Nearly 4,000 babies were born with syphilis in the United States in 2024, marking the 12th consecutive annual increase and pushing newborn infections to their highest level since the 1950s. The CDC’s provisional national data confirms that a preventable bacterial infection, easily treated with penicillin when caught early, is instead killing and disabling infants at a rate not seen in more than seven decades. In 88 percent of cases documented in 2022, the most recent year with full case-level data, a lack of timely testing or adequate treatment during pregnancy allowed the infection to pass from mother to child.
Twelve Straight Years of Rising Newborn Syphilis
The scale of the problem has grown rapidly. Between 2012 and 2022, congenital syphilis cases in the U.S. increased tenfold, according to a CDC analysis published in late 2023. That year’s count exceeded 3,700 affected newborns. By 2022, the CDC’s Vital Signs report documented 3,761 congenital syphilis cases, 231 stillbirths, and 51 infant deaths directly attributed to the disease. The 2024 provisional total of nearly 4,000 cases, released by the CDC’s Division of STD Prevention, shows the trajectory has not reversed.
The broader syphilis epidemic provides context. Total U.S. syphilis cases across all stages reached their highest levels since the 1950s in the 2022 surveillance year. But the newborn crisis carries a sharper edge: these are infections that standard prenatal screening can detect and a single course of penicillin can cure. The gap between what is medically possible and what is actually happening in clinics and hospitals defines the current emergency.
One hypothesis worth examining is whether counties that saw the steepest declines in Medicaid-funded prenatal visits between 2019 and 2022 also experienced the largest spikes in congenital syphilis, independent of broader STI trends. The logic is straightforward: Medicaid covers roughly 40 percent of U.S. births, and pregnant women who lose access to prenatal care are less likely to be screened for syphilis in time for treatment to protect the fetus. The CDC’s own Vital Signs analysis pointed to missed prenatal opportunities as the dominant driver, though the agency has not published county-level data linking Medicaid visit declines directly to congenital syphilis increases. That data gap leaves the precise relationship between insurance access and newborn infections unquantified at the local level.
Federal officials have underscored the urgency. In an early 2025 update on latest national data, the CDC warned that congenital syphilis continues to climb despite being “nearly 100% preventable” with timely testing and treatment. The agency emphasized that prevention hinges less on new medical breakthroughs than on consistently delivering basic prenatal services to people who are pregnant or may become pregnant.
How 88 Percent of Cases Slipped Through the System
The CDC’s 2022 Vital Signs report broke down the failures behind each congenital syphilis case and found that 88 percent could be traced to breakdowns in two areas: testing that came too late in pregnancy or not at all, and treatment that was either delayed or never administered. Nearly 9 in 10 cases, in other words, were preventable with the tools already available in any prenatal care setting.
Several forces feed this failure. Some pregnant women never enter prenatal care, particularly in states with restrictive Medicaid eligibility or in rural areas where obstetric providers have closed. Others receive care but are not tested for syphilis at the right intervals, especially if they acquire the infection later in pregnancy after an initial negative screen. A third group tests positive but does not receive adequate treatment before delivery, sometimes because of penicillin supply disruptions or because they lose contact with the health system before the treatment course is complete.
Missed opportunities also occur when providers do not repeat testing in the third trimester for patients at higher risk, or when laboratory results are not communicated quickly enough to allow treatment before birth. In some jurisdictions, fragmented care-such as emergency department visits substituting for regular prenatal appointments-means no single clinician assumes responsibility for ensuring that testing and treatment are completed.
The federal response has included new diagnostic tools and policy signals. The FDA authorized a point-of-care syphilis test designed to expand screening outside traditional clinical settings, potentially reaching patients in community clinics, mobile vans, or correctional facilities. In January 2024, HHS announced department-wide actions aimed at slowing the epidemic, including guidance to states on strengthening prenatal screening and coordination with drug manufacturers on penicillin supply. But no publicly available data yet quantifies the effect of these initiatives on case counts. The 2024 provisional total of nearly 4,000 cases suggests that, at minimum, these interventions have not yet bent the curve downward.
Gaps in Data and Accountability
Several questions remain open. Full case-level records for 2023 and 2024 from the CDC’s National Notifiable Diseases Surveillance System have not been released beyond provisional aggregates. Without those details, researchers cannot determine whether the geographic distribution of cases is shifting, whether racial and ethnic disparities documented in earlier years are narrowing or widening, or whether specific state-level screening mandates are producing measurable results.
State-by-state prenatal screening compliance data tied to the 88 percent missed-opportunity estimate has not been published in the CDC’s surveillance overview. That means the public cannot identify which states are performing well and which are falling behind on a metric the CDC itself has flagged as the single most actionable lever for prevention. Nor is there a standardized public dashboard tracking how many pregnant patients receive repeat testing in the third trimester or at delivery in high-burden regions, metrics that could show whether policies are changing practice.
Data on insurance status, housing instability, and substance use-factors often linked to both reduced prenatal care and higher STI risk-also remain limited in public reports. Without granular information, local health departments may struggle to target outreach and resources to the communities where they would have the greatest impact. Advocates argue that more transparent, disaggregated reporting would make it easier to hold health systems and policymakers accountable for preventable infections.
What Pregnant Patients and Providers Can Do Now
The practical consequence for pregnant women and their partners is direct. Anyone who is pregnant or planning a pregnancy should confirm with their provider that syphilis screening is part of their initial prenatal blood work, and that repeat testing will occur later in pregnancy if they live in an area with high syphilis rates or have any ongoing risk factors. Partners who may have been exposed should be tested and treated promptly to avoid reinfection.
Clinicians, for their part, can treat every prenatal visit as a chance to verify testing status, review lab results, and close any gaps in treatment. Ensuring that positive tests trigger rapid penicillin therapy, documenting completion of the full treatment course, and coordinating with public health departments for contact tracing are all established practices that directly reduce congenital infections. In emergency rooms, urgent care centers, and substance use treatment programs, offering syphilis testing to pregnant patients can catch infections that routine prenatal care has missed.
Ultimately, the record-high counts of newborn syphilis in 2024 do not reflect a failure of science but a shortfall in access, continuity, and follow-through. The same penicillin regimen that has protected babies for generations still works. Whether the next decade reverses the current trend will depend less on new technologies than on making sure that every pregnant person, in every county, is reached in time.
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*This article was researched with the help of AI, with human editors creating the final content.
