Congenital syphilis is a sentinel health event

The problem

In 2021, there were 2,855 cases of congenital syphilis reported for a rate of 77.9 per 100,000 live births. From 2012 to 2021, the number of cases of congenital syphilis increased 754.8% (334 to 2,855 cases), concurrent with a 676.2% increase (2.1 to 16.3 per 100,000 lives) in the rate of primary and secondary syphilis among women aged 15 to 44 years.¹

Maternal syphilis is associated with a 21% increased risk for stillbirth, 6% increased risk for preterm delivery, and 9% increased risk for neonatal death.²

Optimal treatment of syphilis during pregnancy is estimated to reduce the risk of congenital syphilis by 98%, stillbirth by 82%, preterm birth by 64%, and neonatal mortality by 80%.³ Syphilis is treatable and curable with penicillin. One in two newborn syphilis cases in the United States occur due to gaps in testing and treatment during prenatal care.³

Congenital syphilis: missed prevention opportunities¹

You can make a difference — screen appropriately² and treat early⁴!

Universal screening: All pregnant women at their first prenatal visit. Treat immediately.

High risk screening: Twice in third trimester (28 weeks and at delivery). Ask, document, rescreen:

• History of sex with multiple partners
• Sex in conjunction with drug use or transactional sex
• No prenatal care or late entry
• Methamphetamine or heroin use
• Unstable housing or homelessness
• Incarceration of the woman or her partner
• Prior syphilis diagnosis

High prevalence screening: Twice in third trimester (28 weeks and at delivery) for pregnant women who live in communities with high rates of syphilis. For more information, visit https://gis.cdc.gov/grasp/nchhstpatlas/maps.html.

Do you know the law in your state? Due to the increasing incidence of congenital syphilis in the state of Missouri, the Missouri Department of Health and Senior Services has directed that all pregnant women in Missouri should be tested for syphilis at the first prenatal visit, again in the third trimester (28 weeks), and at delivery regardless of perceived risk.

Do you practice in a high prevalence area? Universal screening in the third trimester and at birth are recommended.