The annual increase in congenital syphilis cases slowed in 2023, but cases still are more than eight times higher than a decade ago, according to a new report from the Centers for Disease Control and Prevention (CDC).

There were 3,882 cases reported by states and Washington, D.C., last year, up 3% from 2022. This follows a 32% jump from 2021 to 2022.

Syphilis during pregnancy can result in miscarriage, stillbirth, infant death or lifelong medical issues for the baby. There were 252 stillbirths and 27 infant deaths related to congenital syphilis in 2023, according to the report.

Congenital syphilis was diagnosed at a rate of nearly 106 per 100,000 live births with stark racial differences. Infants born to American Indian/Alaska Native parents had a rate of about 681 cases per 100,000 live births, while rates were lowest for Asian families at nine cases per 100,000 births. Data also showed Black infants represented 30% of all cases while making up just 14% of live births.

About 43% of birth parents had no documented timely test, and about 23% had no documented treatment.

“Barriers at each step are multifactorial and are frequently related to structural and systematic issues such as housing status and healthcare access, along with syndemics such as substance use disorder,” according to report.

Neonatologist W. Christopher Golden, M.D., FAAP, urged pediatricians at the AAP National Conference & Exhibition in September to watch for cases and know how to manage them.

Because testing mandates for people who are pregnant vary by state, Dr. Golden cited guidance from the AAP Red Book that says, “No newborn infant should be discharged from the hospital without confirmation of the birthing parent’s serologic status for syphilis.”

The AAP Red Book has detailed information on signs and symptoms of congenital syphilis and a diagnosis algorithm.

Across all ages, syphilis cases rose just 1% in 2023 despite a shortage of treatment benzathine penicillin G. The Food and Drug Administration (FDA) has allowed importation of antibiotics from other countries to help fill the gap.

The CDC touted several recent developments, including guidelines for using doxycycline to prevent bacterial sexually transmitted infections (STIs) and FDA authorization of at-home tests. In addition, the National Syphilis and Congenital Syphilis Syndemic Task Force has been working to expand testing and treatment, increase awareness and engage communities and health departments.

The CDC called for continued efforts, including prioritizing the STI epidemic at all levels of government; developing new prevention, testing and treatment solutions; investing in public health systems; and expanding testing and treatment locations.

Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said in a press release that he sees “a glimmer of hope.”

“After nearly two decades of STI increases, the tide is turning,” he said. “We must make the most of this moment — let’s further this momentum with creative innovation and further investment in STI prevention.”

Resources

• AAP Red Book chapter on syphilis
• Information from the CDC on preventing and treating congenital syphilis
• CDC’s “Sexually Transmitted Infection Treatment Guidelines, 2021”