Rural-Urban Differences in Maternal Syphilis Trends in the United States, 2016-2023

Cases of syphilis during pregnancy (maternal syphilis) have risen dramatically in the United States in recent years, with racially minoritized groups experiencing high rates and large increases. Rural residents face diminishing access to maternity care, but prior research has not examined rural-urban differences in maternal syphilis. Using expanded natality data from the Centers for Disease Control and Prevention, we compared maternal syphilis rates among rural and urban residents (2016-2023) and showed that, since 2021, rural rates have exceeded urban rates. From 2016 to 2023, maternal syphilis rates quintupled in rural areas and tripled in urban areas. Rates and increases are particularly high among American Indian and Alaska Native and Black rural residents compared with their urban counterparts.