While doctors in Canada have only seen a few cases of congenital syphilis over the past few years, recent figures from Public Health Ontario show an uptick in reported cases of the rare disease, which passes from a mother with syphilis to a fetus during pregnancy. 

The disease, which has recently spiked to record numbers in Ontario, demonstrates a concerning gap in public health and access to primary care doctors for pregnant people in Ontario, who are required to undergo routine screening for sexually transmitted infections (STIs) and other infectious diseases. 

Babies born with congenital syphilis may have deformed bones, severe anemia, enlarged liver and spleen, jaundice, brain and nerve issues, such as blindness or deafness, meningitis, or skin rashes. The disease can also cause miscarriage, stillbirth, prematurity, low birth weight, or even death shortly after birth. 

According to Public Health Ontario data, an average of one early congenital case was reported per year between 2013 and 2018— typically ranging from zero to two cases per year. Starting in 2019, an increase in congenital syphilis cases was observed, with up to 10 reported cases per year. 

Congenital syphilis means women aren't getting prenatal care because one of the first prenatal visits includes a full screening, including STIs. Is this because to many women can't find family doctors or OBGYNs for regular care?

— Life of Reilly (@AnnaMRG) February 11, 2024

In 2022, a staggering 27 cases were observed in Ontario, with the highest incidence reported in Kingston, Frontenac, Lennox, and Addington Public Health. 

The same year, the age-standardized rate of infection syphilis among females of childbearing age (15-44) was also 2.76 times higher in neighbourhoods with the highest level of material sources-related marginalization, compared to those in the lowest level. 

So many, many diseases making a huge comeback. Measles and syphylis have both been mentioned recently. Our Public Health systems are letting us all down.

— Carol Anne Graham (@CarolAnneGraha4) February 12, 2024

Moreover, the age-standardized rate of infectious syphilis among females of childbearing age was 3.74 times higher in neighbourhoods with the highest level of households and dwellings-related marginalization compared to those with the lowest level. 

"We found those who really struggle from a socio-economic perspective were the individuals who had infectious syphilis during their pregnancy and transmitted it to their fetus or their baby," Dr. Austin Zygmunt, a public health physician with Public Health Ontario told the Star. 

This is horrific!!

— Abigail Whitney🇨🇦 (@AbigailW_RP) February 12, 2024

"(The finding) supports this common principle in public health that providing essential supports, and supporting those with low socio-economic status, can help improve health outcomes."

The number of babies being born
who have caught syphilis before birth
is increasing in Ontario.
Testing, while pregnant, before delivery
means there's time to treat both
before the birth.
Saves problems. https://t.co/LTy31feHbk

— L Graves (@LGSentinel) February 12, 2024

There were also 13,953 cases of syphilis in Canada in 2022, with a rate of 36.1 per 100,000 population — an 11 per cent increase over 2021. Many individuals with syphilis experience symptoms, such as swollen glands, fever, and the appearance of round and painless ulcers, rashes, and wart-like sores in the early stages of the infection. 

While pregnant people are screened for syphilis to help catch cases, difficulty accessing care — including counselling, testing, and treatment — may continue to increase cases beyond numbers ever seen before in the country.