Congenital Syphilis: What Every Pregnant Person Needs to Know
Pregnancy brings with it a long list of health considerations, and one that deserves serious attention is syphilis. While syphilis is a treatable sexually transmitted infection (STI) in adults, when it goes undetected during pregnancy it can have devastating consequences for a baby. Congenital syphilis — syphilis passed from a pregnant person to their baby during pregnancy or childbirth — is a serious, yet almost entirely preventable condition. Understanding the risks, knowing the warning signs, and getting tested early can make all the difference.
What Is Congenital Syphilis?
Congenital syphilis occurs when the bacterium Treponema pallidum, which causes syphilis, crosses the placenta and infects the developing fetus. This can happen at any point during pregnancy, but the risk is highest when the pregnant person has a new or untreated syphilis infection. The infection can also be transmitted during delivery if the baby comes into contact with syphilitic sores in the birth canal.
It's important to understand that syphilis in adults often has mild or no noticeable symptoms, meaning many people don't know they're infected. This is precisely why routine prenatal testing is so critical.
Why Is This a Growing Concern?
Congenital syphilis is not a relic of the past — it is a rapidly growing public health crisis. According to the Centers for Disease Control and Prevention (CDC), reported cases of congenital syphilis in the United States have increased dramatically in recent years. In 2022, the CDC reported over 3,700 cases of congenital syphilis, representing a staggering increase of more than 30% compared to just the previous year. That same year, 231 babies were stillborn or died due to congenital syphilis.
The World Health Organization (WHO) estimates that globally, more than 700,000 cases of congenital syphilis occur each year. These numbers are especially alarming because the tools to prevent transmission are simple, affordable, and widely available.
How Does Congenital Syphilis Affect Babies?
The health consequences for a baby born with syphilis can be severe, long-lasting, and life-threatening. Outcomes vary depending on the stage of the parent's infection and whether or not treatment was received.
During Pregnancy
- Miscarriage (pregnancy loss before 20 weeks)
- Stillbirth (delivery of a baby with no signs of life after 20 weeks)
- Premature birth
- Low birth weight
In Newborns and Infants
Some babies with congenital syphilis show symptoms at birth, while others may appear healthy but develop problems in the weeks, months, or years that follow. Symptoms can include:
- Skin rashes or sores
- Bone and joint pain or abnormalities
- Enlarged liver or spleen
- Anemia (low red blood cell count)
- Jaundice (yellowing of the skin)
- Nasal discharge, sometimes called "snuffles"
Long-Term Complications
If congenital syphilis goes untreated in infancy, it can progress to what's called late congenital syphilis, which may cause:
- Hearing loss or deafness
- Vision problems or blindness
- Neurological (brain and nervous system) damage
- Dental abnormalities (known as Hutchinson's teeth)
- Bone deformities
- Intellectual disabilities
The good news? With early detection and proper treatment during pregnancy, virtually all of these outcomes can be prevented.
Testing During Pregnancy: What You Need to Know
Routine syphilis screening is a standard part of prenatal care in the United States and many countries worldwide. The CDC recommends that all pregnant people be tested for syphilis at their first prenatal visit. However, that single test is not always enough.
Because syphilis rates are rising and reinfection is possible, additional testing is recommended in certain situations:
- At 28 weeks of pregnancy for those living in areas with high rates of syphilis or who are considered at increased risk
- Again at delivery (birth) for those in high-prevalence areas or who have had limited prenatal care
- Any time there is a new potential exposure to syphilis during pregnancy
The test itself is a simple blood draw. Results are typically available within a few days, and if syphilis is detected, treatment can begin right away.
Treatment: Simple, Effective, and Life-Saving
Here's one of the most important things to understand about congenital syphilis: it is almost entirely preventable with timely diagnosis and treatment. When syphilis is identified during pregnancy, it can be treated effectively with penicillin, an antibiotic that has been used safely in pregnancy for decades.
Penicillin G is the only proven treatment for syphilis during pregnancy and is highly effective at curing the infection in the pregnant person and preventing transmission to the baby. In cases of penicillin allergy, a healthcare provider can work with the patient — sometimes including a desensitization process — to ensure safe treatment.
The earlier treatment is given, the better the outcomes. Treatment during the first or second trimester is especially effective at protecting the developing baby. However, treatment at any stage of pregnancy is still beneficial and recommended.
Barriers to Prevention: Why Cases Are Still Rising
If congenital syphilis is preventable, why are rates still climbing? Several complex social and systemic factors contribute to this ongoing crisis, including:
- Lack of access to prenatal care, particularly in rural or underserved communities
- Limited access to STI testing and treatment due to financial or insurance barriers
- Stigma around STIs that discourages people from seeking testing or disclosing their status
- Substance use issues that may interfere with consistent medical care
- Delays in diagnosis or treatment by healthcare providers
Understanding these barriers helps explain why public health advocacy, accessible care, and stigma reduction are just as important as medical treatment in fighting congenital syphilis.
What You Can Do to Protect Yourself and Your Baby
If you are pregnant or planning to become pregnant, there are clear steps you can take to protect your baby's health:
- Start prenatal care early — ideally in the first trimester — and attend all recommended appointments.
- Get tested for syphilis at your first prenatal visit, and again as recommended by your provider.
- Talk openly with your healthcare provider about your sexual health history and any potential exposures.
- Encourage your partner(s) to get tested and treated if necessary, to prevent reinfection.
- Use condoms consistently to reduce the risk of syphilis and other STIs during pregnancy.
- If you are diagnosed with syphilis, complete the full course of treatment as prescribed and attend follow-up appointments to confirm the infection has cleared.
You Deserve Care Without Judgment
Being diagnosed with syphilis during pregnancy can feel frightening or overwhelming, but it is important to remember: this is a medical condition, not a reflection of your worth as a person or parent. Syphilis is incredibly common and can affect anyone who is sexually active. What matters most is getting the care you need — and with proper treatment, your baby can be born healthy.
Healthcare providers who specialize in prenatal care are there to support you without judgment. If you ever feel stigmatized or unheard by a provider, you have every right to seek care elsewhere.
Get Tested — For You and Your Baby
Syphilis testing during pregnancy is one of the simplest, most impactful steps you can take for your baby's health. Testing is quick, confidential, and widely available through OB-GYN offices, family medicine providers, community health centers, and sexual health clinics. Many clinics offer testing on a sliding scale or at no cost.
Don't wait. If you are pregnant and haven't been tested for syphilis yet, speak with your healthcare provider today. If you don't currently have a provider, visit a local sexual health clinic or community health center — they are ready to help you get the care you and your baby deserve. Early testing and treatment can mean the difference between a preventable tragedy and a healthy start to life.