Congenital syphilis re-emergence in Winnipeg, Manitoba

Benoit, Peter; Tennenhouse, Lana; Lapple, Alicia; Hill-Carroll, Gillian; Shaw, Souradet Y.; Bullard, Jared; Plourde, Pierre

doi:10.14745/ccdr.v48i23a06

Cited by 15 publications

(11 citation statements)

References 9 publications

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“…Similar observations were reported in neighboring countries, including Canada, with a 10- to 15-fold increase of congenital syphilis between 2016 and 2020 ( 16 ). Once again, the populations identified as most at risk were Native American and economically challenged patients: they face a lack of access to care, longer delays between diagnosis and treatment with many missed opportunities ( 16 , 34 ). Mexico was also affected by a 6-fold increase in the number of congenital syphilis cases between 2010 and 2019 ( 17 ).…”

Section: Congenital Syphilis: Situation Over the Past Few Yearssupporting

confidence: 85%

Congenital syphilis in Switzerland: a marker of inequality? A mini-review

David,

Posfay-Barbe,

Aguiar Nogueira

et al. 2023

Front. Public Health

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Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals.

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Section: Congenital Syphilis: Situation Over the Past Few Yearssupporting

confidence: 85%

Congenital syphilis in Switzerland: a marker of inequality? A mini-review

David,

Posfay-Barbe,

Aguiar Nogueira

et al. 2023

Front. Public Health

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“…11,14,15 Social determinates of health including poverty and substance use are key factors in the current syphilis crisis. 11,14,15 There is a need for innovative methods to reach persons who experience barriers in accessing care.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have established that late presentation for syphilis screening during pregnancy is a strong predictor of an infant with CS. 11,14,15 Social determinates of health including poverty and substance use are key factors in the current syphilis crisis. 11,14,15 There is a need for innovative methods to reach persons who experience barriers in accessing care.…”

Section: Discussionmentioning

confidence: 99%

“…Screening for syphilis at the first prenatal visit is routine across Canada, and costs are covered. Studies have established that late presentation for syphilis screening during pregnancy is a strong predictor of an infant with CS 11,14,15 . Social determinates of health including poverty and substance use are key factors in the current syphilis crisis 11,14,15 .…”

Section: Discussionmentioning

confidence: 99%

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Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada

et al. 2023

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Background Data on the incidence and characteristics of stillbirths attributed to congenital syphilis were collected. Methods We extracted data on stillbirths in the Edmonton Zone on January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. Results Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths were diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (1 of whom was treated early in pregnancy and presumably reinfected), and 1 had a stillbirth in the week after one dose of benzathine penicillin G. Conclusions Stillbirths due to congenital syphilis were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.

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“…This could be a result of many factors including increased incidence of syphilis in women and men who have sex with women (increasing the number of infectious individuals in a community), reduced effectiveness of partner services, changes in sexual behaviour or sexual networks, or even the effects of expanded electronic laboratory reporting by providers and laboratories (compared with telephone, fax or mailed case reports), which may have increased the capacity to report infections 10. Other countries and jurisdictions have similar screening and treatment protocols to Florida, and have found similar challenges in CS prevention including: lack of or inadequate prenatal care, maternal reinfections or mother’s testing positive after an initial negative syphilis test 19–21. Finally, these increases are not likely a result of an increase in number of live births in Florida as the number of live births only increased 1.5% from 2013–2014 (435 099 live births) to 2018–2019 (441 518) 22…”

Section: Discussionmentioning

confidence: 99%

Exploring changes in maternal and congenital syphilis epidemiology to identify factors contributing to increases in congenital syphilis in Florida: a two time-period observational study (2013–2014 vs 2018–2019)

et al. 2022

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ObjectivesAs, cases of congenital syphilis (CS) and infectious syphilis among women more than doubled in Florida and across the nation during 2013–2019, we sought to understand what may be contributing to these increases in Florida.DesignA two time-period observational study.SettingPregnant women with reported syphilis infections and their pregnancy outcomes (2013–2014 and 2018–2019) in Florida.Participants1213 pregnant women with reported syphilis infections living in Florida and 341 infants meeting the CS case definition.Outcome measuresWe assessed what proportion of the increase in CS was from increases in maternal syphilis infections. We examined maternal demographics, infection characteristics and timing of diagnoses that could explain the increase in CS. Finally, we reviewed if changes in presentation or severity of CS cases occurred.ResultsDuring 2013–2014, 83 (21%) of 404 pregnant women with syphilis delivered babies with CS. During 2018–2019, 258 (32%) of 809 pregnant women with syphilis delivered babies with CS. Comparing CS prevention rates, it was determined that 65% of the increase in CS was due to the increases in maternal syphilis infections. The proportion of maternal cases staged as primary or secondary increased over time (7%–13%) (p<0.01) and reports of drug use became slightly more common (6%–10%) (p=0.02). During 2018–2019, women delivering CS infants were more likely to be reinfected during the same pregnancy (27 (10%) vs 5 (6%) p=0.23) and more had negative third trimester screening tests (43 (17%) vs 7 (8% p=0.07)). The percentage of infants with CS who had ≥1 sign or symptom increased from 35% to 40%, and the combined total of stillbirths and infant deaths increased from 5 to 26.ConclusionsRecently, more pregnant women are being infected with syphilis and a higher per cent are not being treated to prevent CS. The reasons for this finding are unclear.

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Congenital syphilis re-emergence in Winnipeg, Manitoba

Cited by 15 publications

References 9 publications

Congenital syphilis in Switzerland: a marker of inequality? A mini-review

Congenital syphilis in Switzerland: a marker of inequality? A mini-review

Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada

Exploring changes in maternal and congenital syphilis epidemiology to identify factors contributing to increases in congenital syphilis in Florida: a two time-period observational study (2013–2014 vs 2018–2019)

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