Eliminating Congenital Syphilis

Congenital syphilis occurs when people pass syphilis to their babies during pregnancy. Congenital syphilis is preventable, yet the number of cases has more than tripled in recent years. Left untreated, congenital syphilis can result in infant death, developmental delays, skeletal abnormalities, deafness, meningitis, and ongoing adverse outcomes throughout the child’s life. Syphilis risks for the pregnant person include miscarriage, ongoing infection, and more.

Most babies with congenital syphilis are born to people who are publicly insured or uninsured. With Medicaid and Children’s Health Insurance Program (CHIP) agencies covering more than 41% of births nationwide, states have an important role to play in reducing the incidence of congenital syphilis and improving health outcomes for both the newborn and the birthing parent.

A lack of timely testing and treatment before and during pregnancy contributes to 88% of congenital syphilis cases. Screening and treating before pregnancy are the best approach to preventing congenital syphilis. Screening and treatment early in the pregnancy are effective, and screening and treatment in late pregnancy are still beneficial, particularly in addressing reinfection. Screening at birth can help identify the condition early for the infant in addition to treating the parent.

Congenital Syphilis — Rates of Reported Cases by Year of Birth and Jurisdiction, 2013–2022

Source: CDC data on United States and Territories

Learn More

Webinar: Improving Maternal Health: Lessons Learned from States Addressing Congenital Syphilis (video, transcript, slides) September 18, 2024

The Centers for Medicare & Medicaid Services (CMS) hosted a webinar that provided an overview of congenital syphilis in newborns covered by Medicaid and CHIP, in addition to presentations from several states on addressing congenital syphilis in their Medicaid and CHIP programs, the barriers they encountered, and how they overcame challenges to achieve measurable improvement.

Addressing Congenital Syphilis: QI Resources

Coming soon! Driver diagram and change idea table on addressing congenital syphilis. A driver diagram is a visual display of what “drives” or contributes to addressing a condition, in this case, congenital syphilis. This diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to improve postpartum care) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes a change idea table, which contains examples of evidence-based or evidence-informed QI interventions to address congenital syphilis. The change ideas were tailored for Medicaid and CHIP action.
CMS offers numerous QI technical assistance (TA) supports, including real-time and on-demand strategies to build QI skills; QI topic-specific supports, such as driver diagrams and measurement strategies; and links to state Medicaid and CHIP QI work through state quality improvement stories and connections with state QI staff. For support on your state Medicaid and CHIP QI TA project, please reach out to CMS at MedicaidCHIPQI@cms.hhs.gov.

References

McDonald, R., K. O’Callaghan, E. Torrone, L. Barbee, J. Grey, D. Jackson, K. Woodworth, et al. “Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022.” Morbidity and Mortality Weekly Report, vol. 72, no. 46, 2023, pp. 1269–1274. http://dx.doi.org/10.15585/mmwr.mm7246e1

Centers for Disease Control and Prevention. Sexually Transmitted Infections Surveillance 2022. Atlanta: US Department of Health and Human Services; 2024. https://www.cdc.gov/std/statistics/2022/data.zip

Umapathi, K.K., A. Thavamani, and K. Chotikanatis. “Incidence Trends, Risk Factors, Mortality and Healthcare Utilization in Congenital Syphilis-Related Hospitalizations in the United States: A Nationwide Population Analysis.” Pediatric Infectious Disease Journal, vol. 38, no. 11, 2019, pp. 1126–1130. https://doi.org/10.1097/inf.0000000000002445