A preventable epidemic: Canadian Paediatric Society statement on congenital syphilis

There is an epidemic of congenital syphilis in Canada, which the Canadian Paediatric Society (CPS) describes as a “preventable public health emergency.” It’s especially prevalent in Western Canada. In a new position statement, “Diagnosis and management of congenital syphilis—Avoiding missed opportunities,” the society outlines how to identify and treat syphilis during pregnancy, as well as in newborns.About one-third of untreated syphilis infections in early pregnancy will end in spontaneous abortion, fetal demise or late-term stillbirth. It can also lead to a range of issues in infants, including failure to thrive, desquamating, maculopapular rash and hepatosplenomegaly. Congenital syphilis is preventable. However, cases continue in Canada, with the rates rising from 4.6 cases per 100,000 live births in 2018 to 13.4 per 100,000 live births in 2020. Regions in Western Canada were more affected than other parts of the country; in 2019, for example, Manitoba had 10 infants who had congenital syphilis over six months. The disease continues as a result of issues such as insufficient public health resources and lack of prenatal care. It’s also the result of treatment issues, like healthcare professionals failing to provide timely treatments, patients who are reinfected after treatment, and their partners not being treated. Read: FAQ: Why are syphilis cases on the rise in Canada?Syphilis is often missed in mothers because the infection’s symptoms of fever, rash or genital ulcers are mistaken for something else, or because it’s asymptomatic. It can be passed from a mother to their child in utero, or during or after birth. Risk factors are drug use, homelessness, having multiple partners, selling or buying sex, not using condoms consistently, and having recently been diagnosed with other sexually transmitted and bloodborne infections.Among the recommendations in the document that CPS makes is for healthcare providers to perform syphilis serology at the first prenatal visit for all patients, and more testing for people who are at a higher risk or live in areas with outbreaks. The disease can be treated during pregnancy using long-acting benzathine penicillin G, and CPS has detailed recommendations for how long that should last. Women who have had no or limited prenatal care and have an unknown syphilis status should have urgent syphilis testing. If the mother’s status is unknown, doctors should test infants at birth. CPS also says all newborns should be screened for signs of congenital syphilis, though most cases are asymptomatic and the effects might not be able to be seen until weeks to months later. Read: Hospital finds multiple medication mix-ups in syphilis cases

A preventable epidemic: Canadian Paediatric Society statement on congenital syphilis

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