Healthy Mom, Healthy Baby: The Test Every Pregnant Woman in Texas Needs
Why Early Syphilis Screening Saves Two Lives—Not Just One
By New Insights for Sexual Health team: Kaylor Garcia, MSPH; Emily Regan, MPH; Jenn Rogers, MPH; and Catherine Schaefer, MS
Pregnancy is a time of profound change—physically, emotionally, and socially. As you prepare for this transition, you're likely doing everything possible to support your health and your child’s. That includes attending prenatal appointments, caring for your body, and sorting through a constant stream of information and advice. But there’s one essential topic that often gets overlooked during this time: sexually transmitted infections (STIs), and in particular, syphilis.
While it may not be top of mind, syphilis is a growing public health concern—and it can have serious consequences for both pregnant people and their babies if left untreated. Understanding your risk and knowing what to expect during your prenatal care journey, especially when it comes to testing and treatment for syphilis, is one of the most powerful steps you can take to protect yourself and your child.
Syphilis & Congenital Syphilis 101
Syphilis and congenital syphilis, or syphilis passed to a baby during pregnancy, pose a serious and growing threat. The increase in cases is alarming. As reported by the Texas Department of State Health Services, congenital syphilis cases rose by 148% between 2018 and 2022. This mirrors the rest of the country, with congenital syphilis cases rising alarmingly high—more than 3,800 cases reported in 2023—the highest annual total since 1994.
“Understanding your risk and knowing what to expect during your prenatal care journey, especially when it comes to testing and treatment for syphilis, is one of the most powerful steps you can take to protect yourself and your child.”
If left untreated, syphilis during pregnancy can cause serious health problems, like low birth weight, prematurity, birth defects, miscarriage, and stillbirth. Because syphilis often has no symptoms, many people do not realize that they have it.
The good news is that syphilis is curable! Early testing and treatment during pregnancy can help keep you and your baby healthy. Because of the problems syphilis can cause during pregnancy, Texas law requires healthcare providers to test pregnant women for syphilis at their first prenatal visit, in the third trimester, and at delivery. Regular STI screening is a critical, routine part of prenatal care.
“Because of the problems syphilis can cause during pregnancy, Texas law requires healthcare providers to test pregnant women for syphilis at their first prenatal visit, in the third trimester, and at delivery.”
Here are actions that women who are pregnant, and those who support them, can take to ensure everyone is getting this essential part of prenatal care.
Action 1: Connect to prenatal care.
As noted above, syphilis testing is a standard part of prenatal care – and not just once, but multiple times in pregnancy. However, we recognize that finding or accessing prenatal care in the United States can be challenging. About half of Texas is made up of maternity care deserts, which means that there are no hospitals providing birth care or birth centers, no obstetric providers, and few maternity care resources like prenatal services or health education. Not having access to care means that many people have not been tested or treated for syphilis. You deserve access to supportive, compassionate care, and nonjudgmental routine STI testing and treatment. Luckily, many caring state-run and nonprofit organizations exist to support you in your pregnancy journey. Explore some of the resources they provide to help you get the support and services you need.
Action 2: Talk about testing and get tested.
If you are in prenatal care and have not yet had a syphilis test, ask your provider to test you. It might feel uncomfortable at first to ask for this STI care with your prenatal care providers because it feels like a private topic, or you might be worried about being judged. For women in particular, stigma around sexual behavior can lead to harsh judgment and can prevent them from accessing the care they need. But remember—STIs are health conditions—nothing more, nothing less.
You may find it easier to start the conversation by highlighting that the American College of Obstetrics and Gynecology recommends syphilis screening for all pregnant patients, regardless of risk status. You can also lean on the Texas requirement for syphilis screening to point out that you are entitled to care.
To stay well and protect the health of people you care about, it is necessary to become comfortable talking about sexual health. This can be hard, as not all providers are comfortable, either. There are resources that can help you find the right provider and learn to talk about your sexual health. If you’re not quite ready to have these conversations with your provider yet or need to find a more supportive provider, there are more options out there for you. Getting a home syphilis test can be helpful for people who are looking for convenience and a bit more privacy, whereas specialized STI clinics may provide a more comfortable environment with direct access to a provider. To find a low-cost or free option to be tested and/or treated for syphilis near you, visit the CDC’s clinic locator.
Action 3: Follow through on treatment and get your partner involved.
If you test positive for syphilis, do not worry, your provider can make sure that you are treated with the right antibiotics and can also help you get treatment for your sexual partner(s). This step is key to preventing you from getting it again. Your provider may also test and treat you for other STIs. If you test positive for other STIs, like chlamydia and gonorrhea, your provider may also give you a prescription for your partner to be treated without them having to come in at all.
“You can also lean on the Texas requirement for syphilis screening to point out that you are entitled to care.”
The shame or fear that can make conversations hard with providers can also make it difficult to talk to partners about their health status. Breaking down this stigma is essential to promoting healthy relationships and community wellness. Sexual wellness is a part of well-being as a whole, and no one should feel ashamed of protecting their health and the health of those they care for. If you are wondering how to start your conversation with your partner about being tested or treated for syphilis, try these conversation scripts.
Wrap-up: Coming Together to Eliminate Congenital Syphilis
Our vision is a future where every woman who is pregnant has access to quality prenatal care and where congenital syphilis is a thing of the past. Unfortunately, we’re not there yet. The actions above offer ways for women who are pregnant to take control of their health. But this issue is not theirs to solve alone. We all have a role to play. “Now, I’m committed to finding ways to help…the hard first step of sharing is done.”
Eliminating maternity care deserts and reducing STI-related stigma will take a collective effort. Additionally, there are unequal systems of care and critical gaps in care for adults with syphilis that contribute to congenital syphilis—gaps that extend beyond the health care system. Closing them will require uplifting and supporting pregnant people most affected by these barriers so everyone can thrive.
If you’re pregnant, know someone who is, or simply want to be a more supportive community member, you can help. Get tested and retested for syphilis, check in on a pregnant friend, offer a ride to a clinic, and share this blog.
To all of the women who are pregnant out there, remember: You deserve safe, respectful care and a healthy baby. We are in this with you.
This blog was made possible by a cooperative agreement, CDC-RFA-PS-23-0007, from the Centers for Disease Control and Prevention (CDC). Its contents are solely the authors' responsibility and do not necessarily represent the official views of the CDC.
Straight-Up Advice: Know the Signs & Test Early
Why It Matters in Pregnancy: Even without symptoms, untreated syphilis can pass to the baby during pregnancy and cause miscarriage, stillbirth, premature birth, or congenital syphilis, which can lead to serious illness or death in newborns.
Syphilis Can Be Symptomless—Here’s What to Look For
Syphilis is often called “the great imitator” because its symptoms can resemble many other conditions—and sometimes there are no symptoms at all, especially in the early stages. Women are advised to test before getting pregnant, at their first prenatal visit, and then again in their third trimester or at delivery if they are considered high risk.
Here are the common signs and symptoms by stage:
Primary Syphilis:
A painless sore, known as a chancre, usually develops where the bacteria entered the body
Appears 10-90 days after exposure
Often goes unnoticed and heals on its own within 3-6 weeks
Secondary Syphilis (these symptoms may come and go and resolve without treatment, but the infection remains and progresses):
Skin rash, especially on the palms of the hands and soles of the feet
Mucous membrane lesions (sores in the mouth, etc.)
Flu-like symptoms, including fever, sore throat, swollen lymph nodes, fatigue, headache
Patchy hair loss
Latent Stage:
No visible symptoms
Can last for years
The disease is still active in the body
Treatment Is Key: Women who are diagnosed with and treated for syphilis before becoming pregnant are less likely to pass it to their infant during pregnancy. Benzathine penicillin G is the treatment for syphilis during pregnancy.
Congenital Syphilis in Texas
A Disturbing Trend: According to the Texas Medical Association, the number of congenital syphilis cases in 2023 was 12 times higher than in the preceding decade. That year, there were 930 cases across 114 Texas counties.
Did You Know?
In 2022, Texas accounted for approximately 25% of all congenital syphilis cases in the United States, despite representing only about 10% of the nation’s births.
Hispanic/Latina and Black women are disproportionately affected and reflect broader systemic inequities in access to healthcare, education, and insurance coverage.
In recent years, Hispanic mothers accounted for over 50% of congenital syphilis cases.
Do you have an amazing story to share? Please contact us so we can feature your incredible pregnancy or parenting story in a future blog. Your words bring us closer to a safer, healthier Texas for moms and babies.
