When a baby is born with congenital syphilis in Pima County, their first days of life are often spent not at home, but in a hospital.
Newborns typically undergo at least 10 days of treatment to stop the infection—an aggressive but necessary intervention for a disease that can cause blindness, hearing loss and lifelong developmental delays.
It’s also a disease that is entirely preventable.
"The reality of this disease is very sad... we are doing our best to try to connect with those who need the care when and where they need it,” said county epidemiologist Eleana Acosta Savala.
A sharp rise in cases
Altogether, Pima County has experienced nearly a 500% increase in all stages of syphilis cases and congenital syphilis cases since 2010, according to county health officials.
Dr. Andrew Saal, the county’s assistant medical director, said the boost in cases correlates with a recent surge in congenital syphilis—where the infection is passed to the fetus during pregnancy.
"Syphilis is an infectious disease that no one wants to talk about,” Saal said. “It is also silent... it goes dormant and that's where it can do a lot of harm.”
In some years, like 2015, there were zero recorded cases of babies born with congenital syphilis in Pima County. But in 2024, the county recorded about 50 cases.
As a state in 2023, Arizona ranked fourth in the U.S., according to the Centers for Disease Control and Prevention (CDC) with more than 200 congenital syphilis cases.
If untreated, syphilis during pregnancy can lead to miscarriage, stillbirth or serious long-term health complications for the child.
“If you screen... you can treat it, cure it, and protect the life of that unborn child,” Saal said.
Health leaders describe barriers to care
Public health experts say the tools to prevent congenital syphilis are straightforward—testing and antibiotics—but many patients never receive them.
Stigma, lack of insurance and inconsistent access all play a role.
The American College of Obstetricians and Gynecologists recommends that all people who are pregnant screen for syphilis at the first prenatal care visit and universally rescreen during the third trimester and at birth. But many of these patients aren’t getting prenatal care until they show up in the emergency room, Saal said.
Eleana Acosta Zavala (left) and Dr. Andrew Saal review data on syphilis cases in Pima County on Wednesday, April 1, at Pima County Health Department in Tucson, Ariz. Acosta Zavala is an epidemiologist and Saal is the assistant medical director with the department. L. M. Boyd
"Maybe they're afraid to access care. Maybe they don't have insurance and can't afford to get care. But these are symptoms of the greater fabric of the American health care system,” Saal said.
Unlikely to walk into a clinic
To better understand the rise in cases, health officials built a registry that tracks infections and flags cases during pregnancy.
The data revealed a pattern:
- About three-quarters of pregnant individuals with syphilis are experiencing housing instability.
- Nearly three-quarters of pregnant individuals with syphilis report recent methamphetamine or fentanyl use.
- Nearly a quarter of all diagnosed cases were incarcerated in the year before diagnosis.
Saal describes this as a “syndemic”—a public health crisis shaped by overlapping issues like substance use and unstable housing.
“These are patients who are unlikely to walk into a clinic,” he said.
How health workers are curbing cases
Rachel Gordon, a family nurse practitioner and educator with the county, is trying to meet patients “where they’re at,” she said.
To reach them, Gordon and her team use what they call street medicine, bringing testing and treatment directly into the community—including places like the former 100-Acre Wood encampment.
Rachel Gordon, a nurse practitioner with the Pima County Health Department, displays a syphilis testing kit in a patient room on Thursday, April 2, 2026, at the Northwest Public Health Clinic in Tucson, Ariz. L. M. Boyd
"Sometimes when you're able to meet people in open air, it's more inviting. It's more casual, and it takes off the stigma of a medical clinic,” Gordon said.
County health professionals use rapid blood testing to learn in real time what someone’s STI status is. In some cases, the team brings treatment directly to a pregnant woman's home to treat her, and if possible, her partner.
Experts warn cost of inaction
Congenital syphilis is costly, but preventable, according to a 2023 George Washington University study.
A single case of congenital syphilis typically requires 10 days of hospitalization.
A report estimates that the cost of neonatal intensive care for a newborn can approach $50,000–largely funded by tax dollars through Medicaid.
That dollar sum, however, fails to capture long-term costs, said Saal. The impact on families and broader socioeconomic costs often remains underreported.
Beyond the initial hospital stay, a child requires close monitoring every few months to ensure they are meeting developmental milestones and have not suffered permanent eye or hearing damage, experts say.
Preventing the infection during pregnancy is less expensive and less traumatic than treating it after birth, Saal said.
Early results indicate progress.
Pima County confirmed 53 congenital syphilis cases in 2024. In 2025, that number dropped to about 24, according to early county data.
County health officials hope to launch a pilot program to expand screening with a local health provider.
“Even though we're making some progress now, we're not done until that number goes back to zero. This is fully preventable and fully treatable.”
What to know before getting tested
- Testing typically involves a simple blood draw.
- Early testing and treatment can prevent congenital syphilis.
- Experts say to avoid sex until results are in.
- Disclose prior infections, as they can cause long-term positive results.
Where to get tested
- Theresa Lee Public Health Center, 1493 W. Commerce Court, Tucson
- Northwest Public Health Clinic, 1010 W. Miracle Mile, Tucson
- Southern Arizona AIDS Foundation (SAAF), 375 South Euclid Avenue, Tucson
- Planned Parenthood - Southern Arizona Regional Health Center, 2255 N. Wyatt Drive, Tucson