Patient Information: Screening for Syphilis Infection During Pregnancy (2025)

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.

Congenital syphilis occurs when a syphilis infection passes from mother to fetus during pregnancy. Congenital syphilis is associated with premature birth, low birth weight, stillbirth, and infant death. Infants born with congenital syphilis may have deformed bones, anemia, enlarged liver and spleen, jaundice, and inflammation around the brain and spinal cord (meningitis) that may cause permanent vision or hearing loss. In 2023, 3882 cases of congenital syphilis were reported in the US, including 279 stillbirths and neonatal/infant deaths, the highest numbers in more than 30 years.¹ It is estimated that almost 90% of new congenital syphilis cases could have been prevented with timely testing and treatment.

In 2023, data from the Centers for Disease Control and Prevention showed racial and ethnic disparities in congenital syphilis. Compared with infants born to White women, the rate of congenital syphilis was about 12 times higher among those born to American Indian and Alaska Native women, 5 times higher among those born to Native Hawaiian and Other Pacific Islander women, nearly 4 times higher among those born to Black women, and about twice as high among those born to Hispanic or Latina women. Factors such as poverty, incarceration, and segregation likely play a role in these disparities.

The term screening means looking for a condition or illness in individuals who do not have specific symptoms or concerns related to that illness.

Screening for syphilis during pregnancy involves testing blood for 2 types of antibodies that might indicate the individual has syphilis infection. Point-of-care screening tests use a finger-stick blood test and are available for use in a clinical setting or at home. However, without additional confirmatory testing, it is unclear how results from these tests alone should guide treatment decisions.

The US Preventive Services Task Force (USPSTF) recommends that all asymptomatic pregnant women be screened for syphilis at their first prenatal care visit or as early in pregnancy as possible. Although the USPSTF does not make a recommendation on rescreening for syphilis later in pregnancy, decisions about rescreening may be based on a person’s risk factors. HIV infection, multiple sexual partners, incarceration, homelessness, sex in combination with drug use or commercial sex work, and the number of syphilis infections in the community can increase risk. In addition, some US states mandate repeat screening for syphilis early in the third trimester of pregnancy (about 28 weeks) and at delivery.

Injected penicillin G is the only documented effective treatment for syphilis during pregnancy. Pregnant women with later stages of syphilis infection need a longer duration of treatment. A fetal ultrasound to evaluate for signs of congenital syphilis is recommended when syphilis is diagnosed during the second half of pregnancy.

The pros of screening for syphilis during pregnancy include reducing cases of congenital syphilis and improving health outcomes for mothers and their infants. The cons include false-positive or inconclusive results that may require additional testing and anxiety resulting from the initial screening. In addition, penicillin G may produce side effects such as rash, nausea, vomiting, diarrhea, and allergic reactions such as hives.

The USPSTF recommends with high certainty that early screening for syphilis infection in all asymptomatic pregnant women has a substantial net benefit.

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Published Online: May 13, 2025. doi:10.1001/jama.2025.7170

Conflict of Interest Disclosures: None reported.