Syphilis remains an important public health challenge in the Americas, with a rising incidence among adults, including pregnant women, leading to an increased number of cases of congenital syphilis. The syphilis resurgence stems from health system gaps, behavioral changes and social determinants. A regional survey and policy review in Latin America and the Caribbean showed that most countries have national policies for syphilis screening and have made progress in the implementation of rapid tests, test-and-treat strategies, partner services, and timely treatment. However, missed opportunities to reduce congenital syphilis persist. For example, regulatory barriers still prevent non-physician health care professionals from undertaking syphilis screening and treatment, insufficient training on screening and treatment is provided for these health care workers, test results are often delayed, stock-outs of supplies for screening and treatment occur, and strategies for management of pregnant women’s partners are weak. These challenges limit access to timely testing and care. Positioning syphilis and congenital syphilis elimination as a national and local priority is essential to address this growing public health emergency.