The uprise of congenital syphilis in the United States: a preventable failure of perinatal systems.

Congenital syphilis is a preventable infection caused by vertical transmission of Treponema pallidum during pregnancy. Despite effective screening and curative treatment, rates in the United States have risen sharply over the past decade, paralleling increasing syphilis rates among reproductive-aged adults. This resurgence reflects systemic gaps in healthcare access, public health infrastructure, and social support systems. Adverse outcomes include stillbirth, neonatal death, prematurity, and long-term neurologic, skeletal, and auditory complications. This review summarizes current U.S. epidemiologic trends and examines multifactorial drivers of rising congenital syphilis, including inadequate or absent prenatal care, missed or delayed screening, reinfection during pregnancy, and social determinants such as poverty, substance use, and healthcare inequities. System-level challenges such as inconsistent screening practices, treatment delays, and under-resourced public health programs-further sustain transmission. Evidence-based prevention strategies include universal early pregnancy screening, repeat testing for high-risk patients, prompt penicillin treatment, strengthened partner services, and expanded prenatal care access. Policy initiatives and community-based outreach are essential to address structural disparities and improve care engagement. Congenital syphilis is a sentinel marker of healthcare system performance. Coordinated clinical, public health, and policy efforts are urgently needed to reverse current trends and achieve elimination in the United States.