Syphilis is losing ground almost everywhere in America. Reported cases of the most infectious stages fell 22 percent in 2024, the second straight annual decline. Chlamydia dropped 8 percent, gonorrhea 10 percent. Combined case counts for the three most common infections fell 9 percent, a third consecutive year of decreases.
Babies are the exception. Congenital syphilis rose for a twelfth consecutive year, reaching roughly 3,940 cases in 2024, about 110 for every 100,000 live births. Ten years earlier the count was 495. That is close to a 700 percent increase in a condition that a blood test and a course of penicillin prevent.
Why congenital syphilis breaks the trend
The adult numbers and the newborn numbers measure different failures. Falling adult rates reflect testing, awareness and prevention tools reaching people who seek care. The newborn figure measures whether pregnant people got screened and treated in time, which is a prenatal care question rather than a sexual health question.
Federal analysis of a recent year found that 88 percent of cases traced to one of two gaps. Either the pregnancy was never tested at the right moment, or an infection was identified and the treatment was inadequate or came too late. Those gaps appeared across every racial group, every ethnicity and every region of the country.
Timing is the cruelest part. Syphilis treatment has to happen at least 30 days before delivery to reliably protect the fetus. A positive result at 36 weeks is often too late, which means a missed first trimester screening can determine an outcome months before anyone knows there is a problem.
What the infection does to a newborn
This is not a mild condition. In one recent year federal data recorded 231 stillbirths and 51 infant deaths among reported cases. Infants who survive without adequate treatment can develop blindness, deafness, bone deformities, developmental delays and neurological damage.
Where the burden falls
The distribution follows access to prenatal care rather than behavior. Congenital syphilis rates in 2023 were highest among American Indian and Alaska Native people, and that fact matters for anyone reading this as a single community’s story.
The broader pattern is still stark. In 2023, non Hispanic Black Americans accounted for 32.4 percent of all reported chlamydia, gonorrhea and primary and secondary syphilis cases while making up 12.6 percent of the population.
Read that alongside what is known about maternal care. Late entry into prenatal care, fewer visits, clinic closures in rural and low income areas, Medicaid coverage gaps and unstable housing all predict a missed screening. So does incarceration during pregnancy. None of that is about who somebody slept with.
How syphilis in pregnancy is actually prevented
Federal guidance recommends testing pregnant people three times, at the first prenatal visit, again around 28 weeks and once more at delivery. Some states now require it. Pediatric guidance holds that no newborn should leave a hospital before the birthing parent’s status is confirmed.
Penicillin is the only treatment considered reliable during pregnancy, and a national shortage of the injectable form complicated care in recent years, which is worth asking your clinic about directly.
If you are pregnant or planning to be, ask specifically whether a syphilis test was run, not whether your bloodwork was fine. Ask again in the third trimester. Local health departments offer testing at no cost in most of the country, and a partner should be tested too, since reinfection after treatment can undo everything.
The uncomfortable arithmetic
A disease with a known test, a cheap cure and a clear treatment window has climbed for twelve straight years while every comparable infection retreated. That gap is not medical. It is a measure of who reaches a clinic early enough for the medicine to work.
The 2024 syphilis figures are provisional, and the increase was about 2 percent rather than the double digit jumps of recent years. That is the closest thing to good news here, and it is still an increase.
