Record infections, rising congenital cases, and a penicillin shortage expose deep gaps in prenatal care and public health access.
California is facing a public health emergency that is colliding with longstanding gaps in access to care: a record-high surge in syphilis cases, including congenital syphilis, alongside a persistent shortage of the only medication proven to protect unborn babies.
According to the California Department of Public Health, syphilis rates in the state have reached their highest level in nearly three decades. Even more alarming is the rise in congenital syphilis—when the infection is passed from a pregnant person to their baby—which has increased more than elevenfold in California over the past decade. The state now ranks among the highest in the nation for these preventable cases.
At the center of the crisis is a nationwide shortage of Bicillin L-A, a long-acting penicillin that the Centers for Disease Control and Prevention identifies as the only effective treatment during pregnancy to prevent congenital syphilis. The U.S. Food and Drug Administration has confirmed ongoing supply constraints caused by increased global demand and limited manufacturing capacity, with shortages expected to continue into 2025.
For Latino communities—who already face higher barriers to prenatal care due to insurance gaps, language access issues, and immigration-related fears—the consequences are severe. California health officials report that Latina mothers account for a disproportionate share of congenital syphilis cases, reflecting broader inequities in early testing and timely treatment.
“Congenital syphilis is almost entirely preventable,” the CDC notes. “But prevention depends on early prenatal care and access to the correct medication.” When Bicillin is unavailable, providers are forced to ration doses, prioritizing pregnant patients while turning to less effective alternatives for others.
For non-pregnant adults, doctors may prescribe antibiotics like doxycycline. But these require strict, twice-daily dosing for multiple weeks—an approach public health experts say is far less reliable than a single Bicillin injection, particularly for patients juggling work, childcare, and transportation challenges.
Symptoms of syphilis can be subtle or mistaken for other conditions, especially in early stages. A painless sore may appear and disappear, followed weeks later by rashes, fever, fatigue, or swollen glands. Untreated, the infection can silently progress for years, eventually causing permanent damage to the brain, heart, and nervous system.
Health officials urge regular testing, condom use, and emerging prevention tools like DoxyPEP for high-risk populations—but emphasize that medication access and prenatal screening remain the most powerful tools to stop this crisis.
For California’s Latino families, the stakes could not be higher.
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