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Congenital and Adult Syphilis Toolkit

Cases on the Rise

The number of congenital syphilis cases in Indiana has increased by 2,300% from 2018 to 2023. Nationally, there has been a 755% increase in congenital syphilis cases between 2012 and 2021. The Centers for Disease Control and Prevention's recent analysis shows that almost nine in 10 cases of newborn syphilis in 2022 might have been prevented with timely testing and treatment during pregnancy. More than half of cases were among mothers who tested positive for syphilis during pregnancy but did not receive adequate or timely treatment, and nearly 40 percent of cases were among birthing mothers who were not receiving prenatal care.

This toolkit has several different resources to help expand testing and treatment in Indiana. For help obtaining resources, including rapid tests or Bicillin, please contact your local health department.

Congenital Syphilis is Preventable


In 2022, lack of timely testing and adequate treatment of syphilis in pregnancy contributed to almost 90% of congenital syphilis cases in the United States.

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Why diagnose and treat syphilis in pregnant women?

The number of nationally reported congenital syphilis cases increased by 755% between 2012 and 2021 from 335 in 2012 to 2,865 in 2021.


Increased testing and treatment is urgently needed.

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How do you interpret test results for syphilis?

Pregnant patients with reactive syphilis serology must be considered infected unless an adequate treatment history is clearly documented in their medical records and sequential serologic antibody titers have decreased.


Bicillin L-A (Penicillin G Benzathine) is the only known effective antimicrobial for treating syphilis during pregnancy and preventing congenital syphilis.

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Congenital Syphilis Treatment Guidelines

The completion of a penicillin-based regimen, in accordance with Centers for Disease Control and Prevention treatment guidelines, appropriate for stage of infection, initiated thirty (30) or more days before delivery.


Both syphilis and congenital syphilis should be reported to IDOH within one working day.

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How should test results be reported?

Cases can be reported via the Indiana Confidential Sexually Transmitted Disease (STD) Report State Form 56459 by fax, or online.

Congenital Syphilis Case Definition

For public health reporting

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Evaluation and Treatment Algorithm

Clinical management of congenital syphilis
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Congenital Syphilis FAQ

Syphilis During Pregnancy
and Congenital Syphilis
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Adult Syphilis Case Definitions

For public health reporting
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Adult Syphilis Clinical Staging and Treatment

If patient meets testing criteria
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Role of Healthcare Providers

All healthcare providers play a critical role in screening reproductive age individuals. Here are some of our recommendations:

  • Perform syphilis testing on all patients upon finding a positive pregnancy test.
  • Test all pregnant patients three times during pregnancy (at initial prenatal visit, again at 28-32 weeks of gestation, and then at delivery).
  • Meet people where they are with syphilis testing and treatment outside of settings in which pregnant patients are typically encountered. This could include emergency departments, urgent cares, primary care visits, jail/prison intake, local health departments, community programs, and addiction services.
  • Perform screening and treatment of all sexually active women and their partners for syphilis in counties with high syphilis rates.
  • Perform screening and appropriate treatment for those with other risk factors for syphilis (have unprotected sex and do not use condoms or do not use them correctly, have multiple sex partners, have a sex partner who has syphilis and have sex with a partner who has multiple sex partners).
  • Treat all pregnant women who are infected with syphilis immediately upon diagnosis, according to their clinical stage of infection. Treatment must be with penicillin G benzathine (Bicillin LA).

Syphilis Serology Testing Algorithms

Interstate Communication Control Records

Disease Intervention Specialist Map

Colleague Letter