Congenital Syphilis: From Near-Elimination to Crisis.

This analytic essay examines the transformation of congenital syphilis (CS) in the United States from near-elimination to crisis. Drawing from the January 2025 Congenital Syphilis Summit in Atlanta, Georgia-convening public health leaders, Tribal health departments, the National Coalition of STD Directors, and Centers for Disease Control and Prevention experts-we contrast prevention systems during near-elimination (1998-2005) with the current crisis (2018-2025). Evidence revealed how dismantling public health infrastructure produced dramatically different outcomes, with CS cases increasing 937% over the past decade and racial/ethnic disparities worsening. American Indian/Alaska Native communities face rates up to 100 times higher than White populations in some regions, illustrating the multiplicative effects of system failures on vulnerable communities. We identify 5 critical system failures: cyclical boom-and-bust funding, workforce deterioration, fragmented surveillance, disconnected health care systems, and health equity failures. We present policy proposals for rebuilding prevention infrastructure through a deliberate phased approach transitioning from crisis response to sustained maintenance, ensuring prevention systems receive continuous support rather than episodic investments that have characterized past approaches. (