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Congenital Syphilis

Rise in Congenital Syphilis Cases

Congenital syphilis is a growing concern nationally and in NYC. At the national level, the number of congenital syphilis cases is almost 700% higher than it was a decade ago. In NYC there were 37 reported cases of congenital syphilis in 2024, representing a 5.7% increase compared with 2023. Reported cases were relatively low prior to 2018 but increased by 117.6% from 2019 to 2024.

Syphilis is a bacterial infection that spreads through vaginal, anal, and oral sex. Untreated syphilis during pregnancy can lead to miscarriage, stillbirth, premature birth, low birth weight, or infant death shortly after birth. A pregnant person with syphilis can pass the infection to the fetus during pregnancy, giving the infant congenital syphilis. Infants born with congenital syphilis have an increased risk of severe health outcomes, including bone deformities, severe anemia, jaundice, blindness, and deafness.

Congenital syphilis is preventable through timely syphilis screening and treatment of syphilis during pregnancy. In New York, pregnant people are required to be screened for syphilis three times in pregnancy (first trimester, third trimester, and at delivery). The only recommended treatment for syphilis in pregnant people is an injection of the antibiotic, Penicillin G benzathine (Bicillin® L-A). Full treatment is needed to clear an infection.

Congenital Syphilis in New York City

There has been an increase in congenital syphilis cases in NYC in recent years. This increase corresponds to a surge in reported primary and secondary syphilis among people reported as female over the same time period. View reported congenital syphilis case numbers in NYC (PDF)

The Health Department works to ensure providers are aware of screening recommendations for syphilis in pregnancy, works closely with diagnosing providers, and provides outreach to all pregnant people diagnosed with syphilis.

Congenital Syphilis Provider Toolkit

The congenital syphilis provider toolkit provides resources to address congenital syphilis in New York City. This toolkit is designed for health care providers across all clinical settings, and includes the following:

Congenital Syphilis Provider Toolkit: Dear Colleague Letter (PDF)
Congenital Syphilis in NYC (PDF)
Other Languages: Español
GOALS Framework for Sexual History Taking in Primary Care (PDF)
Health Care Provider Reporting Overview (PDF)
New York City Syphilis Registry: Health Care Provider Instructions (PDF)
NYC Health Department Resources for Pregnant People and New Families (PDF)
Other Languages: Español
Patient Engagement and Education Poster (PDF)
Other Languages: Español
The Role of Health Facilities in Preventing Congenital Syphilis (PDF)
Other Languages: Español
The Role of NYC Health Department Staff in Disease Intervention (PDF)
Other Languages: Español
Treatment of Infants Diagnosed With Congenital Syphilis (PDF)
Treatment Recommendations for Adults Diagnosed With Syphilis (PDF)
Syphilis Screening During Pregnancy (PDF)

Recommendations for Health Care Providers

For guidelines in treating pregnant patients, refer to: Congenital Syphilis Prevention Services for Pregnant Patients (PDF).

Screening

Consider any health care encounter during pregnancy an opportunity to screen for syphilis, including encounters outside of usual prenatal care settings, such as in emergency departments, jails, shelters, syringe service programs, and parent and child health programs.
Perform pregnancy testing for all people who are diagnosed with syphilis and could become pregnant.

Diagnosing and Staging

Licensed New York State health care providers can request a patient’s syphilis testing and treatment history from the NYC Syphilis Registry (PDF), which is important for contextualizing serologic results. For assistance with staging, refer to the CDC 2021 STI Treatment Guidelines or call the Health Department’s Provider Access Line at 866-692-3641.

Reporting and Treatment

Report all syphilis cases to the Health Department within 24 hours, as required by law.
Presumptively treat people (including those who are pregnant) who report having a sex partner who has diagnosed syphilis or symptoms of syphilis.
Follow current CDC 2021 STI Treatment Guidelines to manage people with syphilis. Penicillin G benzathine (Bicillin L-A) administered via injection is the only recommended treatment for pregnant people diagnosed with syphilis and infants diagnosed with congenital syphilis. Treatment with Bicillin L-A can prevent the infant from developing severe health problems. The number of doses required to complete treatment depends on the stage of disease.
Refer to the 2024 Health Advisory #4: Increases in Syphilis Among Females and Congenital Syphilis in New York City (PDF) for more details on syphilis screening, diagnostic considerations, and treatment.

Bicillin L-A Supply

There continues to be a shortage of Bicillin L-A, which may not be fully available until the end of the 2026 calendar year. When there is insufficient supply of Bicillin L-A, prioritize available doses for treatment of syphilis in pregnant people.