Medical Advisory: Significant Rise in Syphilis Cases

MEDICAL ADVISORY: Significant Rise in Syphilis Cases

Issued by: Dr. Emily Groot, MPH, MD, FRCPC, Associate Medical Officer of Health (Acting)

Syphilis Incidence in Niagara

Syphilis incidence in Niagara is increasing sharply
From 2015 to 2019, approximately 50 cases were reported per year in Niagara
In 2021, 179 cases were reported in Niagara, including four cases of neuro-syphilis and one case of congenital syphilis

Clinical Considerations

The epidemiology of syphilis in Niagara is changing
- Syphilis incidence is increasing in women. Compared to 2019, the rate of infections in females in 2021 more than doubled (6.3 per 100,000 versus 14.8 per 100,000).
Syphilis incidence may be increasing in individuals who report sex with opposite-sex partners. Given the increasing rate and shift in populations affected, ask all patients about their sexual partners and behaviours, including patients who appear to be in a monogamous relationship.

Testing and Treatment

To order syphilis testing, write ‘syphilis screen’ in section 3 of the PHO general test requisition
In most cases, the first-line treatment for syphilis is injectable BICILLIN (benzathine Penicillin G, 2.4 million units IM LA (long acting). The number of doses required depends on stage of infection. Refer to the Canadian STI Guidelines for more information.
- Note that short-acting Penicillin G is not a treatment for syphilis
Bicillin can be ordered from the Sexual Health Centre or by calling 905-688-3817 ext. 7723
For patients with penicillin allergy or other complex scenarios, refer to the Canadian STI Guidelines or call the Sexual Health Centre

Actions Required

Ask all patients about risk factors for acquisition of sexually transmitted infections (STIs)
- Risk factors for acquisition of STIs include previous STI diagnosis, new sexual partner, multiple or anonymous sexual partners, sexual partner(s) having a STI, condomless sex, and sex while under the influence of alcohol or drugs
Advise patients about the importance of STI testing, even in the absence of symptoms. Encourage the use of condoms.
Have a high suspicion for syphilis and a low threshold for testing. Offer syphilis testing to
- Patients with risk factors for acquisition of STIs,
- Pregnant patients, and
- Patients with presentations consistent with syphilis.
Test all pregnant patients for syphilis in the first trimester. Given the increasing rate of syphilis in Niagara, repeat testing at 28-32 weeks and again at delivery should be offered to pregnant patients with ongoing risk, and should be considered for all pregnant patients.
People being evaluated or treated for a syphilis infection should be tested for chlamydia, gonorrhea, and HIV
Additional educational opportunities regarding syphilis are coming soon. Subscribe to the Physicians' Newsletter for information on upcoming professional development opportunities.

Additional Resources