Health Policy Memo | Liang-Yuan (Claire) Lin | September 30th, 2025
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Winner of the University of Mississippi’s 2025 Terence E. Downer Scholarship
This scholarship honors Terence E. Downer, who worked for 31 years at Johnson and Johnson and died after a short battle with cancer. Mr. Downer’s passions were his family and teaching. Mr. Downer established the scholarship endowment through the Health Care Marketing and Communications Council and it became fully endowed in 2006. It is awarded annually to students pursuing careers in pharmaceutical marketing, and for more than a decade, it continues to support pharmacy students at the University of Mississippi.
Executive Summary
Mississippi faces one of the highest congenital syphilis rates in the US. Limited prenatal care access, maternal care deserts, and stigma prevent timely detection and treatment, leaving infants at risk of severe and preventable outcomes. We propose a statewide mail-order syphilis self-test program, modeled after Alabama’s initiative, to provide free syphilis testing online. By leveraging existing infrastructure, Mississippi can expand early screening, ensure prompt follow-up care, and reduce costly hospitalizations. Similar programs in other states show this approach can improve maternal and infant health outcomes.
An Increase In Early Screening Can Reduce Costly Hospitalizations.
Background
Mississippi is one of the states that had highest new congenital syphilis cases per 100,000 live births reported in 2022.[1] Between 2020 and 2021, the incidence of congenital syphilis rose from 104.3/100,000 live births to 182.0/100,000, a 74.5% jump in a single year. [2] Over the past decade, Mississippi has seen a 1,000% increase in congenital syphilis infant hospitalization, making it a growing public health concern.[2] Moreover, research has shown that it disproportionately affects minority babies and those with limited resources.[2] For example, among infants hospitalized with congenital syphilis, 71.1% were African American, 92.6% were covered by Medicaid, and 58.0% were non-urban residents.[2]
Over The Past Decade, Mississippi Has Seen A 1,000% Increase In Congenital Syphilis Infant Hospitalization.
Congenital syphilis is a serious disease with the potential for both immediate and lifelong health complications. In infants, it can manifest as deformities, hepatosplenomegaly, anemia, and jaundice, often leading to failure to thrive.[3] It is also a significant cause of adverse pregnancy outcomes, including spontaneous abortion, preterm delivery, stillbirth, and neonatal mortality.[3] However, majority of the congenital syphilis is preventable. Early and repeated screening of mothers and penicillin treatment of infected women and their sexual partners can prevent these severe outcomes.[3] Therefore, implementing robust public health initiatives focused on increasing prenatal screening and ensuring access to treatment is essential to combating the rising incidence of congenital syphilis in Mississippi.
The Majority of the Congenital Syphilis Is Preventable.
In response to the escalating crisis, the Mississippi State Department of Health (MSDH) has implemented new policies to improve prevention and control. As of March 2023, the state requires physicians and medical practitioners to perform syphilis testing for all pregnant individuals in their first trimester, again in the third trimester, and at the time of delivery, if no documentation of syphilis test being done for the current pregnancy.[4] Additionally, syphilis infection in pregnancy is now a Class 1B condition, mandating that healthcare providers report cases to the MSDH within one business day of first knowledge or suspicion.[4] The University of Mississippi Medical Center, in coordination with the MSDH, has also launched a syphilis hotline to provide diagnostic and treatment guidance to providers.[5]
Despite these strengthened policies, several persistent challenges limit their effectiveness. First, current clinical policies emphasize repeated prenatal screening, but many pregnant women in Mississippi face challenges in accessing timely care. More than half of all counties in Mississippi do not have healthcare providers offering obstetric care and are considered maternal care deserts.[6] This shortage of facilities means that women often delay prenatal visits especially in rural areas and among minority with limited resources. In addition, stigma around sexually transmitted infections, combined with low health literacy and restrictive sexual health education, also discourages individuals from seeking testing and treatment in traditional clinical settings.[7] Together, these systemic and social barriers reduce the reach of current policies and allow preventable congenital syphilis cases to persist.
Current Policies Implemented in
Mississippi as of 2023:
- State now Requires Syphilis Testing during 1st trimester, 3rd trimester, and (if no record of testing exists) at the time of delivery.
- Syphilis infection in pregnancy is now listed as a Class 1B condition.
- MSDH and UMMC has launched a syphilis hotline.
Current Challenges for Existing Policies:
- Maternal Care Deserts
- Shortage of Providers Offering Obstetric Care
- Transportation allowing Pregnant Women to Access Timely Care
- Low Health Literacy
- Insufficient Sexual Health Education
Implementing an online self-test ordering service for syphilis could expand early detection in Mississippi by reaching individuals who face barriers to care. This approach has already been adopted in states like Alabama and California, where free or low-cost mail-order kits have increased testing rates among underserved populations.[8] By leveraging existing digital and postal infrastructure, Mississippi could replicate this model to provide discreet, confidential, and accessible testing options, helping to identify infections earlier and prevent congenital syphilis transmission.
Key Findings
Mississippi continues to face rising congenital syphilis rates, with more than a 1,000% increase in infant hospitalizations over the past decade.[2] Access to timely prenatal care remains difficult, as over half of counties are classified as maternal care deserts.[6] Alabama has addressed similar challenges by offering free mail-order self-test kits through its public health department, allowing residents to discreetly test for syphilis from home. This model reduces barriers of distance, stigma, and cost, and could be adapted in Mississippi to expand early detection, particularly in rural and underserved communities.
Recommendation
To address rising congenital syphilis rates, we propose a statewide online-order self-test program modeled after Alabama’s initiative. Administered through the Mississippi State Department of Health, this program would allow residents to order free syphilis self-test kits online and return specimens through prepaid mail for laboratory processing. Positive results would trigger follow-up from public health staff to ensure treatment and follow-ups.
Community health centers should serve as hubs for outreach and education, helping residents access the online ordering system. By leveraging existing telehealth infrastructure, the program can also connect individuals who test positive to remote counseling and care navigation.
Community Health Centers Can Serve As Hubs For Outreach And Education, Using Existing Telehealth Infrastructures To Connect Individuals To Remote Counseling And Care Navigation.
This approach would reduce stigma and access barriers by offering confidential, mail-order testing outside of traditional clinical settings. People avoid clinic-based tests due to stigma and access barriers. By allowing individuals to test discreetly at home, the program would encourage screening and earlier detection. Public health staff already engaged in disease intervention could manage follow-up and treatment, ensuring that confidential test transitions smoothly into clinical support. In doing so, Mississippi can overcome longstanding social and structural barriers that drive preventable congenital syphilis cases.
Discreet Online Self-Testing Can Encourage People Who Fear the Negative Stigma of Testing in a Public Clinical Setting.
Conclusion
Mississippi’s congenital syphilis crisis is driven by limited access to care, maternal care deserts, and persistent stigma surrounding sexually transmitted infections. Current testing mandates alone are not enough to address these barriers, leaving undetected infections until it is too late to prevent transmission to infants. A statewide mail-order self-test program would offer a practical solution by expanding access to early and confidential screening and ensuring timely follow-up care. By leveraging existing infrastructure, Mississippi can reduce preventable congenital syphilis cases and improve maternal and infant health outcomes across the state.
References
- America’s Health Rankings analysis of U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention AtlasPlus, United Health Foundation, AmericasHealthRankings.org, accessed 2025.
https://www.americashealthrankings.org/explore/measures/congenital_syphilis/MS - Staneva M, Hobbs CV, Dobbs T. Spike in Congenital Syphilis, Mississippi, USA, 2016–2022 – Volume 29, Number 10—October 2023 – Emerging Infectious Diseases journal – CDC. doi:10.3201/eid2910.230421
- Cooper JM, Sánchez PJ. Congenital syphilis. Seminars in Perinatology. 2018;42(3):176-184. doi:10.1053/j.semperi.2018.02.005
- Emergency Addition of Syphilis Infection During Pregnancy as a Reportable Disease and Requirement of Syphilis Testing During Pregnancy. Published online March 2023. https://msdh.ms.gov/page/resources/19717.pdf
- Combating Mississippi’s syphilis epidemic: MEWI’s multifaceted “We Need to Talk” campaign. University of Mississippi Medical Center. Accessed September 29, 2025.
https://umc.edu/evers-williams/mewi-in-motion-newsletter/2025/Spring/Articles/We Need To Talk.html - Stoneburner A, Lucas R, Fontenot J, Brigance C, Jones E, DeMaria AL. Nowhere to Go: Maternity Care Deserts Across the US. (Report No 4). March of Dimes. 2024. https://www.marchofdimes.org/maternity-care-deserts-report
- Lichtenstein B. Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty. Soc Sci Med. 2003;57(12):2435-2445. doi:10.1016/j.socscimed.2003.08.002
- Analysis of California Senate Bill 306 Health Care: STD Testing. California Health Benefits Review Program. A Report to the 2021–2022 California State Legislature. Published online March 2021.
https://www.chbrp.org/sites/default/files/bill-documents/SB306/sb306-FullReport.pdf
About the Author
Liang-Yuan (Claire) Lin is a fourth-year PhD student in the Department of Pharmacy Administration at the University of Mississippi School of Pharmacy. She received her Bachelor’s degree in Pharmacy from Taipei Medical University in Taiwan. Her research focuses on health outcomes, particularly in pain management, diabetes, and maternal health. In addition to her academic work, she serves as a data analyst for the Center for Pharmaceutical Marketing & Management at the University of Mississippi, where she assists with quality measure, drug utilization review, and other data-driven projects that inform healthcare decision-making. She is passionate about translating research into real-world applications that improve patient care and advance health equity.
