Congenital Syphilis

Every case of congenital syphilis (CS) is entirely preventable and represents a failure in the public health and/or clinical healthcare systems. CS is a result of untreated syphilis infection that is transmitted in utero during pregnancy or during vaginal delivery.

We can all work together to prevent congenital syphilis

Systemic racism is part of the syphilis story, highlighted by one of the most unethical studies in our public health history: the Tuskegee Study. Upon engaging the Tuskegee Institute, the U.S. Public Health Service began a study including only Black men in 1932 to record the natural history of syphilis, at a time when there was no known cure to syphilis. Despite a known cure by 1943, treatment was withheld from the study participants.

Picture 1

Adapted from: The Syphilis Study at Tuskegee Timeline

  1. 1932: 600 black men enrolled in what was called: "Tuskegee Study of Untreated Syphilis in the Negro Male' (Informed consent was not collected).
  2. Mid-1940's: By 1943, penicillin was the treatment of choice for syphilis and becoming widely available, but the participants in the study were not offered treatment.
  3. 1972: The first news article broke about this 40-year study as a result, an advisory panel was convened, and the study was deemed 'ethically unjustifiable' and it was ended.
  4. 1997: A formal presidential apology issued by President Clinton

What you should know about preventing congenital syphilis

When a pregnant person has a syphilis infection, it can cause the fetus/infant to become infected either in utero (during pregnancy) or during vaginal delivery. This is called congenital syphilis, or CS, and can lead to miscarriage, stillbirth, preterm birth, neonatal death, blindness or deafness, bone abnormalities, skin lesions, developmental delays, and other serious health problems. In fact, when syphilis isn't treated in pregnancy it can result in infant death in up to 40% of cases.

Fortunately, congenital syphilis is entirely preventable. New York State is striving to end congenital syphilis through a variety of efforts including promoting testing for syphilis: at first prenatal visit, in the third trimester, and after birth.

What is Syphilis?

Syphilis is a sexually transmitted infection (STI). It is caused by bacteria that enter the body during oral, vaginal, or anal sex. It can also enter the body through small cracks in the skin if an area is exposed to the bacteria. This causes a painless skin ulcer or chancre (sore) to form at the infection site. Syphilis is a complicated infection. Many people don't notice symptoms, or symptoms heal over time. Without treatment, a person still has the infection and can infect others, even if they don't have symptoms. Syphilis infections can increase the risk of getting HIV if someone is exposed.

Preventing Syphilis

Latex or polyurethane condoms used every time for oral, vaginal, or anal sex greatly lower the risk of getting syphilis. They also help prevent pregnancy and the spread of other STIs including HIV. Using a dental dam placed over the vagina or anus can help prevent transmission of syphilis. Condoms and dams will not stop the risk of getting syphilis if they don't cover the ulcer or a syphilis rash. Individuals with an open sore(s) near or on the genitals should not have sex.

Free and confidential HIV and STI testing is available at local health department STD clinics across New York State. To get tested, click here to find a local provider.

Read more about syphilis.

Information for Providers

NYSDOH strongly recommends that all partnering organizations providing services to populations most at risk promote syphilis screening and pregnancy testing. Populations experiencing a disproportionate burden of congenital syphilis and syphilis include, but are not limited to, people of color and people who report drug-related risk behaviors. Further, providers are encouraged to discuss and re-educate staff and clients about signs and symptoms of syphilis (see resources below).

The best way to prevent syphilis is to:

  • Encourage discussions of sexual health and drug use related behaviors;
  • Educate patients and clients on behaviors that increase the risk of syphilis and other sexually transmitted infections (STIs), as well as signs and symptoms of STIs, how they are passed, the health implications, and the importance of screening and early treatment;
  • Screen persons for syphilis as recommended; and
  • Promote linkages of persons diagnosed with syphilis to partner services for public health follow-up, such as partner notification and management.

The best way to prevent congenital syphilis is to:

  • Determine pregnancy status of all persons of reproductive capacity diagnosed with syphilis;
  • Take active steps to connect all pregnant persons to prenatal care, including facilitating enrollment in Medicaid or any other health insurance coverage they may be eligible for when needed;
  • Ensure pregnant persons are tested at 1) the time pregnancy is first identified, 2) early in their third trimester (at 28 weeks or as soon thereafter as reasonably possible but no later than at 32 weeks of pregnancy), and 3) at delivery. Please see the graph below depicting the importance of screening throughout pregnancy; and
  • Prevent syphilis among persons of childbearing capacity.

Congenital syphilis missed opportunities* over time in NYS (outside NYC) suggest seroconversion later in pregnancy** is an increasing concern

Data and analysis conducted by the AIDS Institute, Office Sexual Health and Epidemiology
* 2021 data preliminary and subject to change
**This includes pregnant persons who screened negative for syphilis during their third trimester and seroconverted after

Who to Contact?

For general questions, please contact stdc@health.ny.gov

NYSDOH Resources

Additional Resources