Congenital Syphilis in Texas Section 3 - Understanding Syphilis

Syphilis is an STD caused by Treponema pallidum and is passed from person to person by direct contact with a syphilitic sore. Transmission of syphilis occurs during vaginal, anal, or oral sex. Syphilis is most infectious in the primary and secondary stages (P&S). In 2018, there were 35,063 P&S cases reported nationally. [4] A total of 115,045 syphilis cases were reported to the CDC in 2018. [4] 

Primary syphilis refers to the first stage of the infection in which there is presence of a chancre (painless lesion) approximately 10 to 90 days after infection. Secondary syphilis refers to the next stage of infection characterized by a variety of cutaneous (skin) lesions, including rashes, condylomata lata (wart-like lesions on genitalia), and mucous patches. This occurs approximately four to eight weeks after the primary lesion. Early non-primary non-secondary syphilis refers to syphilis acquired within the last 12 months with no active signs or symptoms. Syphilis of unknown or late duration occurs when there are no active signs or symptoms and no indication that the infection was acquired in the 12 months prior to diagnosis. Per CDC treatment guidelines, patients at an early syphilis stage (primary, secondary, and early non-primary non-secondary) should receive one dose (2.4 million units intramuscularly) of Benzathine Penicillin G and patients with unknown or late duration should receive three doses (2.4 million units intramuscularly, each dose) of Benzathine Penicillin G at one-week intervals. [5] Adequate treatment must be initiated at least 30 days prior to delivery to prevent a CS case.

A Note on Maternal Syphilis Treatment

Assessment of adequate maternal syphilis treatment relies on documentation of diagnosis, treatment date(s), and dosage. DSHS uses treatment information documented in the CS investigation form and treatment tables in databases for complete ascertainment to analyze maternal treatment. For the unknown treatment group, one or more of the following data may have been missing: treatment type, treatment dosage, maternal syphilis diagnosis, or date treatment was initiated.


Note 4. Texas Department of State Health Services. Texas 2018 STD Surveillance Report; Dated August 20, 2019. /sites/default/files/hivstd/reports/

Note 5. Centers for Disease Control and Prevention (CDC). 2021 Sexually Transmitted Diseases Treatment Guidelines.; STI Treatment Guidelines (

Congenital Syphilis in Texas

Table of Contents | Executive Summary | About this Report | Understanding Syphilis | An Overview of Congenital Syphilis and Syphilis in Women of Childbearing Age in Texas | Maternal Demographics for Women Delivering Infants with Congenital Syphilis | Barriers to Care | Birth Outcomes Associated with Congenital Syphilis | Congenital Syphilis Cascade