Let’s talk about syphilis (infographic)

Tips for health professionals on the screening and management of syphilis in Canada

What you can do as a health professional

Talk: Normalize sexual health discussions

Sexual health and STBBI^{Footnote 1} prevention are an integral part of everyone's health care. Provide culturally aware and trauma-informed care when counselling people about syphilis.

Screen: Prevent transmission and complications

Adults and adolescents

• Screen all sexually active persons with a new or multiple partners, and/or upon request of the individual.
• Screen those with multiple partners every 3 to 6 months.

High prevalence groups^{Footnote 2}

• Consider targeted "opt-out" screening as frequently as every 3 months.
• Consult the NAC-STBBI syphilis screening recommendations for more information.

In pregnancy

• Screen in the first trimester or at the first prenatal visit.
• Re-screen at 28 to 32 weeks and during labour in areas with outbreaks and for people at ongoing risk for infection.

Treat: Early diagnosis and treatment lead to better health outcomes

Preferred treatment for syphilis in the absence of contraindications or allergies:

Primary, secondary and early latent syphilis - Benzathine penicillin G-LA 2.4 million units IM as a single dose.

Late latent and tertiary syphilis - Benzathine penicillin G-LA 2.4 million units IM weekly for 3 doses.

Notes

• Manage syphilis in pregnancy in consultation with an obstetric/maternal-fetal specialist. Some experts recommend 2 doses of benzathine penicillin G-LA 2.4 million units 1 week apart for primary, secondary and early latent syphilis in pregnancy, particularly in the third trimester.
• Refer individuals with neurosyphilis to a neurologist or infectious disease specialist.
• Inform patients about the Jarisch-Herxheimer reaction after treatment with penicillin.
• Consider treating sexual contacts of primary, secondary and early latent syphilis from the previous 90 days, especially if they may be lost to follow-up.
• Recommend to individuals and partners to abstain from sexual contact for 7 days after treatment.

Follow-up: Monitor patients and notify contacts

Confirm response to treatment with serologic testing. Notify, assess, and test contacts.

Follow-up serologic testing and trace-back periods for syphilis

Stage	Follow-up serologic testing	Trace back period
Primary, secondary, and early latent syphilis	At 3, 6, and 12 months Pregnancy: At 1, 3, 6, and 12 months (monthly if at risk of re-infection)	Primary: 3 months Secondary: 6 months Early latent: 1 year
Late latent and tertiary syphilis	At 12 and 24 months Pregnancy: At delivery, and at 12 and 24 months	Long-term sexual partner(s) and children as appropriate
Neurosyphilis	At 6, 12, and 24 months	Not applicable
Co-infection with HIV	At 3, 6, 12, 24 months, then yearly	Not applicable

Learn more

Check out the STBBI Guides for Health Professionals.

Download the CDN STBBI Guidelines mobile app (available on the App Store or Google Play).

Note

Recommendations do not supersede any provincial/territorial legislative, regulatory, policy and practice requirements or professional guidelines that govern the practice of health professionals in their respective jurisdictions, whose recommendations may differ due to local epidemiology or context.