Why Can't We Eradicate Congenital Syphilis?

* Abbreviation: CS — : congenital syphilis The epidemic of congenital syphilis (CS) in the United States continues unabated, a tragic indicator of the lack of control of syphilis in many of our communities. Despite evidence-based recommendations for screening all pregnant women and the availability of highly effective penicillin therapy, CS cases continue to increase in the United States, disproportionally affecting racial minorities.1 The national rate of CS in 2019 was 48.5 per 100 000 live births, a 41.4% increase relative to 2018 and a 291.1% increase relative to 2015.1 There were 94 syphilitic stillbirths and 34 additional CS-related infant deaths.1 Although more common in western and southern states, the 1870 cases of CS reported in 2019 were from 43 states and the District of Columbia.2 This preventable infection may result in miscarriage, stillbirth, premature birth, or life-threatening fetal or neonatal illness, but, more commonly, it is completely silent and identified only through appropriate maternal and newborn testing. Failure to diagnose and treat or delays in treatment of syphilis during pregnancy and after the neonatal period can result in more serious disease and lifelong morbidity. In this issue of Pediatrics , Kimball et al3 alert us to an additional challenge for health care professionals who care for children: the increasing number of infants diagnosed with CS after newborn nursery discharge, which is in large part because of the continuing failure … Address correspondence to Joseph A. Bocchini Jr, MD, FAAP, Willis-Knighton Children’s Health Services, 2508 Bert Kouns Industrial Loop, Suite 103, Shreveport, LA 71118. E-mail: jbocchini{at}wkhs.com