The prevalence of syphilis in Windsor and Essex County (WEC) is of particular concern, with rates significantly increasing, both locally and provincially. Although a high proportion of cases are found among men who have sex with men, syphilis is now shifting towards heterosexual populations, including women. Consequently, this has led to the recent diagnosis of congenital syphilis in local infants.
The Windsor-Essex County Health Unit (WECHU) is strongly encouraging all primary care providers and walk-in clinics to routinely include syphilis testing with STBBI screening. Access to early testing and treatment is vital to reducing the rates of all STBBIs. If cases are missed, or denied testing, this can lead to a delay in treatment and the continued spread of infection. By providing these services, health care providers contribute to the health of the community, and ensure that the values and principles of practice and duties outlined in the College of Physicians and Surgeons of Ontario (CPSO) Practice Guide are being met.
Risk Factors
Individuals who request testing and/or present with risk factors should be tested. Common risk factors for syphilis include:
- Unprotected oral, anal, or vaginal sexual activity
- Multiple and/or anonymous sexual partnering
- Sex with someone from a country/region with a high prevalence of syphilis
- Previous syphilis, HIV infection, or other STBBI
- Born to a person diagnosed with infectious syphilis in pregnancy
- Member of a vulnerable population
- Street involvement and/or substance use
Symptoms
Symptoms of syphilis present differently, according to the stage of disease. Syphilis should be considered in individuals presenting with the following symptoms:
Primary Syphilis (3 to 90 days after infection)
- Painless lesion (chancre) around exposed area (in and around the mouth, genitals and/or rectum)
- Regional lymphadenopathy
Secondary Syphilis (2 to 12 weeks, but up to 6 months after infection)
- Rash on the palms of the hands, soles of the feet, or other parts of the body
- Fever
- Malaise
- Headaches
- Mucosal lesions
- Condylomata lata
- Lymphadenopathy
- Patchy or diffuse hair loss
Early and Late Latent Syphilis
- There are no symptoms in these stages, but infection can still spread if infected for less than 1 year
Tertiary Syphilis (1 to 46 years after infection)
- Cardiovascular syphilis or gumma
Neurosyphilis (can occur at any stage of infection)
- Ocular symptoms (e.g., blurred vision, flashing lights, floaters)
- Otic symptoms (e.g., tinnitus, hearing loss)
- Ataxia
- Vertigo
- Dementia
- Headaches
- Personality changes
- Argyll Robertson pupil
Testing and Treatment
It is recommended that patients are tested at baseline, and after a three-month window period from last potential exposure. Information regarding specimen collection and handling can be found on the Public Health Ontario website.
Syphilis treatment is based on the stage of infection. Guidance regarding syphilis staging, treatment, and follow-up can be found in the Canadian Guidelines on Sexually Transmitted Infections.
If you have any questions or concerns, please call the Windsor-Essex County Health Unit, Monday to Friday, between the hours of 8:30 am to 4:30 pm, at 519-258-2146 ext. 1420. For more information about sexual health, please visit the Windsor-Essex County Health Unit website at: www.wechu.org.