Syphilis is on the rise across Saskatchewan and many parts of Canada. Syphilis is a sexually transmitted infection caused by bacteria. It can be of particular concern during pregnancy. Congenital syphilis occurs when a woman transfers this infection to their baby during pregnancy, labour, or delivery. The impact of untreated syphilis can be severe for both the mother and baby including stillbirth, premature birth, low birthweight, neonatal death (death in the first 28 days of life), or miscarriage. Saskatchewan currently has the highest provincial rate of congenital syphilis.

Prevention

There are strategies to help prevent congenital syphilis. The first strategy is preventing syphilis among women of childbearing age. Safer sex practices that reduce the risk of syphilis include:

• Reducing the number of sexual partners
• Correctly and consistently using condoms and dental dams during sexual activities
• Avoiding sexual contact with partners who have symptoms of syphilis infection
• Talking to partner(s) about their sexually transmitted and blood-borne infection (STBBI) status and safer sex, and encouraging them to get tested
• Getting tested regularly for syphilis and other STBBIs (every 3 to 6 months for those who are sexually active)

The second strategy for preventing congenital syphilis is timely treatment of maternal syphilis. If maternal syphilis is diagnosed and treated adequately, the outcome for the infant is excellent. To support timely treatment of maternal syphilis, universal syphilis screening should occur in the first trimester or at the first prenatal visit. Repeat syphilis screening between 28-32 weeks gestation and at delivery is recommended for patients at risk of infection or reinfection.

Maternal syphilis treatment is important even after delivery as transmission can occur postpartum during breastfeeding or milk expression if lesions are present on the nipple, areola, or breast tissue. Successful maternal treatment is also important for preventing congenital syphilis in any future pregnancies.

Newborn Care

When prevention of congenital syphilis prior to delivery fails, prompt identification and treatment of newborns can reduce the risk of long-term health problems. As most infants (70%) with congenital syphilis do not have any symptoms at birth, maternal history and syphilis testing are used to help determine possibility of infection and course of care.

When visible symptoms are present, they include rash, peeling of the skin, excess nasal discharge, jaundice (yellowing of the skin or eyes), swelling due to excess fluid in tissues and/or organs, laryngitis or physical crying without sound, and cataracts (clouding of the eye lens). If caregivers see any visible symptoms of early congenital syphilis, they should seek immediate medical attention. Prompt medical attention and treatment is necessary to prevent organ damage and long-term health consequences associated with late congenital syphilis (i.e., infection in children 2 years of age or older). Late congenital syphilis can result in irreversible hearing and/or vision loss.

For more information and a complete list of references, please refer to: Congenital Syphilis Literature Review – Saskatchewan Prevention Institute.

For more information about syphilis in Saskatchewan, visit the Talk Syphilis website.