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Expanded screening and treatment is needed to address the increasing rate of syphilis cases in women and newborns in Hawai‘i, according to the Department of Health.

Image/Robert Herriman

The continuing rise of cases in women and congenital syphilis is alarming and requires immediate attention. “All sexually active people with risk factors for sexually transmitted infections (STIs) should be regularly tested for syphilis and other STIs,” said Dr. Diana Felton, chief of the Department of Health Communicable Disease and Public Health Nursing Division. “For pregnant persons, we now recommend syphilis screening three times: as early as possible during the first trimester, at 28 to 32 weeks of gestation and at the time of delivery. It is important that sexual partners are also treated to prevent reinfection.”

Because most cases of congenital syphilis in Hawai‘i have been reported in people who received late or no prenatal care, the health department is urging enhanced screening in health care interactions other than prenatal care. Visits to emergency rooms, urgent care and primary care clinics present critical opportunities to identify and treat syphilis and prevent recurrence of congenital syphilis. DOH continues to strongly recommend that women begin receiving prenatal care as soon as they learn they are pregnant, ideally in the first trimester.

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“Syphilis can have severe health impacts, especially for developing babies, including increased risk of stillbirth or death shortly after birth,” Felton said. “The devastating effects of untreated syphilis are preventable if infections are detected early and treatment is initiated promptly.”

In Hawai‘i, the number of babies born with syphilis — known as congenital syphilis — ranged from zero to four cases per year from 2000 to 2019, 12 cases in 2020, and 20 cases in 2021. Preliminary data indicates at least 22 cases in 2022. This dramatic increase in congenital syphilis cases is associated with increasing infections in adults.


The health department is alerting health care providers to be vigilant in screening for cases of syphilis in people who may become pregnant and during pregnancy, and is emphasizing recommendations for diagnosing and treating cases. The department also stresses the importance of treatment of partners to prevent reinfection and follow-up appointments with patients and infants.

Congenital syphilis (CS) is a disease that occurs when a mother with a syphilis infection passes it on to her baby during pregnancy.

CS can have major impacts on a baby’s health. How much CS affects a baby depends on how long the mother had syphilis and if, or when, treatment was received for the infection.

CS can cause:

  • Miscarriage (losing the baby during pregnancy),
  • Stillbirth (a baby born dead),
  • Prematurity (a baby born early),
  • Low birth weight, or
  • Death shortly after birth.

Up to 40% of babies born to women with untreated syphilis may be stillborn, or die from the infection as a newborn.
For babies born with CS, CS can cause:

  • Deformed bones,
  • Severe anemia (low blood count),
  • Enlarged liver and spleen,
  • Jaundice (yellowing of the skin or eyes),
  • Brain and nerve problems, like blindness or deafness,
  • Meningitis, and
  • Skin rashes.

Babies with CS can be without any symptoms at birth, but without treatment the baby can develop serious health problems in the first few weeks or few years after birth. Babies who do not get treatment for CS and develop symptoms later can die from the infection. They may also be developmentally delayed or suffer from seizures.