New government data indicates that the number of babies born with syphilis in the U.S. continued to increase last year, a trend observed even as the overall count of sexually transmitted infections (STIs) in the country saw a decline.
Provisional figures released this week by the Centers for Disease Control and Prevention (CDC) reveal that the total number of reported STI cases dropped by 9% in 2024 from 2023, marking the third consecutive year of such decreases. In contrast, cases of syphilis in newborns, medically termed congenital syphilis, surged for the twelfth straight year. Nearly 4,000 cases were documented in 2024, representing an almost 700% increase since 2015, when just under 500 cases were reported.
In 2024, the escalation of congenital syphilis cases was not as steep as in prior years, rising by just under 2% from 2023. Dr. Bradley Stoner, director of the CDC’s Division of STD Prevention, notes that while the decelerated rate of increase offers some encouragement, the ongoing rise in case numbers remains a significant concern.
Only a couple of decades ago, congenital syphilis cases were on the verge of being eliminated from the U.S. This condition is preventable; syphilis can be cured with appropriate treatment, and if treated during pregnancy, it can effectively protect the fetus from infection.
However, if left untreated, syphilis can be transmitted to a fetus during pregnancy or delivery. Syphilis can damage critical organs such as the heart and brain, potentially leading to blindness, deafness, and even death. Congenital syphilis can also result in miscarriage and stillbirth.
Stoner attributes the increasing rates of congenital syphilis partly to reductions in STI services at state and local levels, alongside challenging social and economic conditions, including poverty and a lack of health insurance, which have likely hindered access to care.
Federal funding for STI prevention has decreased since the early 2000s. The number of people living in poverty increased during that period, although it has since declined. And while the percentage of uninsured individuals has decreased since the Affordable Care Act was signed into law in 2010, millions still lack health coverage or are underinsured. Other complexities in accessing quality care could also affect people with insurance.
Elizabeth Finley, interim executive director of the National Coalition of STD Directors, suggests that a contributing factor is the variability in pregnant people’s access to healthcare or preventive syphilis care. For example, some individuals may not be able to obtain prenatal care consistently or at all. Furthermore, some healthcare providers may be encountering syphilis cases for the first time in their professional careers.
“You get this perfect storm of people who aren’t getting enough prenatal care to begin with for many, many reasons, and then you see providers who haven’t had to identify or test for syphilis in the past,” Finley explains.
Finley also points to supply chain issues that have impacted doctors’ capacity to swiftly treat pregnant individuals with syphilis.
She emphasizes that overall STI rates have also escalated over the past decade or so.
“Overall over the past 10 years, we’ve seen more cases,” Finley states. “Any time there are more STI cases in a community or more cases of any infection—and in this case, syphilis—in a community, you have an increased likelihood that pregnant women will be exposed to it and then that their infants or their fetuses will be exposed to it.”
The overall prevalence of STIs in the U.S. remains high, with over 2.2 million reported cases in 2024—a 13% increase since 2015, according to the CDC. Finley suggests that a primary reason for this is that the U.S. has “really divested significantly from prevention efforts.”
The CDC highlighted several positive developments in addressing the issue: cases of primary and secondary syphilis, the two most infectious stages, saw a nearly 22% decline for the second consecutive year. Stoner expresses hope that congenital syphilis will follow this trend. Additionally, cases of gonorrhea and chlamydia continued to decrease. The agency attributed these reductions to the impact of public health initiatives, such as increased awareness about STIs and the utilization of prevention tools. These tools include self-tests and the antibiotic doxycycline, which can be taken within 72 hours after sex to help reduce the risk of acquiring syphilis, chlamydia, and gonorrhea.
“The data do suggest that we may be turning the corner on STIs,” Stoner comments. “But the fact that congenital syphilis is still a major problem tells us that we have to accelerate progress to stop the STI epidemic and its most tragic consequences. These are preventable infections, and greater awareness and greater early intervention, I think, will help us get these infections under better control.”
The CDC recommends that individuals undergo testing for syphilis three times over the course of their pregnancy. Stoner also encourages people of reproductive age to get tested for syphilis and to engage in conversations with their partners about STIs.
Finley remarks that, while the emergence of public health initiatives to tackle this problem has been encouraging, there is a clear need for a “much more coordinated and intentional effort” to bring various government agencies together to address congenital syphilis. She further notes that funding for STI prevention efforts has considerably decreased in recent years.
“These syphilis cases in pregnant patients don’t happen in a bubble; they happen in a broader context, and right now that broader context is that our overall STI rates are too high,” Finley asserts. “This really does need to be a part of a broader effort to reduce STIs in the U.S.”