US Reports Record High 4,000 Congenital Syphilis Cases in 2024; Public Health Officials Cite Testing and Access Gaps

The United States recorded nearly 4,000 cases of congenital syphilis in 2024, the highest annual count since the mid-1950s, according to data from the Centers for Disease Control and Prevention (CDC).

The cases represent a 700% increase compared to approximately ten years ago and a 28% rise in maternal syphilis rates from 2022 to 2024, from roughly 280 to 360 cases per 100,000 births.

The surge is linked to a combination of increased syphilis infections in the general population, barriers to healthcare access, and gaps in screening and treatment for pregnant individuals. Australia has also reported 42 infant deaths from congenital syphilis in the past decade, leading to a declaration of a national communicable disease incident.

Key Statistics and Trends

• Total cases: Nearly 4,000 new cases of congenital syphilis in 2024 (CDC).
• Maternal rate: Approximately 360 cases per 100,000 births in 2024, up from 280 per 100,000 in 2022 (a 28% increase).
• Historical context: Highest level since the mid-1950s.
• Long-term trend: Increase of 700% over the past decade.
• Outcomes: 5–10% of congenital syphilis cases result in stillbirth or death shortly after delivery. Surviving infants may experience lifelong disability, developmental delay, blindness, hearing loss, bone or tooth malformation, heart defects, and rashes.
• Regional example: New York has seen a fivefold increase in syphilis infections since 2013.

Causes and Contributing Factors

• Approximately one in four pregnant individuals lack first-trimester prenatal care.
• Barriers cited by officials include lack of insurance, poor transportation, rural or urban location, economic status, race and ethnicity, and fear of immigration detention.
• Medicaid enrollment for pregnancy can take months, potentially delaying syphilis screening beyond the first trimester.
• The COVID-19 pandemic reduced staffing and hours at safety-net clinics, limiting screening and treatment capacity.

• Federal funding for sexually transmitted infections (excluding HIV) has remained at about $160 million annually, resulting in a 40% reduction in spending power after adjusting for inflation.
• Proposed budget cuts for 2026 would combine HIV, STI, and tuberculosis programs with a $70 million reduction.

• According to CDC evaluations, most congenital syphilis cases are due to pregnant women not being tested, or, among those testing positive, not receiving adequate treatment.
• Among pregnant individuals who receive prenatal care, only about 80% are tested for syphilis.
• Published studies show screening rates of 80–90% for private insurance and 56–90% for Medicaid, at least once during pregnancy.
• Injectable benzathine penicillin G, the recommended treatment, has faced shortages, stock-outs, and recalls over the past decade.

• Changes in sexual behaviors since the early 2000s, partly attributed to improved HIV treatments leading to decreased safer sex practices.
• Social stigma and healthcare provider biases can deter testing and treatment.
• Providers may assume screening is unnecessary for long-term patients in monogamous relationships.
• Patients may not disclose risky sexual behaviors or may be unaware of exposure through a partner’s infidelity.
• Substance use and mental health issues are cited as barriers to prenatal care.

Syphilis: Symptoms and Transmission

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It progresses through stages:

• Primary stage: Painless ulcer (chancre) at the site of exposure, which resolves on its own.
• Secondary stage (3–6 months after exposure): Flu-like symptoms, weight loss, swollen lymph nodes, non-itchy rash on chest/back and potentially palms/soles, hair loss, mouth lesions, and hearing or vision changes.
• Latent phase: Bacteria remain active without acute symptoms for decades.
• Tertiary phase (in 40–60% of untreated cases): Seizures, heart defects, bone or skin growths, confusion, and dementia.

The bacteria can cross the placenta from mother to fetus via shared blood supply, with transmission more likely within the first year of maternal infection but possible at any stage. Congenital syphilis is treatable with antibiotics, but existing damage cannot be reversed.

Prevention and Treatment Recommendations

• Nearly all states have mandated syphilis screening during pregnancy, often requiring up to three tests.
• New York implemented a requirement in 2024 for screening at the first prenatal appointment, the third trimester, and at delivery.
• Universal screening for all pregnancies is recommended in the first trimester, third trimester, and at delivery.

• Treatment with injectable benzathine penicillin G should be administered immediately upon a positive screening test, without waiting for additional confirmatory testing.
• For non-pregnant patients without neurological symptoms, oral doxycycline for 14–28 days is an alternative.
• Doxycycline post-exposure prophylaxis (doxy PEP) within 72 hours of sexual activity is another prevention option.
• Condom use and ensuring partners are tested negative and exclusive are also recommended.

• Three FDA-approved rapid point-of-care tests are available, providing results in under 15 minutes.
• Advocates recommend deploying these tests in emergency departments, urgent care centers, shelters, correctional settings, and mobile clinics.
• A study showed rapid syphilis testing in an emergency department increased screening from 2% to 56%.
• Lack of deployment of rapid tests has been attributed to absence of political will, leadership, and reimbursement challenges.

• Recommendations include making prenatal care early, easy, and universal with same-week entry, walk-in and telehealth options, and extended clinic hours.
• Expanding Medicaid with presumptive eligibility during pregnancy and zero-cost visits, lab tests, and transportation is suggested.
• Prenatal services should be co-located at WIC sites, substance-use clinics, jails, reentry programs, and homeless shelters.
• Public health agencies should hold medical providers and health systems accountable for compliance, including public reporting and medical-legal action for failures.
• Reminder prompts, hard-stop order sets, monitoring dashboards, and standing nursing protocols should be integrated into electronic health records.
• Government agencies should guarantee a reliable supply of injectable penicillin through state and regional rotating stockpiles, rapid redistribution, and clear allocation protocols.
• Trained nurses and pharmacists should be allowed to administer injectable penicillin per state scope-of-practice rules.
• Congress should fund the CDC to support technical assistance to localities, including an adequate number of disease intervention specialists for case investigation, partner services, and linkage to care.
• Programs should set and regularly report performance targets, such as percentage of pregnant women tested, time from positive test to treatment, and percentage treated adequately before delivery.
• Local health care organizations should engage in real-time monitoring with dashboards for pregnancy-associated syphilis, treatment timeliness, and missed screening. For each case, maternal-child clinical care teams should hold a sentinel event review to identify system failures.
• Integration between maternal health and substance use treatment is recommended. In areas where methamphetamine or opioid use drives congenital syphilis, prenatal services should be paired with opioid use disorder treatment programs, harm reduction, and case management.
• Punitive policies toward women who test positive for substances should be ended.

Statements from Officials and Experts

Jeffrey D. Klausner, clinical professor at Keck School of Medicine of USC: "As a physician and former public health official, I have never been more concerned about those rates of congenital syphilis."

Maciej Henneberg, Emeritus Professor at University of Adelaide: "It worries us a lot. It’s 100% important not to allow it to spread and to become endemic."

Dr. Kelly Hosking of NT Health: "It is entirely preventable, so even if a pregnant person got syphilis, we can totally treat that pregnant person, and then the baby will not be at risk any longer."