Congenital syphilis represents a reemerging threat to the health of pregnant persons, fetuses, and neonates. A testing and treatment cascade offers insights into successes and opportunities for primary CS prevention. Congenital syphilis (CS) rates have risen in the United States since 2013. Prevention of CS requires testing and treatment of pregnant and pregnancy-capable persons at high risk for syphilis. We developed a CS Prevention Cascade to assess how effectively testing and treatment interventions reached pregnant persons with a CS outcome.