Syphilis guide: Key information and resources

On this page

• Key Information
  • Public health importance
  • Screening
  • Diagnostic testing
  • Treatment
  • Follow-up
  • Partner notification
• Resources
  • Awareness resources
  • Surveillance
  • Journal Articles
  • Other Guidance

Key Information

Public health importance

Syphilis is of considerable public health importance in Canada as evidenced by a steep increase in rates since 2014. Left untreated, syphilis has many associated complications. Gay, bisexual and other men who have sex with men (gbMSM) are disproportionately affected. Higher rates are still reported in this population although an increasing number of outbreaks in heterosexual populations have been reported in Canada since 2017. Congenital syphilis is also re-emerging with the highest number of cases ever being reported in 2018 and 2019.

Note: Syphilis infections are reportable to local public health authorities in all provinces and territories.

Screening

Routine screening is recommended for people with risk factors for syphilis and for pregnant people.

Screening is of particular importance in pregnancy for the prevention of congenital syphilis and its impact on pregnancy outcomes. Universal screening is recommended for pregnant people during the first trimester or at first prenatal visit. Repeat screening at 28 to 32 weeks and again at delivery is recommended for pregnant people at ongoing risk of infection or reinfection and in areas experiencing outbreaks of syphilis. Consider screening more frequently pregnant people at ongoing risk of infection. Screen all people who deliver a stillborn infant after 20 weeks gestation.

Diagnostic testing

Syphilis is usually diagnosed through serology regardless of suspected stage of infection. Interpretation of serology results can be complex, and different testing algorithms may be used by provinces and territories. Consult with your local laboratory regarding testing protocols.

Treatment

Infectious syphilis (primary, secondary and early latent stages): Long-acting Benzathine Penicillin G 2.4 million units intramuscular as a single dose.

Longer duration syphilis (late latent and tertiary syphilis): Three (3) weekly doses of Benzathine penicillin G-LA 2.4 million units IM.

Neurosyphilis requires more aggressive treatment with intravenous antibiotics, and should be managed by, or in consultation with, an infectious disease specialist.

Follow-up

Post treatment serologic testing is used to assess treatment response. It should be done at recommended intervals, which vary depending on stage of infection.

Partner notification

Test and treat sexual or perinatal contacts. The trace-back period will depend on the stage of infection of the index case.

Resources

Awareness Resources

• Factsheets
  • Responding to syphilis in Canada (factsheet)
  • Infectious Syphilis in Canada, 2018 (infographic)
• Summary of Recommendations for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Syphilis (factsheet)
• Syphilis among gay, bisexual, two-spirit and other men who have sex with men: A resource for population-specific prevention

Surveillance

• Report on sexually transmitted infections in Canada, 2017

Journal Articles

• Infectious and congenital syphilis in Canada, 2010–2015
• Canadian Public Health Laboratory Network laboratory guidelines for the use of serological tests (excluding point-of-care tests) for the diagnosis of syphilis in Canada

Other Guidance

• Sexually transmitted and blood-borne infections: Guides for health professionals