Syphilis is resurgent in many parts of the world. Even in those countries where rates have fallen focal outbreaks still occur. Congenital syphilis is an inevitable consequence of undetected and untreated syphilis in a pregnant woman. Universal screening in pregnancy, even if the positive yield from the test is low, remains the keystone to congenital syphilis prevention. Programmatic attention to testing, treating, education, and contact tracing in pregnancy and subsequent late trimester retesting of high-risk women will lower congenital infection rates. Any slip in this meticulous process inevitably leads to resurgence of congenital syphilis.