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Health Advisory: Congenital syphilis increasing in Pierce County

Published Feb. 28, 2022.

Pierce County healthcare providers diagnosed 14 cases of congenital syphilis in 2021, the most in any Washington county. This is a dramatic increase from the annual average 1.4 cases in the prior 5 years in Pierce County.

Requested actions

  • Be aware, syphilis in all stages is increasing worldwide and locally.
    • In the United States, adult cases nearly doubled between 2019 and 2021.
    • In Pierce County, increases are mainly among presumed heterosexuals and women.
    • Healthcare providers are diagnosing congenital syphilis at record levels in Washington.
    • Many Pierce County mothers of children with congenital syphilis:
      • Are women 20–35 years old.
      • Are unhoused or unstably housed.
      • Report drug use.
      • Identify as White (about 33%).
      • Had late or no prenatal care. Some were diagnosed with syphilis at or after delivery.
  • Test all pregnant women for syphilis when they:
    • Enter care, as RCW 70.41.090 requires.
    • Begin their third trimester (about 28 weeks gestation).
    • Deliver, if they were not previously tested or have 1 or more risk factors:
      • Unhoused or unstably housed.
      • Drug use.
      • Late or no prenatal care.
      • Previous positive syphilis or other sexually transmitted disease (STD) test.
      • Live in an area with high syphilis prevalence.
    • Go to an emergency department for any reason, if they report no prenatal care.
    • If they deliver and report no prenatal care, test mother and baby. Ensure complete serologic testing and treatment (if needed) before discharge.
  • Immediately treat for syphilis, according to CDC’s 2021 STI Treatment Guidelines:
    • All who test positive or report exposure or symptoms, even before receiving lab results.
    • Their sex partners.
  • Know local resources for counseling, testing and treatment.

Congenital syphilis increase

Washington State Department of Health reported an historic high 17 congenital syphilis cases in 2019. The 2021 case total is pending but is expected to be at least double.

In 2021, Pierce County had 14 cases, the most in any Washington county. King County was next highest, with 11 cases. For comparison, in 2016–2020 Pierce County saw an average 1.4 congenital syphilis cases per year.

Graph of Pierce County congenital syphilis data. For more information, call (253) 649-1412.  

CDC reported a preliminary count of nearly 2,100 congenital syphilis cases in the United States in 2020.

Health Department efforts to address syphilis

We work to identify and address root causes of increased syphilis transmission. We collaborate with local healthcare providers to increase testing and treatment capacity. We have dedicated syphilis surveillance, prevention and control efforts. Our new Community Health Worker reaches out directly to people who are unhoused or using drugs.

Join our new STD Coalition.

The Health Department’s STD program leads our new STD Coalition. It is comprised of internal and external partners that readily access those at risk for STDs and HIV. The coalition works to understand and address upstream issues that affect Pierce County residents. We aim to remove the barriers people face when accessing STD care and, ultimately, limit STD transmission altogether.

To join the STD Coalition, contact Ericka Case at (253) 341-2568 or Invite other interested providers to join, too.

Report suspected or confirmed cases of congenital syphilis.

Call (253) 649-1413 or visit


Contact Teresa Cooper at (253) 281-8003 or Watch for future health alerts and a congenital syphilis toolkit at



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