BACKGROUND: Congenital syphilis (CS) results when an infected pregnant mother transmits syphilis to her unborn child prior to or at delivery. The severity of infection can range from a delivery at term without signs of infection to stillbirth or death after delivery. OBJECTIVES: To describe congenital syphilis (CS) morbidity and mortality during 1999-2013. STUDY DESIGN: National CS case data reported to CDC during 1999-2013 were analyzed. Cases were classified as "dead cases" (stillbirths and deaths up to twelve months after delivery), "morbid cases" (cases with "strong" (physical, radiographic, and/or non-serologic laboratory) evidence of CS), and "non-morbid" cases (cases with a normal physical examination reported, but without strong evidence of infection). Annual rates of these cases were calculated. Cases were compared using selected maternal and infant criteria. RESULTS: During 1999-2013, 6,383 cases of CS were reported: 6.5% (dead), 33.6% (morbid), 53.9% (non-morbid), and 5.9% (unknown morbidity); 81.8% of dead cases were stillbirths. Rates of dead, morbid, and non-morbid cases all decreased over this time period, but the overall proportions that were dead or morbid cases did not significantly change. The overall case fatality ratio during 1999-2013 was 6.5%. Among cases of CS, maternal race/ethnicity was not associated with increased morbidity or death, although most cases (83%) occurred among black or Hispanic mothers. No or inadequate treatment for maternal syphilis, less than ten prenatal visits, and maternal non-treponemal titer ≥ 1:8 increased the likelihood of a dead case; risk of being a dead case increased with maternal non-treponemal titer (chi2 for trend p<0.001). Infants with CS born alive at <28 weeks gestation (RR=107.4, p<0.001) or born weighing <1,500 grams (RR=43.9, p<0.001) were at greatly increased risk of death. CONCLUSIONS: CS remains an important preventable cause of perinatal morbidity and mortality, with comparable case fatality ratios during 1999-2013 (6.5%) and 1992-1998 (6.4%). Detection and treatment of syphilis early during pregnancy remain crucial to reducing CS morbidity and mortality.