Syphilis in Canada: Rising Cases and Prevention Strategies

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/02/28

The Public Health Agency of Canada is an agency of the Government of Canada that is responsible for public health, emergency preparedness and response, and infectious and chronic disease control and prevention. Between 2018 and 2023, infectious syphilis cases in Canada rose by 77% to 12,135 cases (30.5 per 100,000), while congenital syphilis increased by 220% to 53 cases (14.5 per 100,000 live births). Barriers include inequitable access to testing, stigma, and structural inequities. Prevention strategies emphasize regular screening, safer sex practices, and education. The Public Health Agency of Canada collaborates with partners through initiatives like the Syphilis Response Steering Committee and national awareness campaigns. Early and routine screening is crucial, particularly in pregnancy. Improved access includes point-of-care testing and expanded health education efforts to reduce stigma and promote testing.

Scott Douglas Jacobsen: How have infectious syphilis and congenital syphilis cases changed between 2018 and 2023?

Public Health Agency of Canada: In 2023, there were 12,135 reported cases of infectious syphilis, equivalent to a rate of 30.5 cases per 100,000 people in Canada, and 53 cases of early congenital syphilis, corresponding to a rate of 14.5 cases per 100,000 live births. These rates represent a 77% and 220% increase since 2018, respectively.

Jacobsen: What barriers contribute to the rise of syphilis and other STBBI?

Public Health Agency of Canada: Syphilis is a preventable and curable sexually transmitted and blood-borne infection. If left untreated, syphilis can increase the risk of acquiring HIV and can cause severe health complications, including damage to the blood vessels, heart, brain and nervous system. Congenital syphilis occurs when a syphilis infection is passed during pregnancy or at delivery, and can cause adverse pregnancy outcomes and severe health effects in newborns and children. 

Factors contributing to the rise of syphilis in Canada include inequitable access to testing, treatment, and care, alongside social and systemic barriers such as stigma, discrimination, and structural inequities. Syphilis disproportionately impacts communities and groups experiencing these challenges, including individuals facing housing instability and poverty. The presence of overlapping public health threats, such as HIV and problematic substance use, further increases vulnerability to syphilis infection. These interconnected factors create significant disparities in access to care, making it more difficult for certain affected populations to receive timely testing and treatment.

Jacobsen: What prevention strategies can reduce the spread of STBBI, including syphilis?

Public Health Agency of Canada: Signs and symptoms of syphilis include lesions, rashes, and swollen glands. However, syphilis symptoms can mimic other conditions, and syphilis infection can also be asymptomatic. Even with no symptoms, a person can transmit syphilis to sexual partners and during pregnancy and delivery. That is why it is important to know the risks and how to take preventative and early action. 

Timely screening is vital for detecting and treating asymptomatic infections, as well as reducing the risk of transmission and serious complications that may arise from undiagnosed and untreated STBBI. Individuals can reduce their risk of syphilis infection by practicing safer sex (use of barriers such as condoms and dental dams) and getting tested regularly.

Anyone who is sexually active should be aware of risk factors for syphilis such as having barrierless sex, having multiple sexual partners, substance use including chemsex, and having a previous syphilis infection or other STBBI.  

Health and social sector professionals can support individuals to make informed choices about their sexual health, and together we can help curb the spread of syphilis, prevent negative health impacts and promote inclusive and equitable sexual health care for all. The Public Health Agency of Canada (PHAC) encourages health professionals to integrate syphilis screening into routine health care to reduce stigma and foster a supportive environment for individuals to seek testing and treatment.

Jacobsen: What is being done to increase collaboration across sectors and jurisdictions in addressing syphilis?

Public Health Agency of Canada: PHAC is committed to working with partners and stakeholders across the country in support of the global goal of ending syphilis, viral hepatitis, HIV and other STBBI as public health concerns by 2030. Through the actions outlined in the Pan-Canadian STBBI Framework for Action and the Government of Canada’s STBBI Action Plan, the Government of Canada is working to reduce the impact of syphilis and other STBBI in Canada, and is collaborating with and supporting community-based organizations, Indigenous partners, provinces and territories, researchers, and the health sector towards this goal. 

In late 2022, the Pan-Canadian Public Health Network established a federal, provincial, and territorial committee on STBBI, providing a structured approach to strengthen cross-jurisdictional collaboration. The Syphilis Response Steering Committee (SRSC) serves as a key forum to identify opportunities for action based on emerging evidence and national trends. To further support knowledge exchange and collaborative action, PHAC hosted the Taking Action on Congenital Syphilis in Canada: National Conference 2024 in February 2024 in Ottawa. The event brought together 75 delegates from federal, provincial, territorial, Indigenous, academic, and community sectors, reinforcing the importance of multi-sector collaboration in addressing the rising rates of congenital and infectious syphilis.

Investments in community-based projects continue to be a pillar of the Government of Canada’s strategy and have remained stable for the past decade. The contribution of community-based organizations remains central to Canada’s ability to achieve its public health targets. Projects funded through the HIV and Hepatitis C Community Action Fund (CAF) and the Harm Reduction Fund (HRF) are designed to reach key populations and target regions most affected by HIV, hepatitis C, and other STBBI, including syphilis. To support the coordination of Canada’s response to rising syphilis cases and outbreaks, PHAC established the Syphilis Outbreak Investigation Coordinating Committee (SOICC) in July 2019. Through this committee, provinces and territories share enhanced syphilis surveillance data with PHAC, informing the development of evidence-based policies, programs, and interventions while identifying support needs. Public health surveillance of congenital syphilis is conducted in partnership with provincial and territorial public health authorities. PHAC receives de-identified data on diagnosed cases annually to track trends and inform public health action. More information is available on PHAC’s interactive web platform, Notifiable Diseases Online, and the STBBI surveillance page.

Jacobsen: Why is early and routine screening critical in dealing with syphilis?

Public Health Agency of Canada: Screening is testing that is done to detect conditions in people without any symptoms. Screening is particularly important for STBBI, including syphilis, because symptoms may not be noticed at all, or they may be confused with other conditions, or they may not present until very late, once complications have developed. Syphilis screening and timely treatment are thus essential to prevent complications and reduce ongoing transmission. Syphilis screening is particularly important in pregnancy, because an undetected and untreated infection in pregnancy can be passed during pregnancy or delivery and can cause congenital syphilis for infants.

Jacobsen: How can access to testing and treatment for syphilis be improved?

Health professionals can find PHAC’s syphilis screening recommendations, including recommendations for screening during pregnancy, in the STBBI Guides for Health Professionals. New diagnostic modalities, like point-of-care tests, can expand access to syphilis testing. Health Canada has authorized two dual HIV/syphilis point-of-care tests. These tests can be performed using fingerstick specimens and yield preliminary results for both HIV and syphilis within minutes, providing the opportunity for immediate treatment. It’s important to note that the syphilis component of these tests cannot distinguish between a current or past syphilis infection. Further confirmatory testing with standard laboratory tests and clinical evaluation for accurate diagnosis and treatment planning are necessary. The purchase and implementation of syphilis point-of-care tests falls within the roles and responsibilities of the provinces and territories.  

Jacobsen: How can ordinary Canadians help to foster an inclusive, culturally safe, and stigma-free health system important for addressing syphilis?

Public Health Agency of Canada: Canadians play a role in educating themselves and others in understanding the facts about syphilis. To raise awareness of syphilis and promote the availability of testing and treatment, PHAC developed a knowledge mobilization strategy in close collaboration with community and key populations. It includes advertising campaigns, conferences, webinar series, toolkits and tailored materials for community groups, key populations and health professionals. In March 2023, PHAC launched a short-term social media campaign targeting provinces and territories most affected by increasing infectious and congenital syphilis rates over the past few years in collaboration with key partners and stakeholders. The advertisements were targeted to people 18-40 yrs., with interests in pregnancy and geotargeted to regions with higher rates of syphilis. This small campaign was very successful, reaching people 5,256,164 times and having 6,072 engagements (liked, clicked, shared). During the campaign period, web visits increased by 228%, resulting in 10,985 visits during the 22-day campaign. Canadians can help by sharing this important information with their social networks to help amplify the message and build more awareness of the high rates of syphilis and congenital syphilis.

Building on last year’s efforts, PHAC launched a new awareness campaign (February–March 2025) to encourage young adults (18–39 years old) and health professionals to discuss sexual health, reduce stigma, and promote STBBI testing and prevention, with a focus on syphilis. It expands messaging to overall sexual health while maintaining a two-pronged approach: a national STBBI awareness campaign and targeted syphilis ads in high-incidence regions. The campaign features digital and social media ads, audio ads, and targeted ads to health professionals. Ads will direct traffic to Canada.ca/STI and Canada.ca/syphilis for accessible, evidence-based information.

Jacobsen: Thank you for the opportunity and your time.

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