From Crisis to Action—Policy Pathways to Reverse the Rise in Congenital Syphilis

N Engl J Med . 2025 Dec 18;393(24):2388–2391. doi: 10.1056/NEJMp2513438. Several decades ago, syphilis in the United States appeared to be nearing elimination. However, the disease has resurged dramatically in recent years. After peaking in the 1940s and reaching historic lows in the early 2000s, overall syphilis rates have climbed steadily, reaching 62 cases per 100,000 people in 2023. Congenital syphilis, transmitted from mother to fetus during pregnancy, has followed a similar pattern. Once reduced to single-digit rates per 100,000 live births in the early 2000s, it rose sharply to 106 cases per 100,000 live births in 2023. Untreated maternal infection can result in devastating outcomes, including stillbirth, organ damage, skeletal abnormalities, hearing loss, and blindness.