy prevents the infection from reaching the fetus. Routine prenatal screening can catch it early. The public health playbook has not changed. What has changed is whether the system executes it.Congenital syphilis was nearly eliminated in the United States by the early 2000s, the result of sustained investment in disease intervention specialists, contact tracing, and sexual health infrastructure. What followed was a familiar cycle: Success bred complacency, funding was redirected, sexually transmitted infection clinics shuttered, and the public health workforce eroded.The rise of online dating platforms expanded sexual networks faster than surveillance systems could track them. By the time cases began climbing again, the infrastructure that had beaten the disease back was largely gone.In 2022, lack of timely testing and adequate treatment during pregnancy contributed to 88 percent of congenital syphilis cases in the United States, with gaps cutting across all races, ethnicities, and regions. Each case requires multiple simultaneous failures: undiagnosed syphilis in men, untraced female partners, missed screening during pregnancy, a failure to treat in time.The breakdown is not in the knowledge of the disease or the drug, it is in the prenatal prevention system itself, says Chad Abresch, Chair of the Department of Health Promotion at the University of Nebraska Medical Center’s College of Public Health.“Congenital cases reflect what happens when the maternal-child prevention infrastructure that connects screening to treatment has been hollowed out,” Mr. Abresch tells the Sun. “The disease shows up where the system has the least slack.”A January 2025 Congenital Syphilis Summit in Atlanta identified five critical system failures driving the crisis: cyclical funding instability, workforce deterioration, fragmented surveillance, disconnected health care systems, and health equity failures. The geographic concentration tells its own story — Texas, California, Arizona, Florida, and Louisiana accounted for 57 percent of all reported congenital syphilis cases in 2022.However, no state captures the catastrophic convergence of poverty, prenatal care gaps, and public health collapse more starkly than Mississippi, where the rate of maternal syphilis infections grew more than 1,000 percent between 2013 and 2023, climbing from 86 cases per 100,000 births to more than 1,000 per 100,000, according to a study published in JAMA Network Open.The state declared a public health emergency in August 2025 after its overall infant mortality rate reached 9.7 deaths per 1,000 live births — the highest in more than a decade.Infectious disease specialist Thomas Dobbs described the consequences for babies of affected mothers as “catastrophic.” As sexually transmitted infection clinics have closed and public health workers have been laid off, syphilis has come raging back, warned Dobbs, Dean of the John D. Bower School of Population Health at the University of Mississippi Medical Center.The Drug That Isn’t ThereThe treatment supply problem has compounded the screening problem, leaving providers with few good options. Benzathine penicillin G, sold as Bicillin L-A and the only medication proven to prevent fetal transmission, has been in limited supply since 2023.In July 2025, King Pharmaceuticals — a subsidiary of Pfizer — issued a voluntary recall for specific lots due to particulates identified during visual inspection. As of April 2026, the manufacturer does not expect full supply recovery until the fourth quarter of 2027.For pregnant patients, there is no acceptable substitute; alternative antibiotics used in nonpregnant adults do not cross the placental barrier effectively enough to protect the fetus.A spokesperson for the American College of Obstetricians and Gynecologists tells the Sun the shortage has now been extended into the fourth quarter of 2026.“We are telling our members that they should prioritize their remaining stock for pregnant patients, as it is the only effective treatment for preventing prenatal transmission,” the spokesperson says. “Nonpregnant patients should be given alternative antibiotics such as doxycycline.”Since 2024, the FDA has authorized the temporary importation of Lentocilin, a Portuguese alternative formulation manufactured by Laboratórios Atral and not otherwise FDA-approved. Access through standard pharmacy and hospital channels, however, has proved uneven.Maternal syphilis rates have more than quadrupled since 2016, reaching 357.9 per 100,000 births in 2024. Racial disparities within that surge play a part: American Indian and Alaska Native communities in some regions face congenital syphilis rates up to 100 times higher than those in White populations, while Black mothers face rates of 887.6 per 100,000 births, with the most recent data showing the steepest proportional increases now concentrated among mothers aged 35 and older.There is a muted, partial signal of progress. Primary and secondary syphilis cases declined 22 percent in adults in 2024, a second consecutive year of declines the Centers for Disease Control and Prevention attributed partly to better awareness, expanded at-home testing, and wider use of doxycycline post-exposure prophylaxis.However, the 2024 provisional surveillance data show congenital syphilis cases rose nearly two percent over 2023 — still rising, though notably slower than the double-digit increases of recent years.Information provided to the Sun by the Centers for Disease Control and Prevention on background also notes that the timing of congenital diagnoses — often at birth, months or years after the mother’s original infection — contributes to a lag between trends in women and trends in newborn cases, meaning the full impact of recent adult declines may not yet be visible.Chief Medical Officer and Senior Vice President for Health at Fedcap, Jay Varma, is direct about the political headwinds.“I am pessimistic that we will see the funding, staffing, and political will to bring congenital syphilis rates down in the United States over the next few years,” Dr. Varma tells the Sun, pointing to recent federal cuts to CDC sexually transmitted infection prevention programs, Title X family planning funding, Medicaid, and the Affordable Care Act marketplace.“If we want to be serious about eliminating a completely preventable and devastating disease such as congenital syphilis, then we need to invest federal, state, and local resources into ensuring that all pregnant women get high-quality prenatal care throughout their pregnancy.”The data, stripped of politics, tell a simple story.“The early 2000s near-elimination was not a technological achievement,” Mr. Abresch adds. “It was an infrastructure achievement — and we dismantled the infrastructure once we thought we had won.”

Failing To Prevent the Preventable: The Resurgence of Congenital Syphilis

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