Syphilis

Syphilis case rates in Saskatchewan have been steadily increasing since 2017 with a sharp increase observed in 2019. Cases have been reported in all age groups with the majority of cases in young adults 20-39 years of age. Case rates are increasing most rapidly among heterosexual populations and are now higher in women than men, although elevated rates of infection continue to occur in gay, bisexual and men who have sex with men (gbMSM). The increase in cases in females of childbearing age has led to a re-emergence of congenital syphilis with 68 cases (including 8 stillbirths) reported in Saskatchewan between 2019 and 2022. Cases of neurosyphilis have also been reported among persons also infected with human immunodeficiency virus (HIV).

What You Need to Know

Syphilis is a sexually transmitted infection (STI) caused by the bacterium treponema pallidum. If left untreated, syphilis may permanently damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.

Congenital syphilis (CS) is a disease that occurs when a baby is infected during pregnancy or at the time of birth. Syphilis in pregnancy can lead to serious birth defects and death of the fetus in pregnancy (spontaneous abortion or miscarriage) or death of the baby at the time of birth (stillbirth).

Neurosyphilis is a disease that occurs when the brain or spinal cord is affected. Untreated neurosyphilis can result in permanent paralysis, dementia and death. Neurosyphilis may occur more frequently and progress more rapidly in people who also have a HIV infection.

Being infected with syphilis increases a person’s risk of being infected with HIV and other STIs (co-infection).

Syphilis spreads through direct contact with a syphilis sore during vaginal, anal, or oral sex. Having a sore or break in the skin from an STI such as syphilis may allow HIV to more easily enter the body. It may not be obvious that a person has syphilis. Syphilis sores in the vagina, anus, mouth, or under the foreskin of the penis may be small and can be hard to see.

Condoms, used properly and consistently, are effective in preventing syphilis, HIV and other STIs.

Testing for syphilis requires a blood test. It is a good idea to be tested at the same time for other STIs. Follow-up testing is required to make sure that treatment is successful.
When diagnosed and treated in its early stages, syphilis is easy to cure with antibiotics; usually given by injection (shot). Congenital syphilis and neurosyphilis are complications of syphilis infection, and so treatment may not be able to reverse damage that has already occurred. Having syphilis once does not protect people from getting the disease again. Even after successful treatment, people can be re-infected during unprotected sex.

Symptoms

Primary Stage (the first stage)

• A painless sore called a chancre ("shank-er") will appear 10-90 days after infection occurs.
• The chancre is usually firm, round, small and painless.
• The sore appears where the bacteria enters the body such as the vagina, penis, mouth or anus and may not be noticed.
• Symptoms may be mild.
• Symptoms may go away without treatment, but the infection will progress to the secondary stage.

Secondary Stage (the second stage)

• Starts two to four months after becoming infected and lasts for several weeks.
• Starts with a non-itchy rash.
• The rash may appear as rough, red or reddish brown spots on the palms of the hands and bottoms of the feet.
• Rashes with a different appearance may occur on other parts of the body.
• Other symptoms may be fever, swollen glands, sore throat, hair loss, headaches, weight loss, muscle aches and tiredness.
• The signs and symptoms will resolve without treatment, but the disease will progress to latent and possibly late stages of the disease.

Latent and Late Stages

• Begins when the symptoms of the secondary stage disappear.
• There are no signs or symptoms (latent stage), but the disease may begin to damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.
• Symptoms may appear 10 to 20 years after infection (late stage) and may include difficulty in coordinating muscle movements, gradual blindness, dementia, and may result in death.

The long-term complications of Syphilis

It can damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.

Syphilis in a pregnant woman can lead to miscarriage, serious birth defects and possible death of the newborn.

Testing and Treatment

For testing and treatment, contact your local public health office, your physician, nurse practitioner, or a sexual health clinic.

For more information, contact HealthLine811 or HealthLine Online.

Risk to Canadians

PHAC updated the Public Health Risk Profile: Infectious syphilis outbreaks and re-emergence of congenital syphilis in Canada in July 2023. The risk profile characterizes the public health risk associated with the increasing rates of infectious and congenital syphilis in multiple provinces and territories in Canada.

Information for Health Professionals

• Syphilis Laboratory Testing Algorithm for reflex testing performed and test interpretation guidance (Saskatchewan Health Authority)
• Syphilis Notification Form (Ministry of Health)
• Syphilis Public Health Resources (Saskatchewan Health Authority)
• Infant Exposed to Syphilis in Utero or During Birth/Congenital Syphilis Notification Form
• Syphilis Maternal/Children’s Health Clinical Resources (Saskatchewan Health Authority)
• Syphilis Guide: Key information and resources for the management of primary, secondary, latent and tertiary syphilis (Canadian Guidelines on Sexually Transmitted Infections, Public Health Agency of Canada)
• STBBI Treatment Education Program for Saskatchewan (STEPS) (University of Saskatchewan)