In 2024, the US Department of Health and Human Services shared a shocking statistic: US syphilis cases had surged to levels not seen since the 1950s–including a staggering 773% increase in congenital cases from 2012 to 2022. Syphilis is a sexually transmitted disease that is easily treated with a course of antibiotics. However, left untreated, it can damage the heart, the brain, and cause blindness, deafness, and paralysis. For those infected during pregnancy, it can cause miscarriage, lifelong medical issues, and death.
PITCH fellow John “Jack” Flores, currently completing his fourth year of a pediatric and adult infectious diseases fellowship at the University of Chicago, has dedicated his research to investigating the rise in congenital syphilis cases. In 2022, while rotating in pediatric inpatient care and interning weekly in the Chicago Department of Public Health’s HIV and STI division, he witnessed the alarming trend firsthand. “That year, we saw the biggest spike in congenital syphilis cases since the 1970s and 1980s,” he recalls. “I was seeing the rise in cases not only at the University of Chicago but across the city and nationally. I thought, ‘This is a disease that’s preventable and treatable. Why is this still happening?’”
Syphilis, particularly in its congenital form, is entirely preventable and highly treatable—often with a single shot of penicillin. “It just shouldn’t exist at this scale,” says Flores. “Unlike diabetes or hypertension, which are complex and take years to develop, syphilis can be contracted in a single encounter and cured just as easily.” Though he had initially planned to study HIV, Flores became determined to make a difference in the syphilis epidemic.
Babies contract syphilis when a pregnant person either acquires syphilis during pregnancy or enters pregnancy already infected. Treatment at least 4 weeks before delivery reduces the risk of congenital transmission by over 90%.
Yet because early phases of the disease are not severe, people may not realize they are infected. “Primary syphilis usually shows up as a single, painless skin lesion that disappears on its own. Secondary syphilis appears one to two months later and can resemble the flu—with fever, rash, muscle aches, fatigue—and also tends to resolve without treatment. However, the infection doesn’t go away. It enters the latent phase, during which a person has no symptoms, but the bacteria linger in the body,” explains Flores. “That’s why syphilis can be dangerous—someone could get infected in their 20s, think they just had a mild viral illness, and years later become pregnant without knowing they still carry the disease.”
Current guidelines from ACOG (the American College of Obstetricians and Gynecologists) recommend syphilis screening in the first trimester, again in the third trimester, and at delivery using a widely available test called an RPR (rapid plasma reagin).
However, inexpensive testing and simple treatment has not prevented syphilis from spreading, especially among newborns. And if babies with congenital syphilis don’t receive treatment, the problem only compounds: symptoms that may not appear until two years or more after birth include stunted growth, bone deformities, cognitive delays, vision loss, and deafness.
Through interviews of mothers of infants with congenital syphilis and prenatal care providers, Flores identified several reasons syphilis is undertreated, including difficulty attending appointments due to lack of transportation, lack of childcare, job inflexibility, and other general barriers to care.
“Another issue is stigma,” he says. “A syphilis diagnosis can be emotionally difficult—some people feel shame or fear telling their partner. Sometimes they were infected by a partner who cheated on them, adding layers of trauma. And even when treatment is given, reinfection is a concern. If the partner isn’t tested or treated, they can reinfect the pregnant person. In fact, in our cohort here at the University of Chicago, we saw that around 10% of congenital syphilis cases were due to reinfection after appropriate treatment.”
“Everyone we spoke to, including providers and patients, emphasized that education is key. Many pregnant people don’t realize how serious syphilis can be. We need to be clear about what symptoms to look for, and the importance of testing, treatment, and communicating with partners. Even simple things like promoting condom use during pregnancy can make a big difference.”
Community health workers, trusted community members can bridge the gap between patients and healthcare systems, reducing congenital syphilis rates. “They know the community. They speak the language—literally and culturally,” says Flores. “They can follow up when providers are too busy, offer transportation help, and even provide basic health education.”
Flores’s goal is to eventually build a community-based intervention that relies on community health workers to identify and support high-risk pregnant individuals—particularly those who are uninsured or on Medicaid, who currently represent the majority of congenital syphilis cases. Such an intervention could also be cost-effective. “If a community health worker is paid $50,000 a year and prevents just five cases, that pays for itself,” he says, pointing out that a typical stay in the NICU for congenital syphilis costs about $10,000.
Participating in the PITCH Fellowship, a HRSA T32-funded research training program that supports physician-investigators working on chronic disease prevention and health disparities, has been a “game changer,” says Flores. The fellowship has provided him with protected research time, funding for an MPH, and access to valuable mentors and collaborators. “They helped me build the research and analytic skills I needed, and also opened doors to other departments and resources I didn’t know existed.” Through the program, he’s collaborated with biostatisticians, public health researchers, and fellow clinicians, gaining insights not only into disease trends but also the human and institutional factors behind them.
As he nears the end of his fellowship, Flores is preparing to transition to a clinical role at Cook County Health, where he’ll work with adults and children—and continue to fight against congenital syphilis. He hopes to maintain collaborations with the University of Chicago and the Department of Public Health, continuing to build community-based solutions and work toward long-term disease suppression. “I want to work myself out of a job,” he says. “If in 10 years congenital syphilis is so rare that no one needs to study it anymore, that’s a win.”
Flores encourages younger researchers to stay hopeful and adaptable. “I hope junior researchers will stay optimistic,” he says. “Science is still here. I’ll still be doing research, still serving vulnerable populations, and still in Chicago. It’s not about walking away from academia—it’s about adapting. Science is a team sport. Whether you’re the PI or the clinical coordinator, we’re all working toward the same goal. Collaboration is more important than ever—across disciplines, across institutions. I think with the right partnerships, we can truly suppress congenital syphilis in the next decade.”