Congenital Syphilis: Understanding the Rising Rates
Content reviewed against published CDC, AAP, WHO guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect congenital syphilis: understanding the rising rates, here is what the evidence says.
The short answer
Congenital syphilis, transmitted from mother to baby during pregnancy, has been rising alarmingly in recent years. The CDC reported a tenfold increase in US cases between 2012 and 2022. Congenital syphilis is almost entirely preventable with early prenatal screening and penicillin treatment during pregnancy. Untreated syphilis can cause miscarriage, stillbirth, and severe complications in newborns including bone abnormalities, liver disease, and neurological damage. Screening in pregnancy is essential.
Key takeaways
- Congenital syphilis, transmitted from mother to baby during pregnancy, has been rising alarmingly in recent years. The CDC reported a tenfold increase in US cases between 2012 and 2022. Congenital syphilis is almost entirely preventable with early prenatal screening and penicillin treatment during pregnancy. Untreated syphilis can cause miscarriage, stillbirth, and severe complications in newborns including bone abnormalities, liver disease, and neurological damage. Screening in pregnancy is essential.
- Usually normal when: You were screened for syphilis during pregnancy and your results were negative.
- Call your doctor if: You received a positive syphilis test during pregnancy and have not yet been treated.
- Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
This is one of the most common questions parents ask. Searching for answers means you care.
When to Seek Immediate Care
- You received a positive syphilis test during pregnancy and have not yet been treated.
- Your newborn was born to an inadequately treated mother and needs immediate evaluation and possible treatment.
- Your baby has symptoms consistent with congenital syphilis: rash on palms and soles, bloody nasal discharge, bone tenderness, or liver enlargement.
By Age
What to expect by age
Prenatal
All pregnant individuals should be screened for syphilis at the first prenatal visit. The CDC now recommends additional screening at 28 weeks and at delivery for those at higher risk or in areas with high syphilis rates. If syphilis is detected, treatment with penicillin during pregnancy can prevent transmission to the baby in most cases. Treatment is most effective when given at least 30 days before delivery. Pregnant individuals with penicillin allergy should be desensitized and treated with penicillin, as no alternative is adequate for preventing congenital syphilis.
0-1 month
Congenital syphilis in newborns may present with a range of symptoms or may be asymptomatic at birth. Early signs can include rash (especially on palms and soles), nasal discharge (snuffles), hepatosplenomegaly (enlarged liver and spleen), jaundice, anemia, and low birth weight. Some affected newborns appear healthy and develop symptoms weeks to months later. All newborns born to mothers with syphilis require evaluation, testing, and potentially treatment with intravenous penicillin.
1-24 months
Late signs of untreated congenital syphilis can emerge during infancy and include bone changes (periostitis, osteochondritis), failure to thrive, persistent rash, and neurological symptoms. Developmental delays and hearing loss may develop. Infants who received appropriate treatment at birth generally have excellent outcomes. Those diagnosed later may require extended treatment and monitoring. Regular follow-up with repeat blood tests is essential to confirm successful treatment.
What Should You Do?
When to take action
- You were screened for syphilis during pregnancy and your results were negative.
- Your baby was born to a mother treated adequately for syphilis during pregnancy and the baby's evaluation was normal.
- Your newborn's syphilis blood tests are being monitored and show expected decline after maternal treatment.
- You are pregnant and unsure whether you have been screened for syphilis.
- You are at higher risk for syphilis (new or multiple sexual partners, STI history) and want to ensure adequate screening.
- Your newborn has an unexplained rash, persistent nasal discharge, or jaundice and you have risk factors for syphilis.
- You received a positive syphilis test during pregnancy and have not yet been treated.
- Your newborn was born to an inadequately treated mother and needs immediate evaluation and possible treatment.
- Your baby has symptoms consistent with congenital syphilis: rash on palms and soles, bloody nasal discharge, bone tenderness, or liver enlargement.
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Congenital Syphilis: Understanding the Rising Rates.
Things to mention
- You are pregnant and unsure whether you have been screened for syphilis.
- You are at higher risk for syphilis (new or multiple sexual partners, STI history) and want to ensure adequate screening.
- Your newborn has an unexplained rash, persistent nasal discharge, or jaundice and you have risk factors for syphilis.
Observations to share
- You are pregnant and unsure whether you have been screened for syphilis.
- You are at higher risk for syphilis (new or multiple sexual partners, STI history) and want to ensure adequate screening.
- Your newborn has an unexplained rash, persistent nasal discharge, or jaundice and you have risk factors for syphilis.
Urgent signs to report immediately
- You received a positive syphilis test during pregnancy and have not yet been treated.
- Your newborn was born to an inadequately treated mother and needs immediate evaluation and possible treatment.
- Your baby has symptoms consistent with congenital syphilis: rash on palms and soles, bloody nasal discharge, bone tenderness, or liver enlargement.
My notes
From ismybabyalright.com — free, evidence-based baby health guides
Related Conditions
Childhood Immunization Schedule: 2026 Updates
The childhood immunization schedule is reviewed and updated annually by the CDC's Advisory Committee on Immunization Practices (ACIP), the AAP, and the American Academy of Family Physicians. The schedule may include changes to timing, new vaccine recommendations, or updates to catch-up schedules. Always consult your pediatrician for the most current recommendations, as the schedule is designed to provide the earliest possible protection during the most vulnerable periods.
Delayed-Onset Hearing Loss in Children
While newborn hearing screening catches most hearing loss present at birth, some children develop hearing loss after the newborn period. This can be caused by congenital CMV infection (the most common non-genetic cause), genetic conditions that cause progressive loss, chronic ear infections, meningitis, or ototoxic medications. Even if your baby passed the newborn hearing screen, ongoing monitoring of hearing milestones is important, as early intervention for hearing loss significantly improves language outcomes.
Developmental Delay and Why Early Intervention Matters
Early intervention refers to services and support for infants and toddlers (birth to age 3) with developmental delays or disabilities. Research consistently shows that the earlier a delay is identified and addressed, the better the outcomes. The brain's neuroplasticity is greatest in the first three years of life, making this a critical window for therapeutic intervention. Early intervention services are available in every US state through the Individuals with Disabilities Education Act (IDEA) Part C program at no or low cost to families.
Related Resources
Frequently asked questions
Is congenital syphilis: understanding the rising rates normal?
When should I call the doctor about congenital syphilis: understanding the rising rates?
When is congenital syphilis: understanding the rising rates normal?
What causes congenital syphilis: understanding the rising rates?
What should I mention to my pediatrician about congenital syphilis: understanding the rising rates?
Is congenital syphilis: understanding the rising rates normal at Prenatal?
Is congenital syphilis: understanding the rising rates normal at 0-1 month?
Should I go to the ER for congenital syphilis: understanding the rising rates?
Does congenital syphilis: understanding the rising rates go away on its own?
References
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Resources
Bottom line
Most cases of congenital syphilis: understanding the rising rates are normal. Talk to your pediatrician if you received a positive syphilis test during pregnancy and have not yet been treated.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
Was this page helpful?
Related Medical Concerns
Childhood Immunization Schedule: 2026 Updates
The childhood immunization schedule is reviewed and updated annually by the CDC's Advisory Committee on Immunization Practices (ACIP), the AAP, and the American Academy of Family Physicians. The schedule may include changes to timing, new vaccine recommendations, or updates to catch-up schedules. Always consult your pediatrician for the most current recommendations, as the schedule is designed to provide the earliest possible protection during the most vulnerable periods.
Delayed-Onset Hearing Loss in Children
While newborn hearing screening catches most hearing loss present at birth, some children develop hearing loss after the newborn period. This can be caused by congenital CMV infection (the most common non-genetic cause), genetic conditions that cause progressive loss, chronic ear infections, meningitis, or ototoxic medications. Even if your baby passed the newborn hearing screen, ongoing monitoring of hearing milestones is important, as early intervention for hearing loss significantly improves language outcomes.
Developmental Delay and Why Early Intervention Matters
Early intervention refers to services and support for infants and toddlers (birth to age 3) with developmental delays or disabilities. Research consistently shows that the earlier a delay is identified and addressed, the better the outcomes. The brain's neuroplasticity is greatest in the first three years of life, making this a critical window for therapeutic intervention. Early intervention services are available in every US state through the Individuals with Disabilities Education Act (IDEA) Part C program at no or low cost to families.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.