In 2024, the Centers for Disease Control and Prevention (CDC) reported nearly 4,000 new cases of congenital syphilis in infants, marking the highest number since the mid-1950s. Approximately 5% to 10% of these cases result in stillbirth or early death, while many survivors face lifelong disabilities or developmental delays. The rise in congenital syphilis cases is attributed to a decline in syphilis control efforts following the Great Recession and subsequent funding cuts to local public health programs in 2008.
The CDC has indicated that most congenital syphilis cases arise from pregnant women who are not tested for syphilis or, if tested positive, do not receive treatment. Barriers to prenatal care include lack of insurance, limited access, fear of immigration issues, and other medical conditions. Despite mandates for syphilis screening during pregnancy, compliance remains an issue, with only about 80% of pregnant women being tested.
To address this public health concern, experts recommend improving access to prenatal care, expanding Medicaid, and ensuring that prenatal services are available in various community settings. They emphasize the importance of accountability for healthcare providers regarding screening compliance and suggest implementing electronic health record reminders for syphilis testing.
Immediate treatment upon a positive screening test is advised, and the availability of injectable benzathine penicillin G in clinics is crucial. However, there have been ongoing challenges with the supply of injectable penicillin. Furthermore, Congress is urged to fund the CDC to enhance local public health efforts and ensure adequate staffing for disease intervention specialists.
The article also highlights the potential of rapid point-of-care syphilis tests, which can provide results in under 15 minutes, to increase screening rates significantly. However, the deployment of these tests has been hindered by reimbursement issues and a lack of leadership. Lastly, the integration of maternal health services with substance use treatment programs is recommended, particularly in areas where substance use contributes to higher rates of congenital syphilis.