Syphilis rates have surged nationwide, notably among females aged 15-39. Since 2018, there has been 109% increase in infectious syphilis in Canada1. This increase has contributed to a dramatic 599% increase in congenital syphilis cases since 2018, with Canada reporting 117 confirmed cases in 2022, compared to just 4 cases in 2016 1. Locally, there has been a concerning increase in syphilis rates, as well. While syphilis is preventable, 206 confirmed infectious syphilis cases and 7 confirmed congenital syphilis cases have been reported in Windsor and Essex County since 2022. These trends highlight the need for increased awareness and intervention to prevent further spread and permanent complications.
Healthcare Providers are encouraged to recommend syphilis screening as frequently as every 3 months for anyone with risk factors1. Risk factors for syphilis include:
- Substance use.
- Unprotected or anonymous sexual activity.
- Sexual contact with a known case of syphilis.
- Sex with someone from a country/region with a high prevalence of syphilis2.
- Previous syphilis, HIV infection or other STBBI.
- Born to a person diagnosed with infectious syphilis in pregnancy.
- Member of a vulnerable population.
- Street involvement.
Prenatal Syphilis Screening Recommendations
The Public Health Agency of Canada (PHAC)1 recommends the following for prenatal syphilis screening:
- Universal screening for all pregnant individuals:
- during the first trimester or at their first prenatal visit.
- repeat screening at 28-32 weeks (or as close to this interval as possible).
- repeat again at delivery for those at ongoing risk of infection or reinfection.
- More frequent screening for individuals at high risk for syphilis.
- Screening for all individuals delivering stillborn infants after 20 weeks gestation.
- Testing of infants with signs or symptoms consistent with early congenital syphilis, even if their mother was seronegative at delivery, as they may have been infected near-term.
Neonatal Assessment for Congenital Syphilis1
Neonates born to individuals with untreated syphilis at delivery or those with a history of recent or inadequate treatment should undergo evaluation for congenital syphilis. This includes pregnant individuals who:
- Received treatment for syphilis within 4 weeks of delivery or were treated with non-penicillin medications.
- Are treated for syphilis prior to pregnancy without proper serologic follow-up.
- Have evidence of reinfection/relapse post-treatment (e.g., a 4-fold increase in antibody titers).
- Have insufficient response to treatment (e.g., failure to achieve a 4-fold decrease in titer despite appropriate penicillin treatment).
- Do not have a well-documented treatment history for syphilis.
Since many infected infants are asymptomatic at birth, it is essential that neonates are not discharged without confirmation that they or their mothers have undergone appropriate serologic testing.
Treatment Protocols
Pregnant individuals diagnosed with syphilis should be treated with the recommended penicillin regimen for their stage of infection, with treatment ideally commencing at least one month prior to delivery1. Maternal treatment before 16 weeks gestation can prevent fetal infection. Testing and treating syphilis promptly are essential to the prevention of congenital syphilis. Healthcare providers should administer the recommended syphilis treatment at every feasible opportunity and consult with an infectious disease specialist for cases of infectious syphilis during pregnancy, particularly when congenital syphilis is suspected. Administer the recommended syphilis treatment at every feasible opportunity and consult with an infectious disease specialist for cases of infectious syphilis during pregnancy, particularly when congenital syphilis is suspected. The PHAC1 advises that neonates exposed to syphilis be assessed at birth by an infectious disease specialist and treated at birth if:
- They exhibit symptoms of congenital syphilis.
- The infant's NTT is at least 4 times higher than the birthing parent’s at birth.
- Maternal treatment was inadequate or occurred within the last month of pregnancy, or if maternal serological response was inadequate.
- Adequate follow-up care cannot be ensured for the infant.
Additional information on treatment and further testing for infants born to mothers with reactive syphilis serology is available from the Canadian Pediatric Society: Congenital Syphilis: No Longer Just of Historical Interest3. Notably, Table 3 of the article outlines the recommended serological follow-up for infants born to mothers with reactive syphilis serology. Free syphilis treatment is available through the WECHU: STI Medication Order Form.
ADDITIONAL READING AND RESOURCES
- Syphilis Guide: Key Information and Resources, 2024 – Public Health Agency of Canada
- Yu W, You X and Luo W. (2024). Global, regional, and national burden of syphilis, 1990–2021 and predictions by Bayesian age-period-cohort analysis: a systematic analysis for the global burden of disease study 2021. Front. Med. 11:1448841. doi: 10.3389/fmed.2024.1448841
- Canadian Pediatric Society, 2024 – Diagnosis and Management of Congenital Syphilis – Avoiding Missed Opportunities
For questions or concerns, please contact us at:
Infection Disease Prevention Department
Windsor-Essex County Health Unit
519-258-2146, ext. 1420
Fx. 226-783-2132