Prevention of congenital syphilis: The current state of legislation and public health guidelines.

Syphilis infection among pregnant people and congenital syphilis rates have risen considerably in the United States, leading to adverse maternal and neonatal health outcomes. Most cases of congenital syphilis are preventable, but diagnosis and treatment are complex and frequently complicated by stigma and limited access to care. Screening guidelines for perinatal syphilis in the United States vary by state, government agency, and professional organization. The Centers for Disease Control and Prevention (CDC) recommend universal screening of pregnant patients in the first trimester and repeat screening for high-risk patients at 28 weeks' gestation and at delivery, while the American College of Obstetricians and Gynecologists (ACOG) newly recommends universal screening at all three time points. Legislation meets CDC and ACOG guidelines in only 46% and 17% of states, respectively. In response to the congenital syphilis crisis, 25 states' health departments have issued advisories recommending more frequent screening. Despite testing state-level guidelines, opt-out screening and legislation do not benefit all patients equally; different rates of syphilis by race, ethnicity, and socioeconomic status highlight the need for additional resources and public health support. Moreover, perinatal syphilis remains challenging due to fragmented health care in the United States. Future directions to optimize public health support for congenital syphilis prevention include developing public health-clinical-academic partnerships that address some of these gaps by providing expert assistance to clinical teams, centralizing reporting and data availability, and supporting patients via novel models of care.