Hospital data show the number of U.S. newborns diagnosed with congenital syphilis rose from an estimated 597 in 2012 to 3,325 in 2022, a nearly sixfold increase. The rate climbed from 16.0 to 94.7 cases per 100,000 birth admissions.
Congenital syphilis happens when a pregnant person with untreated syphilis passes the infection to the baby. It can cause miscarriage, stillbirth, premature birth, low birth weight, lasting health problems, and death shortly after birth.
Because a simple blood test and timely penicillin can prevent transmission, almost every case represents a missed preventive opportunity that could be addressed during prenatal visits.
Nationwide rise and demographic patterns
Rates increased in every racial and ethnic group examined. The steepest jump was among American Indian and Alaska Native infants, whose rate rose from 22.7 to 486.0 per 100,000—about a 21-fold increase, though the estimate is imprecise due to small numbers.
In 2022, Hispanic infants accounted for roughly 1,010 cases, Black infants for 970, and White infants for 785. The highest incidence appeared in the lowest-income ZIP codes, at 186.8 per 100,000, and among newborns with public insurance, at 177.4 per 100,000.
Geography also mattered. The West posted the highest regional rate at 126.0 per 100,000, while the South contributed more than half of all affected births, accounting for about 1,682 hospitalizations.
Drivers behind the surge
Researchers cited limited access to prenatal care, particularly in rural areas, federal cuts to family-planning programs, and persistent shortages of the penicillin formulation used to treat pregnant patients as key factors.
The analysis relied on hospital discharge records, excluding stillbirths and births at Indian Health Service facilities, which serve about 10% of American Indian and Alaska Native deliveries. Those omissions likely undercount the true burden.
Provisional CDC data released for 2024 show roughly 4,000 reported cases, a 2% rise from the prior year and the twelfth consecutive annual increase.
The CDC advises syphilis testing at the first prenatal encounter, with repeat testing around 28 weeks and again at delivery for individuals at higher risk or residing in high-prevalence areas. The American College of Obstetricians and Gynecologists recommends this three-point schedule for all pregnant patients.
Testing gaps and treatment shortages
Most congenital cases stem from a missed screening or delayed therapy. A CDC Vital Signs report identified that inadequate testing and treatment during pregnancy accounted for the majority of cases in the most recent year, highlighting the importance of timely diagnosis. Many infected individuals experience no symptoms, and the classic painless sore may go unnoticed, which explains why routine testing is essential even for those who feel well.
The recommended regimen for pregnant patients is benzathine penicillin G, marketed as Bicillin L-A, administered in one to three injections based on infection duration. Supply constraints have persisted for several years, prompting the FDA to extend the use dates on 21 lots of Bicillin L-A to sustain availability.
Practical steps for patients and partners
Expectant parents can obtain syphilis testing at any point of care, including urgent-care centers, emergency departments, or local health-department clinics, many of which provide free or low-cost services. People who start prenatal care late, or have none, can still be tested at these locations.
Partners need testing and treatment too, ideally at the same time as the pregnant person. A person who is treated during pregnancy can be reinfected by an untreated partner, putting the baby at risk again.
After birth, newborns may appear healthy, but pediatricians often perform confirmatory testing and provide prophylactic therapy, followed by close follow-up to monitor for late-appearing symptoms.
