A preventable infection killed 279 American babies in 2023, as congenital syphilis cases surged to levels not seen in three decades and health officials urge stronger national action.
At a Glance
- 3,882 congenital syphilis cases reported in 2023, the highest since 1992
- 279 infant deaths recorded, with nearly 90% deemed preventable through treatment
- Nationwide shortage of benzathine penicillin forces hospitals to ration supplies
- American Indian/Alaska Native, Black, and Hispanic populations face highest case rates
- State testing requirements vary widely, leaving uneven protection across the country
Rising Cases Across the Country
Congenital syphilis has re-emerged as a significant health concern in the United States. The Centers for Disease Control and Prevention (CDC) reported 3,882 cases in 2023, marking more than an elevenfold increase since 2012. This spike in cases led to 279 infant deaths, through either stillbirths or complications following delivery. According to federal data, nearly nine out of ten of these outcomes could have been avoided with consistent prenatal screening and timely treatment.
The resurgence represents a reversal of earlier progress. In the mid-20th century, congenital syphilis rates sharply declined following the widespread introduction of penicillin and standardized prenatal care. However, reduced public health funding, diminished sexually transmitted infection (STI) prevention programs, and gaps in healthcare access have contributed to the infection’s return.
Watch now: Congenital Syphilis Surge Explained · YouTube
Drug Shortages and Treatment Barriers
One of the most pressing challenges in addressing congenital syphilis is the limited availability of benzathine penicillin, the only recommended treatment for preventing transmission during pregnancy. Hospitals have reported rationing supplies, with priority given to pregnant patients, as supplies of the decades-old drug remain constrained.
Manufacturing difficulties contribute to the shortage, including challenges tied to the byproducts of production and the limited number of companies willing to manufacture an inexpensive, low-margin medicine. These constraints leave healthcare providers with difficult decisions as they attempt to balance immediate patient needs against scarce supplies.
Uneven Impact and Public Health Response
The impact of congenital syphilis is not evenly distributed across the U.S. American Indian/Alaska Native, Black, and Hispanic families are disproportionately affected, reflecting wider disparities in healthcare access. Specialists highlight barriers such as limited insurance coverage, reduced access to consistent prenatal services, and higher poverty rates as contributing factors.
Watch now: Syphilis Crisis in America’s Babies · YouTube
Policy responses remain uneven across states. While certain jurisdictions mandate early screening in pregnancy, others do not require repeat testing in later stages or after delivery. Public health experts emphasize that more comprehensive and consistent testing could sharply reduce infant mortality associated with the infection. Calls for a coordinated federal approach have increased, though implementation varies.
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