AB137. Global approaches to preventing congenital syphilis: a United States policy and health equity perspective

Background: Congenital syphilis (CS) is a preventable yet resurging public health crisis in the United States. Despite the availability of reliable screening and treatment, reported cases of CS increased by over 755 percent between 2012 and 2022. This alarming trend reflects deeper systemic and structural failures within maternal health and public health infrastructures. Our objective is to examine the systemic and structural drivers contributing to the rise of CS in the United States and to assess how international public health models inform more effective prevention strategies. Understanding these drivers is critical to informing evidence-based interventions and reducing health inequities.

Methods: This study investigates the systemic and structural contributors to rising CS rates in the United States through a systematic literature review of peer-reviewed studies published within the past decade. Public health models and prenatal screening frameworks in the United States were compared with those in the United Kingdom, Canada, and Brazil. Key areas of focus included access to prenatal care, syphilis screening policies, healthcare financing, and structural inequities affecting maternal health outcomes.

Results: The analysis demonstrates that universal prenatal screening protocols and accessible, publicly funded prenatal care systems in the United Kingdom and Canada have effectively limited CS incidence. In contrast, Brazil and the United States continue to experience elevated CS rates due to economic inequality, fragmented healthcare delivery, and underfunded public health systems. In the United States, nearly 40% of mothers of infants diagnosed with CS received no syphilis screening during pregnancy. These gaps disproportionately affect marginalized populations due to systemic racism, limited Medicaid coverage, and longstanding distrust in healthcare institutions. Beyond perinatal outcomes, evidence also indicates adverse long-term neurodevelopmental, cognitive, and behavioral outcomes among adolescents with in utero exposure to syphilis, underscoring the lasting consequences of inadequate prevention.

Conclusions: This study highlights the urgent need for comprehensive, upstream interventions to address the resurgence of CS in the United States. Recommended strategies include expanding Medicaid coverage to improve prenatal care access, establishing nationwide syphilis screening mandates, increasing investment in sexually transmitted infection prevention initiatives, and strengthening culturally competent, community-based outreach efforts. By integrating lessons from international public health systems, these approaches offer a viable path to reducing CS incidence, advancing health equity, and improving long-term outcomes for vulnerable populations.

Keywords: Congenital syphilis (CS); prenatal screening; health equity; public health policy; maternal health