A third of these mothers were diagnosed in time and not treated

Congenital syphilis is Treponema pallidum passed to a fetus or infant
from a mother with untreated or inadequately treated syphilis. It can cause
miscarriage, stillbirth or early infant death, and infected infants can
have lifelong physical and neurological problems.

It is also preventable: **timely identification and treatment of maternal
syphilis during pregnancy prevents it.**

Where prevention failed

The largest category is the one that is hardest to explain away. In roughly a
third of cases, the system found the syphilis in time — the screening
worked, the result came back, the diagnosis was made during the pregnancy —
and the treatment did not happen, or was not adequate.

That is not a knowledge gap or a testing gap. Somewhere between a positive
result and a course of penicillin, the connection failed.

The second category is a different problem entirely: **28% never had timely
prenatal care**, so there was no visit at which to screen. And the third —
11% seroconverted after an early negative test and were not caught again,
which is what the second and third screenings exist for.

**Prevalences of these missed opportunities differ regionally and by race and
ethnicity**, which is why the report's recommendation is not one national fix.

What the recommendation actually is

Four things, matching the failures:

• Reduce barriers to family planning and prenatal care — for the 28%
• Screen for syphilis at the first prenatal visit
• Rescreen at 28 weeks' gestation and at delivery, as indicated — for the
  11% who seroconvert later
• Adequately treat pregnant women with syphilis — for the 31%

And the framing that ties them together: **congenital syphilis prevention
involves syphilis prevention for women and their partners**, not only
screening during pregnancy. A pregnancy screening programme, however good, is
catching a problem that already happened.

**Halting continued increases in congenital syphilis requires understanding
the missed prevention opportunities and implementing tailored interventions
based on local experience.**

Local, because the three failures are not distributed evenly, and a programme
built for a region where the gap is prenatal access will not help a region
where the gap is treatment after diagnosis.

Source: Centers for Disease Control and Prevention, MMWR.