REACT-Syph: Maternal and Congenital Syphilis Surveillance

Syphilis infection rates have increased drastically and disproportionately among women in Canada (252% increase over 5 years in women compared to 67% in men). This has resulted in increasing rates of syphilis in pregnancy and transmission of syphilis to infants during pregnancy/delivery (congenital syphilis). In 2022, there were 246 reported cases of congenital syphilis or 31.7 cases of confirmed early syphilis per 100,000 births. The number of cases has drastically increased since 2017, when there were only eight total diagnoses of confirmed early congenital syphilis in Canada. While syphilis has increased most significantly in the Prairie provinces, other provinces including BC, Ontario, and Quebec have also documented substantial increases. The World Health Organization (WHO) released a call to action to eliminate congenital syphilis in 2007 and while Canada as a whole remains below the elimination target (<50 per 100,000 live births), several provinces/territories are above the elimination target with rates of confirmed early congenital syphilis up to 175 cases per 100,000 live births. Despite the current screening and treatment guidelines for syphilis in pregnancy, our dramatically increasing and regionally high rates of syphilis are resulting in poor health outcomes for women and their infants.

In order to combat the rising rates of syphilis in pregnancy and congenital syphilis and create evidence-based prevention strategies, we need a better understanding of the circumstances surrounding infections and why diagnosis and treatment in pregnant women is not happening consistently across the country. There is currently limited surveillance data on syphilis cases in pregnancy in Canada, which constrains our ability to inform best intervention strategies for the prenatal population.

As part of this project, we are creating a pan-Canadian syphilis in pregnancy surveillance program that includes cases from 2013-present. This surveillance system will build on the established infrastructure and relationships with regional and provincial public health to characterize cases of antenatal syphilis, including cases that result in congenital syphilis, identify barriers to care and gaps in current prevention strategies, and inform future interventions.

Principal Investigator: Dr. Deborah Money, MD, FRCSC, Professor, Obstetrics & Gynecology, Medicine, SPPH, Clinician Scientist, Women’s Health Research Institute.

For further information please contact the Congenital Syphilis Research Manager Emma Karlsen: emma.karlsen@cw.bc.ca