By KAYLA KELLY

Every semester I have the privilege of guiding nursing students through their maternal and pediatric clinicals. At the beginning of the semester, their enthusiasm is contagious. They share stories about witnessing their first delivery, helping a new mother with breastfeeding, and practicing developmental assessments on pediatric patients. As the semester progresses, I see their demeanor shift. “You were right, we took care of another congenital syphilis baby today.” Their reflections on the clinical day are a mixture of emotions: frustration, anger, and sadness, as they watch fragile infants fighting an infection that no child should ever have to endure.

When I first tell my nursing students that they will likely care for infants born with syphilis during their clinical rotations, they look at me with wide-eyed disbelief. “Didn’t we cure syphilis in the 1950’s?” some ask. A few of my students usually recall hearing about the Tuskegee Study, but most have no idea that we are still fighting (and losing) a battle against congenital syphilis in the United States today. 

Congenital syphilis occurs when a mother transmits the infection to her infant during pregnancy or delivery. It is almost entirely preventable with timely screening and treatment, yet the number of cases continues to rise at an alarming rate. Between 2018 and 2022, the United States experienced a 183% increase in congenital syphilis cases, rising from 1,328 cases to 3,769. This national trend was mirrored at the state level, with Texas reporting 179 cases in 2017 and 922 in 2022. During those five years, the rate of infants born with congenital syphilis in Texas rose from 46.9 to 236.6 per 100,000 live births, a sharp increase that necessitates action.

Texas now has one of the highest congenital syphilis rates in the country, despite having one of the most comprehensive prenatal screening laws. According to the Texas Department of State Health Services, policy mandates syphilis screening at three points during pregnancy:

(1) at the first prenatal visit

(2) the third trimester (but no earlier than 28 weeks)

(3) at delivery

But herein lies the problem: What happens when a woman never attends prenatal care? How do we reach those who never step into an OB/GYN office during pregnancy? Screening laws only protect those who are able to access care. In 2022, over 1/3 of Texas mothers whose infants were diagnosed with congenital syphilis did not receive any prenatal care. Each of these cases represents a failure of our current medical system, a system that should be protecting the most vulnerable yet remains unable to reach those who need it most.