How to Teach Congenital Syphilis: A Curriculum Integration Playbook

Congenital syphilis affected 3,941 U.S. newborns in 2024, the 12th consecutive yearly increase and a figure most faculty have not yet written into a single course objective. The clinical content moved; the curricula largely did not.

That gap is the problem worth solving this term. CDC Vital Signs data tied 83% of congenital syphilis cases to missed screening or timely treatment, which makes this a teaching target, not just a public health statistic.

Nurse educators need usable material: where the topic lands in BSN and graduate coursework, innovative teaching strategies for simulation scenarios and competency rubrics, and one documented case from the University of Cincinnati's WHNP program that absorbed the content without building a new course.

Why Congenital Syphilis Education Can't Wait

Congenital syphilis is an infection a pregnant patient passes to her baby during pregnancy or birth, and it is preventable when it is caught and treated on time. It has become one of the clearest tests of whether nursing education is keeping up with practice.

What the Latest CDC Numbers Show

CDC's provisional surveillance data count 3,941 congenital syphilis cases in U.S. newborns in 2024, a rate of 109.6 per 100,000 live births.¹ That is the 12th consecutive yearly increase.² Cases rose 1.6% from 3,878 in 2023 and 81.8% from 2,168 in 2020.¹ Against 495 cases in 2015, the jump is about 696%, which CDC describes as nearly 700%.¹ CDC expects to finalize the 2024 figures in 2026, with only slight count changes anticipated and no substantial change expected in national rates or trends.³

The stakes are clinical, not abstract. CDC notes that the infection can cause miscarriage, stillbirth, or neonatal death.⁴ Infants who survive without adequate treatment can develop blindness, deafness, developmental delays, or skeletal abnormalities.⁴

Why Nurses Are at the Center

CDC's Vital Signs assessment found that missed timely testing and inadequate treatment contributed to substantial proportions of cases in all parts of the country and across all racial and ethnic groups.⁴ This is not a regional or single-population problem. Those gaps surface in the settings where nurses already work: preconception and prenatal visits, labor and delivery, postpartum follow-up, and newborn units. A missed screen, a delayed result, or an incomplete treatment course often passes through a nurse's hands before anyone names it as a failure.

That is why education matters. Nurses see patients before, during, and after pregnancy, and they are positioned to notice risk, prompt screening, and confirm treatment is completed.

The Curricular Takeaway

This is a skills gap, and educators can close it. Students need to practice recognizing risk, ordering and interpreting screening, and following up on treatment. Memorizing a statistic will not do that.

Congenital Syphilis in the U.S.: the 2026 Snapshot

The most recent CDC figures show congenital syphilis climbing for the 12th straight year, with cases nearly 700% higher than in 2015. Every one of these infections traces back to a pregnancy where screening and timely treatment could have changed the outcome, which is why this number belongs in your lecture slides and simulation debriefs.

Case Study: How UC's WHNP Program Added Two Syphilis Modules Without a New Course

You do not need a new course, a curriculum committee cycle, or a credit-hour fight to put congenital syphilis content in front of students. The University of Cincinnati College of Nursing's Women's Health Nurse Practitioner program proved it by dropping two externally developed syphilis modules into a course it already required.

What UC Joined

According to UC College of Nursing news coverage published October 7, 2026, the WHNP program was one of three graduate education sites selected for a national multisite educational initiative on infectious diseases during pregnancy, with congenital syphilis as the focal point. The project was led and coordinated by the University of Missouri-Kansas City and supported by the National Association of Nurse Practitioners in Women's Health, with funding through the CDC Foundation. UC's contribution was both nursing education curriculum and evaluation: students received the intervention, and the program fed participation data into the standardized multisite assessment.

Three faculty carried the work: Tamara Pavlik-Maus, MSN, APRN-CNP, WHNP-BC, who directs the WHNP program, and assistant professors Heather McCracken, DNP, APRN, WHNP-BC, and Glenna Kersten, MSN, WHNP-BC. Their rationale was straightforward. WHNP students care for patients before, during, and after pregnancy, which puts them in exactly the position to identify risk, order screening, recognize infection, and confirm that treatment happens on time.

What the Modules Actually Are

UC used two syphilis lessons from the National STD Curriculum, a free, web-based self-study resource from the University of Washington STD Prevention Training Center. The general syphilis lesson runs roughly two hours and walks through epidemiology, microbiology and transmission, clinical manifestations, laboratory diagnostics, screening, treatment, partner management, and counseling. The companion lesson on syphilis during pregnancy and congenital syphilis takes about an hour and covers screening recommendations for pregnant patients, evaluation of intrauterine fetal infection, treatment in pregnancy, neonatal manifestations, and management of newborns born to mothers with syphilis.

Registration is free but required if you want credit tracking. Learners review the lesson, pass a five-question quiz at 80% or better, complete a feedback survey, and print a certificate. Free CME, CNE, and CE contact hours are available, which also makes these modules a ready option for continuing education for nurse educators.

The Transferable Lesson

UC added no new course and did not restructure the program. Authoritative, provider-level material already exists, is free, and is kept current with the latest treatment guidelines. Your job is placement, not production.

What the Multisite Evaluation Actually Showed (And Didn't)

The national evaluation was small, and the results are easiest to read when the numbers come first.

The Results

Thirty-one students took part, and 27 supplied matched pre- and post-intervention responses for paired analysis. After completing the syphilis modules, students' self-rated ability to apply evidence-based recommendations for syphilis care improved significantly on both clinical measures evaluated. Knowledge scores rose modestly, but the change was not statistically significant. Finally, 81.5% of participants said they intended to apply what they learned.

How to Read Them Honestly

Self-rated confidence is not demonstrated competence. A student who feels more capable of applying screening and treatment guidance may or may not do so correctly at the bedside. The design adds limits: a small sample, and no control group, so you cannot say the modules caused the gains rather than coursework, clinical rotations, or simple familiarity with the survey. Intent to apply is a promising signal, not a measured behavior.

Why the Knowledge Result Isn't a Failure

It would be easy to treat the flat knowledge scores as a warning sign. Consider the faculty goal, though. The point was not to have students memorize today's recommendations, which will shift as guidance evolves. It was to teach them to locate and use authoritative, current resources when they face a real patient. Seen that way, a significant jump in self-rated ability to apply recommendations is closer to the target outcome than a recall quiz would be. Small paired samples also have little power to detect modest knowledge changes, so a non-significant result here is not proof of no learning.

Your Takeaway

If you copy this model, do not stop at a pre/post survey. Add a performance-based measure, such as competency assessment tools, so you can see what students actually do:

• simulation in nurse education: Observe a student counseling a pregnant patient and ordering the right screening at the right time.
• Chart review: Have students audit a de-identified prenatal record for missed screening or treatment opportunities.
• Resource lookup task: Ask students to find and cite the current guidance for a given scenario, which tests the skill you actually want.

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Where Congenital Syphilis Fits in BSN, MSN, WHNP, and Neonatal Tracks

You do not need a new course to teach congenital syphilis well. Map it into a course your students already take, write one measurable objective per level, and tie that objective to an AACN Essentials domain or NONPF population-focused competency so accreditation reviewers can trace it. Use the rows below as a starting map, and adjust the verbs and assessment to match your program's existing course outcomes.

The Clinical Content Students Must Get Right: Screening, Treatment, and Newborn Evaluation

The major guideline bodies no longer give identical advice on when to rescreen in pregnancy, so students need to learn the differences, not just one rule. Everyone agrees on the first step: screen at the first prenatal visit (USPSTF says as early as possible, and at delivery admission if screening was missed).³ After that, the advice splits. CDC recommends rescreening at 28 weeks and at delivery for patients in communities with high syphilis rates or with HIV or increased acquisition risk.¹ ACOG's 2024 advisory calls for universal third-trimester and birth rescreening.² Have students explain which approach their clinical site follows and why.

Treatment and the 30-day window

Penicillin G is the only antimicrobial known to be effective for preventing fetal infection, and the regimen depends on maternal stage.¹ The detail students most often miss is timing. Maternal treatment counts as inadequate for neonatal management if it was never given, was incomplete or wrong for the stage, or began fewer than 30 days before delivery.¹ Any of those puts the infant on the CDC congenital syphilis pathway.

How the neonatal algorithm sorts infants

Every neonate born to a mother with reactive nontreponemal and treponemal tests gets a physical exam and a quantitative nontreponemal test on the infant's serum, not cord blood.¹ Cord blood can be contaminated with maternal blood (false positive), and Wharton's jelly can cause a false negative.

From there, four scenarios turn on maternal treatment history, the infant exam, and titers:

• Proven or highly probable: abnormal findings, an infant titer at least fourfold above the mother's at delivery, or positive direct detection.
• Possible: the mother was untreated, inadequately treated, undocumented, or treated under 30 days before delivery.
• Less likely: appropriate maternal treatment at least 30 days before delivery, with no reinfection or relapse.
• Unlikely: adequate treatment before pregnancy and a low, stable maternal titer.

The category drives the evaluation, the treatment, and the follow-up.¹ Infants with reactive tests get repeat RPR or VDRL every 2 to 3 months.¹ Titers should fall by 3 months and be nonreactive by 6 months.¹ A test still reactive at 6 months in an infant who was not treated at birth signals likely infection and needs evaluation and treatment.¹

Failures students should catch

• An unresulted maternal test at delivery.
• A treatment record that is unknown or undocumented.
• Cord blood sent in place of infant serum.
• Discharge before the maternal result and treatment dates are reconciled.
• No plan for the 2 to 3 month follow-up testing.

Do not hand out dosing tables. Direct students to the live CDC congenital syphilis guidance, and tell them plainly that recommendations change, so checking the current version is part of the competency.

Simulation and Case-Based Scenarios You Can Run This Term

A systematic review of simulation-based infection prevention and control education pooled 10 studies and found that knowledge improved with both simulation and lecture, with no significant difference between them.¹ Let that shape your planning. Simulation earns its place through confidence, decision-making, and problem-solving, not through a knowledge-score advantage.

What the Evidence Does and Doesn't Support

Be candid with your curriculum committee: no published study directly evaluates simulation for syphilis or other perinatal infection education. The nearest evidence comes from adjacent areas, including a scoping review of community and public health simulation (34 studies, 3,498 participants)² and a review of scenario-based nursing courses (33 studies, 15 of them randomized trials).³ These generally report gains in knowledge, skills, and communication. Findings on confidence and satisfaction vary, and retention beyond five months is rarely tested. Treat the scenarios below as design proposals, not validated interventions.

Three Scenarios to Adapt

• Late entry to care: A patient arrives for a first prenatal visit in the third trimester. Students decide which tests to order, how to open the conversation about sexual health, and what to document.
• Reactive result, unclear history: Students review a lab result alongside incomplete prior records. They determine whether treatment can be confirmed, who must be notified, and how partner treatment is raised.
• Newborn handoff: A mother's syphilis status is unknown or her treatment unconfirmed at delivery. Students give an SBAR report to the neonatal team and explain what drives the newborn evaluation, a skill that overlaps with pediatric nursing simulation integration.

Role play and demonstration were the most common intervention type among the infection-control studies reviewed¹, so you do not need a high-fidelity manikin. A standardized patient or a faculty partner is enough for the communication-heavy scenarios when psychological safety in nursing education is in place.

Debrief With Structure

PEARLS, a debriefing framework built around Description, Analysis, and Clinical Application, fits these cases well.⁵ Its use in syphilis-specific simulation has not been established, so present it as a sound general tool rather than a proven fit. A review of 48 debriefing studies found named frameworks were uncommon, while faculty development was linked to better debriefing quality and educator confidence.⁴ If several instructors will debrief, brief them together first, a practice covered in nurse educator teaching strategies.

Find and Vet Your Own Materials

Do not hard-code treatment details into a scenario script. Build the habit you want students to have:

• CDC guidance: Pull current screening and treatment recommendations directly from the agency, and note the date you accessed them.
• National STD Curriculum: Use its case-based modules as a ready source of vetted patient scenarios.
• Professional associations: Women's health and perinatal nursing organizations publish practice standards worth checking against your learning objectives.
• State and local health departments: These set reporting rules and prenatal screening requirements that vary by location.
• Peer program websites: Look at how other schools schedule simulation lab time and where they place infection content.

For the research itself, search PubMed Central and nursing education journals, and read each review's limitations before citing it. Recheck your scripts every term, because recommendations evolve.

Teaching Screening Barriers, Stigma, and Culturally Safe Communication

Congenital syphilis is now treated as a failure of access and communication as much as a failure of knowledge, so curricula are shifting toward the conversations that decide whether a test happens. CDC data show cases rising for a 12th straight year, which means students need to understand why screening gets missed, not just when it is due.

Barriers Students Should Recognize

• Access: Limited or late prenatal care, plus gaps in insurance coverage.
• Logistics: Transportation problems, work schedules, and childcare that make repeat visits hard.
• Fear of judgment: Patients may delay care if they expect to be blamed.
• Stigma: An STI diagnosis can carry shame that shapes whether a patient discloses, returns, or completes treatment.

Stick to CDC-reported healthcare disparities when discussing who is most affected, and avoid generalizing about any group beyond what the data show.

Four Teaching Strategies

• Role-play: Pairs practice a nonjudgmental syphilis discussion, then swap roles and debrief on tone.
• Bias reflection: A short written prompt asking students to name assumptions they bring to sexual health conversations.
• Structural-barrier vignettes: Cases where a patient misses visits because of cost or transportation, asking students what the system could change to address social determinants of health.
• Trauma-informed language practice: Students rewrite blaming phrases into neutral, collaborative ones.

A Starter Phrase Bank

Offer these as scaffolds, not scripts, and have students adapt them in their own voice.

• "We test everyone who is pregnant for syphilis. It's part of routine prenatal care."
• "This protects you and your baby, and the results stay confidential."
• "If anything comes back positive, treatment is available and we'll work out next steps together."
• "What would make it easier for you to get to your visits?"

Debrief by asking which phrases felt natural and which sounded rehearsed. That gap is where the coaching happens.

Who Does What: Interprofessional and Public Health Collaboration

Syphilis prevention works as a relay across the perinatal continuum, not as one clinician's task; only the relay model prevents congenital cases. Your students need to see every runner and every handoff.

Mapping the Relay

• Prenatal clinicians and NPs: Screen at the first visit, retest when risk or current guidance calls for it, stage the infection, start treatment, and document dates and doses so the record follows the patient.
• Labor and delivery nurses: Confirm that maternal serologic status is documented before the newborn goes home. A missing or outdated result is a flag, not a formality.
• Neonatal team: Evaluate exposed infants using maternal treatment history, the newborn exam, and comparative titers, then decide on treatment and follow-up.
• Health department: Lead case investigation, surveillance reporting, and partner services.

Partner Notification Belongs to Public Health

Students often assume they must contact partners themselves. Typically, health department staff lead partner notification and arrange partner testing and treatment. The nurse's role is a timely referral, clear documentation, and patient teaching on why partner treatment matters, since reinfection after successful treatment can still end in a congenital case. Reporting rules vary by jurisdiction, so teach students how to find their own state's requirements rather than memorizing one version.

Where Exposed Infants Get Lost

The weakest link is often after discharge. An exposed infant may need repeat testing over several months, yet the birth hospital, the pediatric practice, and the health department can each assume someone else is tracking it.

Build a joint activity around that gap:

• Handoff exercise: Pair prelicensure and graduate students in a structured SBAR handoff of a syphilis-exposed newborn from the birth unit to a pediatric clinic, and require them to name who owns each follow-up task.
• Guest session: Invite a health department nurse or partner services specialist to walk students through a de-identified case from referral to closure.

Evaluating Student Competency in Syphilis Care

The multisite evaluation of UC's WHNP modules found significant gains in students' self-rated ability to apply evidence-based syphilis recommendations, but knowledge gains that were not statistically significant. Self-ratings alone are not enough. Use this rubric to pair confidence measures with observed performance, and set expectations by level so BSN students recognize and escalate while graduate students interpret, order, and plan.