CDC data released earlier this year suggests the U.S. may be turning a corner on its broader sexually transmitted infection epidemic. Cases of chlamydia and gonorrhea have declined for multiple consecutive years, and even the most infectious stages of syphilis have begun to fall after a prolonged rise. On paper, the trend lines are moving in the right direction.
But the aggregate obscures what the breakdown reveals.
Cases of congenital syphilis — when the infection is passed from mother to child during pregnancy — have continued to rise for the 12th consecutive year, reaching nearly 4,000 cases in 2024, the most recent year for which federal data is available. While adult infections show signs of stabilization, outcomes among newborns are worsening. Compared to a decade ago, congenital syphilis cases have increased by roughly 700 percent — turning what is widely considered a preventable condition into a persistent, measurable public health failure.
The divergence is not a medical mystery. Congenital syphilis can typically be prevented with timely testing and treatment during pregnancy. The barrier is not a lack of tools — it is a lack of access. Consistent prenatal care, routine screening, and timely treatment remain unevenly distributed, particularly in lower-income communities and areas with limited healthcare infrastructure. Where those systems are thin, the condition persists. Where they are absent, it compounds.
This is the tension embedded in aggregate progress: improvements across a population can mask deterioration within it. Declining STI numbers reflect prevention strategies that are working — for some. Rising congenital syphilis rates reflect where those same strategies are not reaching. Both things are true simultaneously, and reporting only one of them tells a story that is accurate in the aggregate and misleading in the particular.
The headline number is real. So is what it leaves out. Progress that bypasses the most vulnerable isn’t a finished story — it’s the beginning of a harder one.