DSHS Asks to Increase Prevention Efforts for Congenital Syphilis

In its effort to turn the tide against rising congenital syphilis rates, the Texas Department of State Health Services (DSHS) is asking physicians to increase screening and prevention efforts among pregnant women and their partners. 

The recommendations come in a letter sent to physicians Sep. 17, amid news that the shortage of intramuscular penicillin G, the standard treatment for syphilis outpatient treatment in most patients, has ended.  As of September, both the higher dose (2.4 million Units/4 mL) and the lower dose (1.2 million Units/2 mL) of the medication are available. 

However, Texas continues to have an average of two to three babies born every day with congenital syphilis, DSHS says.  

“CS [congenital syphilis] can have profound effects on babies and is completely preventable with appropriate treatment,” DSHS Commissioner Jennifer Shuford, MD, said in the letter to physicians. “This issue is a priority for me, for DSHS, and for public health in Texas, and we need your help to turn the tide and protect some of our most vulnerable Texans.” 

In accordance with state law, Texas physicians must screen pregnant women for syphilis at least three times during pregnancy at:

• The first prenatal examination and visit; 

• The third trimester visit (no sooner than 28 weeks’ gestation); and 

• Delivery. 

DSHS asks physicians to consider: 

• Screening more frequently when clinically indicated or when a patient requests it, regardless of the health care setting; 

• Completing a sexual health history as part of a patient’s initial and annual primary care visit and anytime there are reproductive, genital, or urological issues; 

• Provide or arrange for treatment for any patient diagnosed with syphilis; 

• Encourage any patient diagnosed with syphilis to notify their sexual partners about the need for testing and treatment; 

• Provide expedited partner therapy when possible and appropriate; and 

• Confirm a mother’s syphilis test result is available and reviewed before a newborn is discharged from the hospital to ensure that the newborn receives any evaluation, treatment, and follow up needed. 

All syphilis cases, including congenital syphilis, must be reported to the health department within 7 days of diagnosis, using Form STD-27, so continuity of care and follow-up can occur. 

According to DSHS, the number of congenital syphilis cases in Texas quadrupled between 2017 and 2022, from 166 cases to 922 cases. That same year, Texas accounted for 25% of national congenital syphilis cases, according to a 2022 Centers for Disease Control and Prevention resource, but just 10% of national births, per an April 2024 study by the National Center for Health Statistics. 

The Texas Medical Association recently took steps to address congenital syphilis during the association’s annual TexMed conference in May. During the event, TMA’s House of Delegates established new policy that aims to reverse rising rates of syphilis and congenital syphilis through: 

• Further educational efforts for all physicians, health practitioners, patients, and public health systems about the rise of syphilis across the state, syphilis testing and treatment guidelines, transmission, and disease presentation; 

• Improving public health funding and infrastructure in addressing increased syphilis and other sexual infection rates; 

• Encouraging efforts to address the shortage and cost prohibition of intramuscular penicillin G, the standard treatment for syphilis outpatient treatment in most patients; 

• Aiding DSHS and public health systems in studying the causes contributing to the increased incidence and prevalence of syphilis and congenital syphilis; and  

• Encouraging DSHS and public health in reversing the causes leading to increased incidence and prevalence of syphilis and congenital syphilis. 

TMA also offers continuing medical education on congenital syphilis to TMA members. 

For more information, visit DSHS’ congenital syphilis resources page. For questions about syphilis screening, diagnosis, or treatment in pregnancy, contact DSHS at (737) 255-4300 or hivstd@dshs.texas.gov.