Syphilis

Syphilis is on the rise in the Middlesex-London region.

Syphilis cases started increasing in 2017 with about 38 cases per year. Between 2019 and 2022, cases increased to over 100 per year. This equals an average of 20.9 cases per 100,000 people, which is higher than the Ontario rate of 15.7 per 100,000 people (Public Health Ontario, 2020).

How is it spread?

Syphilis is a sexually transmitted infection (STI) caused by the bacteria Treponema pallidum. It’s spread to others during sexual contact (vaginal, oral, or anal).

What are the risks?

Most people who have syphilis don't even know it - you may not experience symptoms! This makes it very easy to spread the infection to others.

• Longstanding untreated syphilis can damage the heart, the nervous system, and other major organs.
• Individuals infected with syphilis are at greater risk of getting and spreading other STIs, including HIV.
• Taking medication will treat syphilis but any damage that has been done to the body before treatment cannot be reversed.

How to protect yourself

The best way to prevent infection is to make sure that you and your partner have both been tested and are syphilis-free before having sex.

• Get tested
• Use condoms or dental dams every time you have sex, even if you are using another form of birth control.
• Do not share sex toys

NOTE: If a syphilis sore is outside of the area covered by a condom, you could still be infected or infect your partner.

What are the symptoms?

Symptoms may appear 3 to 90 days after sexual contact with an infected person. Once the bacteria enters the body, the disease goes through a few stages. Symptoms will vary depending on the stage of the infection.

Primary Syphilis (1st Stage)

• Symptoms usually develop 3 days to 3 months after contact.
• A painless open sore develops around the genitals, rectum, and/or mouth.
• The sore will heal on its own, but the infection remains.

Secondary Syphilis (2nd Stage)

• Symptoms usually develop 2 to 24 weeks after exposure.
• A rash can develop anywhere on the body, including on the palms of the hands and soles of the feet.
• Flu-like symptoms develop, including headache, slight fever, fatigue, loss of appetite, weight loss, and sore throat.

Latent Syphilis (3rd Stage)

• Latent syphilis occurs after secondary syphilis.
• Typically, there are no symptoms.

When should you get tested?

• If you have any signs or symptoms of syphilis
• If you are a contact of a partner with positive Syphilis result
• After any type of unprotected sex
• After your last partner and before a new partner

To get tested, contact your healthcare provider or call 519-663-5317 to get tested at the Middlesex-London Health Unit’s STI Clinic.  A blood test is required.

How is syphilis treated?

• Your healthcare provider will give you antibiotics.
• Avoid all sex (oral, anal, and/or vaginal) for 14 days after taking the medication.
• Do not have sex with your current partner until they are tested and treated.
• Syphilis treatment is available at the STI Clinic. Please call 519-663-5317 to speak with a nurse and book an appointment for treatment.

What about your sexual partners?

• Individuals who test positive for syphilis are asked to tell all sexual partners so they can be tested and/or treated. A public health nurse can help you contact sexual partners if needed.

Is follow up needed?

• Yes. After treatment, blood tests are required to confirm that the infection has been treated properly.

Syphilis for Healthcare Providers

For general information about syphilis, scroll to the top.

Syphilis is a reportable disease and any confirmed or suspected cases should be reported as soon as possible to public health or by the next working day.
To report a confirmed or probable case of syphilis, please use – MLHU Reportable Disease Notification Form or alternatively call us at 519-663-5317.

Infectious Diseases Protocol

The Infectious diseases protocol 2023 (PDF) includes:

• Appendix 1: Case Definitions and Disease Specific Information Disease: Syphilis a disease of public health significance. (Ministry of Health, Ontario Public Health Standards: Requirements for Programs, Services and Accountability Infectious Disease Protocol)

Testing and Treatment for Syphilis

• As a healthcare provider, you can call the health unit to order medications (i.e., Bicillin) for your patients at 519-663-5317
• Syphilis testing and treatment is also available at the Middlesex-London Health Unit’s STI Clinic. Your patient can call 519-663-5317 to speak with a nurse and book an appointment for treatment. A blood test is required.
• Refer to MLHU Sexually Transmitted Infections (PDF) -Recommended Treatment for Syphilis
• Public Health Ontario Syphilis-Serology
• Government of Canada Staging a Syphilis Infection in Adolescents and Adults: Selected Physical Exam Findings According to Stage of Disease
• Government of Canada Syphilis Guide: Treatment and follow-up
• Public Health Ontario Bacterial STI Testing: Quick Reference

Healthcare Provider Resources

• Government of Canada Simplified algorithm for clinical syphilis staging and treatment in adolescents and adults
• Government of Canada Syphilis Guide: Key information and resources
• Public Health Ontario Syphilis (includes Best Practice, data and analysis, laboratory testing, etc,)
• Public Health Ontario Enhanced Epidemiological Summary Infectious Syphilis and Early Congenital Syphilis in Ontario: Focus on 2022
• Government of Canada, 2020 Syphilis in Canada, Technical Report on Epidemiological Trends, Determinants and Interventions

Contact Us

For more information, please contact the MLHU at 519-663-5317.

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