Health officials across the United States are sounding an urgent alarm and a warning about congenital syphilis, a previously uncommon reason for infant mortality, continues its upswing. In 2023, the Centers for Disease Control and Prevention (CDC) reported 3,882 cases, the most since 1992. In 1992 alone, 279 babies died from the infection or were delivered stillborn, with 252 of them listed as stillbirths—a 6.3 percent rise from 2022.The country's congenital syphilis rate is currently 105.8 cases per 100,000 live births, a three percent rise from last year. Experts cite the increase mainly due to loopholes in prenatal care, inadequate screening, and lacking follow-up treatment during pregnancy.What Is Congenital Syphilis?Syphilis is a sexually transmitted disease produced by the bacterium Treponema pallidum. The primary signs are sores in the location of infection, usually the genitals or mouth, whereas secondary syphilis may present with rashes on hands and feet.Congenital syphilis takes place if a pregnant mother passes the disease to her unborn child, which might lead to severe complications. These may involve bone abnormalities, jaundice, skin rashes, neurological complications, and even in extreme cases, stillbirth or death of the infant. According to the World Health Organization, 1.5 million cases of congenital syphilis are estimated worldwide each year.Fortunately, syphilis and congenital syphilis are preventable using condoms and can be treated using penicillin. Unattended cases, however, have disastrous and permanent effects.What Is Behind The Spike In Congenital Syphilis?Evidence indicates that much of congenital syphilis is a result of failed screenings and untreated infections. Across the country, 43 percent of birth parents were not screened for syphilis during pregnancy, and 23 percent of the infected were not treated. Gaps in 2022 accounted for almost 90 percent of congenital syphilis.Unscreened or untreated sexual partners further contribute to the issue. "Early detection is the key," asserts Dr. Jim Saperstone of Community Care Pediatrics. "Syphilis, if left untreated, can affect a newborn's brain, heart, eyesight, and development.New York State has experienced an alarming increase in the number of cases, with three infant fatalities reported in 2025 and 21 cases outside of New York City to date this year. The city alone had 35 cases in 2023. In reaction, officials in New York are pushing for mandatory blood tests for expectant mothers."No baby should ever die from syphilis in New York State or in this nation," said State Health Commissioner Dr. James McDonald. He points out that early diagnosis by easy blood tests is key to quick treatment and healthy results.Hotspots and national trendsAlthough New York is precarious, the most elevated rates of syphilis and congenital syphilis reside in states such as South Dakota, New Mexico, Mississippi, Arizona, and Texas. Such states have the highest rates per 100,000 live births, making them priority targets for public health initiatives.The CDC states congenital syphilis cases can be prevented but are made difficult by structural issues like a shortage of prenatal care, reduced access to testing, and nationwide deficiencies in the specialized penicillin treatment. Pfizer, the only company producing the penicillin formulation given to pregnant women, already has a national shortage, leading officials to ration its availability for congenital cases.Why Screening Is Equal Way Part Of Prevention?Syphilis testing is universally recommended by every U.S. state in the first trimester, but the recommendations differ for third-trimester and post-birth periods. Eighteen states recommend testing in the third trimester, nine suggest testing after birth, while just eight require screenings at the time of delivery. Experts emphasize that early screening, regular follow-up, and compliance with treatment are the best methods to avoid congenital syphilis."Early involvement with healthcare providers is key," Dr. McDonald said. "Blood tests during the first trimester, again at 20–32 weeks, and close to delivery should be given to pregnant women. The use of condoms also decreases transmission risk."Medical education and awarenessIn response to increasing cases, the U.S. Department of Health and Human Services, Office on Women's Health, introduced a new continuing medical education (CME) course: "Syphilis and Congenital Syphilis on the Rise – How to Protect Your Patients." The course provides practicing physicians, nurses, and pharmacists with effective strategies for screening, diagnosis, and patient-centered care. Physicians learn how to put guideline-based recommendations into practice, recognize key screening opportunities, and deliver empathetic treatment to infected families.The rise of congenital syphilis also points to gaps in public health infrastructure, especially in prenatal care and follow-up treatment. Though most cases can be prevented with screening and penicillin treatment, shortages and uneven test schedules expose many newborns to dangers.Physicians and public health practitioners advise all pregnant women to visit their physician regularly for prenatal care, adhere to recommended testing schedules, and have their treatment completed if they are found to be infected. Sexual partners should also be tested and treated to avoid reinfection.