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Congenital Syphilis Prevention Project

The number of congenital syphilis cases reported to the Alabama Department of Public (ADPH) hit an all-time high of 23 cases reported in 2020 (Figure 1). Since 2015, the number of congenital syphilis cases reported in Alabama has increased by 667 percent.

Alabama Congenital Syphilis Trends (2015-2020)

From 2018 to 2020 (Figure 2), 45 congenital syphilis cases have been reported to ADPH o  which 22 pregnant women tested negative for syphilis during their initial prenatal visit and subsequently tested positive at delivery. Six pregnant women received inadequate treatment for syphilis infection; and two pregnant women were never tested for syphilis.

Alabama Missed Opportunities to Prevent Congenital Syphilis (2018-2020)


  • Late identification of seroconversion by the provider during pregnancy (Non-reactive initial prenatal visit syphilis test; No additional until labor and delivery)
  • No prenatal care (Presents for care during labor)
  • Inadequate maternal treatment by the provider (Bicillin injection interval > 7 days)
  • Unidentified Missed prevention opportunity (Clinical evidence of congenital syphilis despite adequate maternal adequate treatment 30 days before delivery.)
  • Late prenatal care (Prenatal care < than two months to deliver)
  • No syphilis testing despite receipt of timely prenatal care (No syphilis test ordered by the provider
    during prenatal visits until delivery)

Recommendations for Prenatal STD Testing

Alabama Prenatal Syphilis Testing

Download our full guide for a list of all recommended STD tests broken down by initial prenatal visit, third trimester, labor & delivery, and for patients who present at delivery with no prenatal care.

Recommended STD Treatment During Pregnancy

Newly Diagnosed Syphilis:

  • Treat all pregnant women with a positive syphilis test or signs and systems of syphilis at least 30 days before delivery to prevent congenital syphilis.
  • Primary Syphilis, Secondary Syphilis, or Early Non-Primary and Non-Secondary
  • Syphilis: Benzathine penicillin 2.4 million units IM every week for two weeks at a 5-7-day intervals.
  • Syphilis Unknown Duration or Late Syphilis: Benzathine penicillin 2.4 million units IM every week for three weeks at a 5-7-day intervals.
  • Refer the patient’s partner for treatment to prevent reinfection of the pregnant woman.

History of Adequately and Inadequately Treated Syphilis

In 2019, four infants whose mothers were treated adequately for syphilis before pregnancy  received the full congenital syphilis work-up. All four infants had significant abnormal lab findings and required treatment. These cases were reported to CDC as probable cases. Hence, the following is recommended as a preventive measure:

  • Pregnant women with history receive repeat treatment as Late Latent Syphilis with Benzathine penicillin 2.4 million units IM every week for three weeks at a 5-7-day intervals.

Reactive Gonorrhea Test Results

  • Person < 300 lb. Ceftriaxone 500 mg IM in a single dose.
  • Person ≥ 300 lb. Ceftriaxone 1 g IM in a single dose.
  • If Chlamydia Test Result is Positive - Add Azithromycin 1g orally in a single dose.

Reactive Chlamydia Test Results

  • Azithromycin 1 g PO in a single dose

ADPH Support

  • ADPH offers free syphilis testing and treatment for pregnant women and their partners.
  • Contact Dr. Agnes Oberkor, DrPH, at 334-206-3913 for help with determining syphilis history and the stage of syphilis infection.

Disease Reporting

Contact Us

  • Mr. Anthony Merriweather, M.S.P.H. - 334-206-2765
  • Dr. Agnes Oberkor, DrPH - 334-206-3913

Page last updated: December 13, 2021