The signal Every missed screening visit during pregnancy is a potential congenital syphilis case — stillbirth, neonatal death, bone deformities, neurological damage, blindness. At 3,941 cases annually, the U.S. is now approaching rates last seen in the early 1990s. This is a real increase in preventable infant death and disability.
Congenital syphilis is almost entirely preventable with a single injection of benzathine penicillin G (Bicillin L-A) 2.4 million units IM during pregnancy — about $30 a shot. The CDC’s 2024 data shows 88% of cases occurred in mothers who were never screened, screened but not treated, or treated too late. The simultaneous Bicillin shortage — some states reporting supply meeting only 7% of historic need — widens both the screening gap and the treatment gap at once.
The treatment is one shot. One injection, $30, given during a routine prenatal visit, and the baby is born healthy. But the drug isn’t on the shelf. The appointment wasn’t made. The screen wasn’t ordered. And a baby is born blind, with bone fractures, or not born at all — because a disease we’ve known how to cure since 1943 outran a supply chain that nobody was watching.
What it means — by audience The same signal, translated for the people who act on it.
For OB Providers
Syphilis screening is non-negotiable at every prenatal entry point. If your state doesn’t mandate third-trimester rescreening, do it anyway — in 2024 every state qualifies. Know your Bicillin supply status this week, not last month. If supply is zero, have your ceftriaxone alternative protocol written and approved before you need it. Document every treatment delay caused by drug shortage.
For Midwives (CNM/CPM)
Order RPR at the first midwifery visit regardless of risk profile — universal screening is the standard. If a client tests positive, this is an immediate physician referral for same-day treatment, not a “rescreen in 4 weeks” situation. If you’re in a birth center without injection capability, have a standing agreement with the nearest clinic that stocks Bicillin. Every week of delay increases vertical transmission risk.
For Birth Workers & Doulas
You’re not diagnosing or treating, but you can close the gap. If your client mentions she hasn’t had her “blood work” done, that’s your opening: “Have you been screened for syphilis? It’s a simple blood test and the treatment is one shot.” Normalize the conversation — syphilis carries stigma that keeps people from asking. Keep the number for your local health department STI clinic in your phone.
For Institutional Leaders
Pull your congenital syphilis numbers for the last 3 years. If they’re rising, you have a system failure in prenatal screening completion. Audit: what percentage of pregnant patients received all three recommended syphilis screens? What’s your time-to-treatment for positive results? How many days of Bicillin supply do you have on hand right now? Advocate for emergency Bicillin production authorization.
For Everyone
The treatment is one shot. One injection, $30, given during a routine prenatal visit, and the baby is born healthy. But the drug isn’t on the shelf. The appointment wasn’t made. The screen wasn’t ordered. And a baby is born blind, with bone fractures, or not born at all — because a disease we’ve known how to cure since 1943 outran a supply chain that nobody was watching.
Next steps - Screen every pregnant patient for syphilis with RPR or VDRL at the first prenatal visit AND again in the third trimester AND at delivery — three touchpoints minimum.
- Treat positive results same-day with benzathine penicillin G 2.4M units IM — do not wait for confirmatory testing to begin treatment.
- If Bicillin is unavailable, consult infectious disease for the ceftriaxone desensitization protocol — do not simply defer treatment.
- Implement a syphilis treatment tracker in your EHR to flag untreated positives within 48 hours.
- Report supply shortages to the FDA Drug Shortage Staff (drugshortages@fda.hhs.gov) and your state health department.
Sources & provenance ~3,941 congenital syphilis cases in 2024 — the 12th consecutive annual rise and ~700% above 2015 (495 cases).
Source: Labora Rounds · Research Intelligence, Neonatal & Infant Health — synthesized from CDC 2024 STI Surveillance data.
Status: Active crisis · Bicillin L-A in shortage — some states at 7% of need.
Watch for: CDC’s next annual STI Surveillance Report; FDA Bicillin L-A shortage updates (fda.gov/drug-shortages); state-level congenital syphilis emergency declarations (Louisiana, Texas, Mississippi active); Pfizer Bicillin manufacturing-capacity announcements.
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