Who is affected and how:

• Pregnant people and their infants: The guidance is intended to increase screening (including in late pregnancy and at delivery), testing, and rapid treatment, which should reduce the number of babies born with congenital syphilis and lower pregnancy-related complications from untreated maternal infection.
• Health care providers and clinical systems: Providers who deliver prenatal care, labor/delivery, and newborn services will be asked to follow recommended practices for additional screening, education, and treatment protocols. This may require changes to clinic workflows, testing schedules, and patient counseling.
• State Medicaid and CHIP agencies and state public health systems: Agencies that finance and oversee care for many pregnant people will receive HHS best‑practice guidance and may need to update coverage policies, provider guidance, or quality measures to align with recommendations.
• Indian Health Service, tribes, and Urban Indian organizations: These organizations are specifically named as recipients of guidance to address syphilis in American Indian and Alaska Native populations and to improve access to testing and treatment in tribal and urban Indian health settings.
• Public health programs and telehealth services: The guidance emphasizes telehealth and education approaches to expand access to testing and follow-up care, potentially increasing use of remote services and public health outreach.

Potential effects and risks:

• Benefits: More consistent screening in late pregnancy and at delivery, better provider and patient education, and improved access to testing and treatment could substantially reduce congenital syphilis cases.
• Resource and administrative implications: Because the law does not provide new funding, implementing guidance (e.g., extra tests, staff time, telehealth expansion) may create costs or require reallocation of existing resources at state and tribal programs and health providers.
• Variable uptake: Guidance is nonbinding—public health impact depends on how quickly and thoroughly states, payers, and providers adopt the recommendations.
• Reporting transparency: The required public report to Congress will provide information on implementation that can identify gaps and further needs, which may prompt future policy or funding action.