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

Objectives. To assess trends in prenatal syphilis screening and treatment in the United States and evaluate newborn syphilis screening. Methods. 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. Results. 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. Conclusions. Prenatal syphilis screening in the United States may fall short of recommendations, although increasing repeat screening is encouraging progress. (Am J Public Health. Published online ahead of print September 3, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308657).