Syphilis: Key information and resources

This guide is about management of primary, secondary, latent and tertiary syphilis.  Some information about neurosyphilis and congenital syphilis is included, however their treatment is outside the scope of this document. Individuals with these conditions should be managed by or in consultation with an infectious disease specialist or an experienced colleague.

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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 woman 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

Surveillance

Journal Articles

Other Guidance

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