A New Call to Action to Combat an Old Nemesis: Addressing Rising Congenital Syphilis Rates in the United States

Abstract

Congenital syphilis (CS) is on the rise in the United States and is a growing public health concern. CS is an infection with Treponema pallidum in an infant or fetus, acquired via transplacental transmission when a pregnant woman has untreated or inadequately treated syphilis. Pregnant women with untreated syphilis are more likely to experience pregnancies complicated by stillbirth, prematurity, low birth weight, and early infant death, while their children can develop clinical manifestations of CS such as hepatosplenomegaly, bone abnormalities, developmental delays, and hearing loss. One of the ways CS can be prevented is by identifying and treating infected women during pregnancy with a benzathine penicillin G regimen that is both appropriate for the maternal stage of syphilis and initiated at least 30 days prior to delivery. In this article we discuss many of the challenges faced by both public health and healthcare systems with regards to this preventable infection, summarize missed opportunities for CS prevention, and provide practical solutions for future CS prevention strategies.

Keywords: congenital syphilis; pregnancy; prenatal care; sexually transmitted infections.

FIG. 1.

CS—reported cases by year of birth and rates of reported cases of P&S syphilis among females aged 15–44 years, United States, 2010–2019. *Per 100,000. CS, congenital syphilis; P&S, primary and secondary syphilis.