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In a busy clinic in Jackson, Mississippi, a clinician performs a rapid syphilis test on a pregnant woman. Within 15 minutes, the results are in — she is infected — and treatment can begin immediately.

This process, once uncommon, is becoming more widely adopted as healthcare providers reevaluate screening and treatment protocols to curb the nationwide surge in congenital syphilis.

Cases of the condition have increased 10-fold between 2012 and 2022. With early treatment using parenteral benzathine penicillin, 90%-100% of cases of congenital syphilis can be averted. Yet the lack of testing and delayed treatment during pregnancy contributed to 88% of cases of the infection in infants in 2022, according to the US Centers for Disease Control and Prevention.

The consequences of not receiving treatment are dire: The condition can cause miscarriage, stillbirth, or even neonatal death in up to 40% of cases. Babies who survive often face long-term health problems like hearing loss or developmental delays.

Mississippi has the third highest rate of cases in the country, with 377 infants out of 100,000 born with the condition, behind South Dakota and New Mexico.

After data showed a staggering 900% increase in cases of congenital syphilis over a 6-year period ending in 2021, state officials took action. In April 2023, the Mississippi State Department of Health implemented a point-of-care (POC) testing program, mandating healthcare clinicians screen pregnant people and provide treatment in a single visit.

State officials say they are finally seeing rates slowly decrease. Between January and February 2025, 9 cases of congenital syphilis were reported compared with 29 cases during the same period in the previous year, according to the state’s health department.

“The benefit of point-of-care testing for pregnant and all patients provides the ability to begin treatment at that appointment instead of waiting on lab results and then reappoint the patient to return to the clinic,” said Kendra Johnson, MPH, director of the Office of Communicable Diseases at the Mississippi State Department of Health. “If the test is positive, the woman is followed closely to ensure they receive all three treatments for syphilis.”

Racing to Test and Treat

In early 2024, the Centers for Disease Control and Prevention released new guidance supporting the use of POC tests for syphilis to help clinicians quickly diagnose and treat infections. The tests provide results in about 15 minutes.

Several states — including New York, Mississippi, North Carolina, and Texas — have implemented that guidance in response to rising rates of congenital syphilis.

POC testing addresses one of the most significant barriers to effective syphilis prevention: The delay between testing and treatment. One recent study found 42% of people who had syphilis during pregnancy received either none or an incomplete course of the multidose treatment. Researchers found those with syphilis on average received treatment 9 days after testing. Delaying the start of benzathine penicillin can lead to adverse birth outcomes like stillbirth or preterm birth.

The American College of Obstetricians and Gynecologists also recommends universal syphilis screening three times during pregnancy: At the first prenatal visit, in the third trimester, and at birth.

In Mississippi and other rural states, many women do not access prenatal care until their second or third trimester due to delays in gaining Medicaid coverage or living in counties with little or no obstetric care.

Research suggested POC syphilis testing can help close gaps in prenatal care and prevent congenital infections. One study published in 2021 found using rapid syphilis tests during pregnancy led to a 93% drop in congenital cases compared with standard lab testing, likely due to the ability to test and treat in a single visit.

“We’ve seen far too many preventable cases of congenital syphilis,” said Christopher Golden, MD, a neonatologist at Johns Hopkins Children’s Center in Baltimore.

Maryland has about 100 cases of congenital syphilis for every 100,000 babies born, ranking the state 19th in the country for the disease. Despite state-mandated screenings for syphilis, many pregnant people do not receive the test in a timely manner, which delays the opportunity to treat the condition before birth.

“By implementing point-of-care testing, we can dramatically reduce the risk of transmission from mother to child,” Golden said.

In Mississippi, rather than relying solely on state-run clinics, the state’s Department of Health partnered with hospitals, individual OB/GYNs, and community providers like federally qualified health centers and free clinics to roll out POC testing across all prenatal care settings. The effort included training clinicians and reorganizing workflows to ensure rapid testing could be completed during routine visits.

Challenges to Implementation

Despite its effectiveness, POC testing faces several challenges. While the tests themselves are relatively inexpensive, implementing a new testing protocol and providing treatment can be costly for healthcare systems.

Benzathine penicillin, the primary treatment for syphilis, costs private and hospital-associated clinics nearly $500 per dose. Public health departments, safety-net providers like rural clinics, and disproportionate share hospitals can obtain discounted syphilis medications through a federal discount drug program, said Thomas Dobbs, MD, dean of the John D. Bower School of Population Health at the University of Mississippi Medical Center in Jackson, Mississippi, who has studied methods to prevent syphilis.

Dobbs said cuts to funding of public health departments, both at the state and local levels, also threaten the ability to reduce congenital cases.

“We’ve seen public health teams dismantled over time, reducing our ability to track sexual networks and ensure partners are treated,” he said.

Kristin Wall, PhD, an associate professor of epidemiology at Emory University’s Rollins School of Public Health in Atlanta, said staff administering tests need training on how they work, lab teams must ensure the testing devices meet federal regulatory standards, and reporting systems must be updated so results can be shared with public health agencies.

But because the strategy is still so new, “the evidence base for implementation is still limited,” and best practices are yet to come, said Wall.

In Mississippi, collaborations between health departments and private healthcare systems have helped offset costs and improve access to testing. Community health workers employed by the state-funded Syphilis Task Force educate pregnant people about the importance of testing and facilitate access to care.

Some health departments have also launched mobile testing units that bring POC testing directly to rural communities. Virtual training programs and real-time consultation services also can help healthcare clinicians in remote areas administer and interpret tests accurately.

No Cure Without Systemic Change

Integrating POC testing into existing clinical workflows can be a challenge for overburdened healthcare staff, especially in high-volume or resource-limited settings. But Wall said these concerns are short-lived.

“While there are initial growing pains, data indicate that POC testing can actually save providers time, particularly time spent recontacting patients and managing follow-up appointments,” she said. “Syphilis [point-of-care] testing is a promising strategy with relatively low barriers to entry.”

Wall urged health clinicians to prioritize POC testing for pregnant individuals who do not receive routine prenatal care, especially in emergency departments, urgent care centers, rural clinics, and harm reduction settings like needle exchange programs.

According to Dobbs, widespread implementation of POC testing, coupled with improved access to prenatal care and ongoing community education, is essential to bring the current epidemic under control.

“We won’t doctor our way out of this epidemic,” she said. “It will take systemic changes and coordinated efforts from all sectors.”

Lara Salahi is a health journalist based in Boston.