Syphilis guide: 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) continue to be disproportionately affected by syphilis and other sexually transmitted and blood borne infections (STBBI) in Canada. Reported cases of syphilis among heterosexual populations, particularly among females, have significantly increased in recent years. Congenital syphilis has re-emerged with a record number of cases being reported each year from 2018 to 2020.
Note: Syphilis infections are reportable to local public health authorities in all provinces and territories.
Screening
Screening for syphilis is recommended for all sexually active persons with a new or multiple partners, and/or upon request of the individual. For individuals with multiple partners, it is recommended to screen every 3 to 6 months.
Targeted "opt-out" screening programs should be considered as frequently as every 3 months when serving population groups and/or communities experiencing high prevalence of syphilis (and other STBBI).
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/Infographics
See the following webpage for more resources: Syphilis: Awareness resources
Surveillance
For the most up-to-date surveillance information on syphilis and other STBBI, consult the Sexually transmitted and blood-borne infections surveillance webpage.
Journal Articles
- Canada Communicable Disease Report, Volume 48-2/3: February/March 2022: Syphilis Resurgence in Canada
- 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
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