# Rising Rates, Silent Risks: Navigating the Congenital Syphilis Crisis in Prenatal Care

> Congenital syphilis cases surged 700% in a decade. Learn how new ACOG 2024 screening guidelines, shifting demographics, and treatment gaps impact maternal-fetal health.

- Source: https://gender-medicine-gap.nicheflash.com/blogs/rising-rates-silent-risks-congenital-syphilis-prenatal-care-2026
- Publisher: Gender Medicine Gap
- Published: 2026-09-18
- Updated: 2026-09-18

### Key Takeaways

- Congenital syphilis cases surpassed 4,000 in the United States in 2024, marking a 700% increase over the past decade due to gaps in screening protocols and partner management.
- The American College of Obstetricians and Gynecologists (ACOG) updated guidance in April 2024 to recommend universal screening at three time points: first visit, third trimester, and delivery.
- Emerging epidemiological data from 2026 indicates a significant shift in risk profiles, with accelerating incidence rates among rural populations and predominantly White women, challenging traditional provider biases.
- Treatment efficacy remains high when Penicillin G is administered timely; however, nearly one-third of diagnosed pregnant patients received little to no treatment before delivery due to logistical and allergy-related barriers.

## Is the current protocol sufficient to prevent vertical transmission?

No. While initial screening for syphilis is nearly universal in early prenatal care, it often fails to detect infections acquired later in pregnancy. Vertical transmission is defined as the passage of the *Treponema pallidum* bacteria from an infected pregnant person to the developing fetus. This transmission can result in severe outcomes including stillbirth, prematurity, and permanent neonatal disability. Historically, many clinical guidelines prioritized first-trimester screening alone for asymptomatic patients, assuming low risk for subsequent infection.

This static approach has proven inadequate against the rising tide of sexually transmitted infections. In response to the persistent crisis, the American College of Obstetricians and Gynecologists (ACOG) issued updated guidance in April 2024. These recommendations advocate for universal syphilis screening at three distinct intervals: the first prenatal visit, during the third trimester (approximately 28 weeks), and at delivery [15], [20]. The goal is to capture infections that occur dynamically throughout gestation, regardless of initial negative test results.

> The 2024 clinical guidance represents a necessary shift toward recognizing that sexual behavior—and consequently STI exposure—can occur dynamically throughout pregnancy, regardless of initial negative test results [15].

Despite this evidence-based update, implementation across healthcare systems remains uneven. Many facilities continue to rely on single-time testing schedules until the second half of gestation, creating windows where infectious partners can transmit the disease undetected until it is too late to prevent fetal harm.

## How does geography and ethnicity influence detection biases?

Detection bias significantly impacts congenital syphilis outcomes, often rooted in outdated assumptions about who is at risk. For decades, syphilis diagnoses were disproportionately associated with marginalized communities and urban centers due to entrenched disparities in healthcare access and social determinants of health. Black and Hispanic heterosexually active women have historically experienced significantly higher rates of primary and secondary (P&S) syphilis, with diagnosis rates estimated up to 6.42 times higher than those of White women [22], [24].

However, recent temporal analyses reveal a profound epidemiological shift. Emerging evidence from 2026 highlights accelerating spikes in other demographics, particularly in rural areas and predominantly White suburbs. A longitudinal study published in early 2026 noted an Annual Percentage Change (APC) of 17.84% in syphilis incidence among White pregnant women, outpacing increases in some minority cohorts [28]. Furthermore, research covering the period from 2016 to 2023 demonstrated that syphilis rates during pregnancy quintupled in rural areas, often exceeding growth seen in urban equivalents [30].

Detection Challenges by Demographic Profile- **Rural Populations:** Increased isolation and reduced access to specialized infectious disease clinics may lead to delayed follow-up or misinterpretation of mild symptoms like mucous patches as non-infectious dermatologic issues.
- **Predominantly White Suburbs:** Provider bias rooted in outdated statistical norms can result in lower index-of-suspicion for sexual history-taking, leading to deferred serological testing until complications arise.

When providers lack awareness of this shifting demographic baseline, diagnostic delays exacerbate the risks of congenital transmission. The assumption that syphilis is exclusively an urban, minority health disparity creates a blind spot in comprehensive prenatal care for rural and suburban patients [29]. This bias undermines the universality of screening protocols and contributes to the overall rise in cases.

## What are the systemic barriers to effective partner management?

Detecting infection in the pregnant patient is only half of the preventive equation. If the sexual partner remains untreated, the likelihood of reinfection—and subsequent vertical transmission—remains critically high. Partner notification is the process by which sexual partners of an individual diagnosed with a sexually transmitted infection are informed of their potential exposure and offered testing and treatment [35]. Despite its critical importance, partner engagement remains a significant failure point in current care models.

Recent evaluations highlight that only a fraction of partners attend clinic-based testing after a positive diagnosis in the pregnant patient. In one analysis, merely 18.3% of male partners received appropriate treatment following screening [36]. Without treating the reservoir of infection in the community, treating the pregnant patient becomes a temporary measure at best. Reinfection rates remain high because the source of transmission is not eradicated.

Strategies such as patient-led partner notification or the use of digital platforms have been proposed to mitigate appointment attendance barriers. However, uptake and effectiveness remain limited [31]. Structural support systems that automate notifications or provide direct linkage to care for partners are needed to close this gap, but widespread adoption has yet to occur.

## How do treatment gaps persist even after diagnosis?

Even when detected via robust multi-point screening, ensuring timely administration of curative therapy presents another layer of vulnerability. According to the CDC, approximately 88% of congenital syphilis cases in 2022 could have been prevented through timely screening and appropriate intervention [14]. Yet, recent studies indicate that nearly one-third of pregnant patients with confirmed syphilis received little to no treatment prior to delivery [27].

The cornerstone of treatment for syphilis during pregnancy is Penicillin G. It is the only antimicrobial agent currently documented to effectively cross the placenta and treat both the fetus and the mother [12]. Because Penicillin G cannot be substituted for beta-lactam allergies without risking fetal harm, patients reporting allergies must undergo desensitization followed by standard therapy—a logistical hurdle that contributes to treatment delays [12].

This requirement for hospital-based desensitization creates resource-intensive bottlenecks. Patients in under-resourced regions may face longer wait times, increasing the risk that treatment is administered too late in the pregnancy to fully protect the fetus. Addressing these treatment gaps requires not only guideline adherence but also infrastructure improvements to facilitate rapid, equitable access to Penicillin G therapy.

## References

1. [[1] CDC. (2024). Syphilis Statistics and Trends.](https://www.cdc.gov/syphilis/statistics/index.html)
2. [[5] National Health Statistics Reports. (2024). Rise in Congenital Syphilis Cases.](https://www.acog.org/womens-health/faqs/sexually-transmitted-infections/sti-screening-during-pregnancy)
3. [[12] FDA & CDC Guidelines. (2023). Penicillin G Efficacy in Pregnancy.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10000000/)