Medical Advisory - Heightened Surveillance for Infectious Syphilis

Released September 5, 2017

Issued by: M. Mustafa Hirji, MD, MPH, FRCPC Associate Medical Officer of Health​


  • ​​There have been 20 laboratory confirmed cases of infectious syphilis as of August 2017
  • This compares to 23 laboratory confirmed cases of infectious syphilis in all of 2016
  • In 2017, Niagara’s incidence of females with infectious syphilis is the highest in Ontario by a large margin
  • All health care providers are encouraged to be on heightened surveillance for syphilis and to consider testing symptomatic patients, and screening those with the highest risk

Clinical Presentation

Primary Syphilis is characterized by

  • Painless chancre 3mm-3cm diameter (clean base, rolled border, associated regional lymphadenopathy)
  • Heals spontaneously in 1 to 12 weeks

Secondary Syphilis involves some combination of

  • ​Maculopapular rash
  • Fever and malaise
  • Mucous patches
  • Condyloma latum (wart-like genital lesions)
  • Headaches/meningitis
  • Patchy/diffuse alopecia
  • Lymphadenopathy

High Risk Groups

  • Sexual contacts of known syphilis cases
  • Men who have sex with men
  • Individuals with a history of multiple STIs/HIV
  • Those engaging in high risk behaviours (multiple partners, anonymous sex, injection drug use)
  • Street-involved, homeless or under-housed
  • Those involved with sex trade


  • ​Serology is used to diagnose, assess with staging, and monitor response to treatment
  • Use the Public Health Ontario General Test Requisition
  • Consultation with a physician experienced in syphilis diagnosis & treatment is encouraged
  • Benzathine Penicillin G is available for free for treatment. For office delivery, order online or via phone at 905-688-3817 ext. 7741

Additional information

  • ​Syphilis Laboratory Interpretation & Treatment Recommendations resource is available by ordering online at, or by phone at 905-688-3817 ext. 7741
  • Canadian STI Guidelines available at and on mobile apps

For further information, please contact Niagara Region Public Health, Sexual Health program at 1-888-505-6074 or 905-688-8248 ext. 7741 Monday to Friday 8:30 a.m. to 4:30 p.m.

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