Prenatal Care and Congenital Syphilis in the United States: Characterizing Screening and Treatment.

Abstract

<b>Objectives.</b> To assess trends in prenatal syphilis screening and treatment in the United States and evaluate newborn syphilis screening. <b>Methods.</b> We conducted a retrospective cohort study using Medicaid (2014-2021) and commercial insurance claims (2010-2023). We assessed syphilis screening by trimester, repeat screening (> 1 trimester), temporal trends, treatment with benzathine penicillin G or nonrecommended antibiotics, and screening of infants born to pregnancies diagnosed with syphilis within 30 days of birth. <b>Results.</b> Syphilis screening occurred in 75.2% of Medicaid-insured and 92.8% of commercially insured pregnancies; 51.8% and 81.7%, respectively, were screened in the first trimester. Screening increased in Medicaid (67.6% to 80.5%) and remained high in the commercially insured cohort (91.0% to 94.0%). Repeat screening more than doubled in both cohorts. Approximately half of pregnancies diagnosed with syphilis had evidence of benzathine penicillin G treatment, whereas 5% to 6% had evidence of nonrecommended antibiotics. Infant screening was rarely identified, likely reflecting incomplete capture in claims data. <b>Conclusions.</b> Prenatal syphilis screening in the United States may fall short of recommendations, although increasing repeat screening is encouraging progress. (<i>Am J Public Health</i>. Published online ahead of print September 3, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308657).