CONGENITAL SYPHILIS

A RISING PROBLEM IN BALTIMORE CITY

Congenital syphilis, a sexually transmitted infection that can spread from a parent to a child during pregnancy or delivery, has been a growing challenge in Baltimore City.

Between 2010 and 2023, the number of cases of congenital syphilis reported in Baltimore City skyrocketed from five to 27. In Maryland and across the U.S., rates of congenital syphilis hover around 100 per 100,000 live births. In Baltimore City, the rate is about four times higher.

The adverse maternal and child health outcomes related to syphilis and congenital syphilis can be significant.

Mothers can experience miscarriages or stillbirths, and that’s in addition to syphilis symptoms that, depending on stage, can include fevers, headache, sore throat, or more severe health problems.
Infant risks also depend on staging and treatment; untreated maternal syphilis can lead to low birth weight, bone deformities, anemia, skin rashes, enlarged spleen or liver, blindness, deafness, meningitis, lung infections, and other health concerns that can appear after birth.

Given these risks, testing and early treatment are essential for maternal and fetal health. Providers can reinforce the importance of testing and either initiate treatment on the day of diagnosis or urgently refer patients to the Baltimore City Health Department for same-day treatment.

Congenital Syphilis FAQs

PREVENTABLE THROUGH PARTNERSHIP

These are preventable — and treatable — diseases. But, they can be complicated to diagnose and stage, as providers may have not seen cases in their practices, and patients may not remember past test results.

Reducing syphilis and congenital syphilis in Baltimore City requires a robust partnership between health care providers and public health practitioners.

Familiarize yourself with your hospital or clinic’s syphilis and congenital syphilis protocols.
Talk with every patient about the risk of syphilis and congenital syphilis, explain when, why, and how you will test, as well as the treatment protocols. Create a trusting partnered relationship, use a non-judgmental, culturally and linguistically relevant tone, and allow time for patients to ask questions.
The Baltimore City Health Department can answer questions about testing, staging, diagnosis, and treatment, as well as providing access to previous test results and supporting partner identification, notification, and treatment.

The Johns Hopkins Center for Communication Programs is working with local communities to develop strategies and resources providers can use to provide patients with support around the prevention and treatment of syphilis and congenital syphilis.
In 2024, Maryland passed the Giving Infants a Future Without Transmission (GIFT) Act, which strengthens reporting and testing standards to ensure pregnant people are tested at the first prenatal visit, at 28 weeks gestation, and at delivery.

ADDITIONAL RESOURCES

Educational Video on Syphilis Testing, Staging, and Treatment

FAQ CS

Congenital syphilis occurs when the mother is not adequately treated or is reinfected by a partner and syphilis passes to the infant during pregnancy. Preventing congenital syphilis by testing and treating people before they are pregnant or during pregnancy is very important.

Syphilis is more complex to diagnose and treat than other sexually transmitted infections. Screening and treatment guidelines are available through the Centers for Disease Control and the American College of Obstetricians and Gynecologists. Additional resources (such as this evaluation guide) support accurate staging.

In general, if an initial test comes back positive, you may need a confirmatory test. Following that, you should do a full health history and physical examination of the pregnant patient to determine staging and immediately start treatment with penicillin G to try to avoid transmission to the infant. The number of penicillin injections required will vary based on staging — whether the patient has primary, secondary, early latent, or late latent syphilis. (Patients who are allergic to penicillin should see a specialist to begin penicillin desensitization.)

Syphilis is a reportable disease to the Baltimore City Health Department (BCHD). The Sexually Transmitted Infections (STI) team can help providers find past testing and titer results and offer support to better understand a patient’s staging and treatment needs. Providers can report positive tests and ask for testing and diagnosis support by contacting BCHD's Perinatal Coordinator at 410-396-4448.

BCHD offers syphilis testing, diagnosis, and treatment services through STI clinics. There, your patient and their partner(s) can also receive other STI testing and treatment services, and referrals for physical, mental, and substance use services. The clinics (hours, locations, and available services) do not turn patients away based on ability to pay.

Free testing and resources are also available at the AHF Wellness Center.

Free kits for STI testing are also available to Maryland residents through I Want the Kit.

IMPORTANT CONTACT INFORMATION

FREQUENTLY ASKED QUESTIONS

Given the high rate of syphilis in Baltimore, it is vital to talk with all clients about the importance of testing and treating the disease. The resources below can support providers working with any patients.

Regional Provider Hub STD Clinical Consultation Network

BCHD's Perinatal Coordinator

410-396-4448

ABOUT US >

CONGENITAL SYPHILIS

PREVENTABLE THROUGH PARTNERSHIP

ADDITIONAL RESOURCES

Educational Video on Syphilis Testing, Staging, and Treatment

What do I do if a pregnant patient tests positive for syphilis?

How do I treat congenital syphilis?

What if I can’t access the appropriate medication?

What resources support testing of partner(s) to improve health and avoid reinfection?

Where can I send patients or partners who wish to be tested and treated, regardless of their pregnancy status?

What is the GIFT Act?

IMPORTANT CONTACT INFORMATION

FREQUENTLY ASKED QUESTIONS