Syphilis remains a major global public health threat that in recent years has increased dramatically among pregnant women and infants in the United States.1–3  Health care professionals caring for mothers and newborns have voiced an urgent call to action, but, unfortunately, roadblocks persist. In the current issue of Pediatrics, O’Connor et al highlight the ongoing challenges with the management of syphilis in people of all ages, not just mothers and infants, namely, the lack of accurate modern diagnostic tests and provider knowledge on the interpretation of the available assays.

In addition to demonstrating the importance of maternal syphilis screening throughout pregnancy, the authors also detail the predicament posed by the relatively high false-positive rates in both traditional and reverse sequence syphilis screening algorithms. Traditional syphilis screening consists of an initial nontreponemal antibody test (eg, rapid plasma reagin test) that, if reactive, is followed...

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