Reporting and Services Health Topics Resources Emergency Prep

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 increased 740% from 2014 to 2023. In NYC, congenital syphilis cases have increased since 2018. In 2023, there were 35 cases of congenital syphilis in NYC, representing a 67% increase from 2022.

Sexually Transmitted Infections Report 2023 (PDF)

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.

Recommendations for Health Care Providers

Screening

Make any health care encounter during pregnancy—including encounters outside of usual prenatal care settings, such as in emergency departments, correctional health facilities, syringe service programs, and maternal and child health programs—an opportunity to screen and treat syphilis (or refer to screening and treatment, if not offered).
Determine the pregnancy status of all people who are diagnosed with syphilis and could become pregnant.
Screen for syphilis three times during all pregnancies: (1) at first prenatal care examination, (2) between 28 to 32 weeks gestation, and (3) at delivery.

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

After a prolonged shortage of Bicillin L-A, supply has improved but may not be fully available until early 2025.

Where there is insufficient supply of Bicillin L-A, prioritize available doses for treatment of syphilis in pregnant people.