Summary
A surge in Ontario syphilis cases among women has triggered a dangerous rise in preventable congenital infections in newborns. This crisis is fueled by a critical screening gap, with one in five pregnant individuals, particularly those in vulnerable or rural communities, missing early prenatal testing.
Syphilis was once considered a disease largely under control in Canada. That’s no longer the case.
Across Ontario, reported infectious syphilis cases quadrupled between 2013 and 2023. What was historically concentrated in urban centres and among men has become a province-wide concern and the demographic shift is alarming. Women of reproductive age now represent the fastest-growing at-risk group, with female cases rising five-fold over the last decade.
The consequences of that shift are now showing up in newborns.
What is congenital syphilis and why does it matter?
Congenital syphilis occurs when a pregnant person passes the infection to their baby. It is entirely preventable. With timely screening, syphilis is treated with one to three penicillin injections, depending on the stage of the infection. But if it goes undetected and untreated during pregnancy, the outcomes can be severe: miscarriage, stillbirth, preterm birth, developmental delay, blindness, deafness, and infant death.
In Canada, the rate of congenital syphilis reached 14.5 cases per 100,000 live births in 2023, a 220% increase since 2018.
A new study reveals the screening gap
New research published in the Canadian Medical Association Journal (CMAJ) examined over 550,000 pregnancies in Ontario between 2018 and 2023. The findings are sobering.
One in five pregnant women in Ontario did not receive timely first-trimester syphilis screening, which is the window when testing is most effective and treatment has the greatest chance of preventing harm to the baby. More than 44,000 pregnant people were not screened when they should have been.
Of those who were screened, 86% received testing in the first trimester. About 3% were screened as late as the third trimester or at delivery, far too late for optimal prevention.
Who is most at risk of falling through the cracks?
The study found that late or missed screening was not random, it was concentrated among people who already face the greatest barriers to care.
Risk factors for late or missed screening included a history of injection or illicit drug use, living in lower-income neighbourhoods, and living in rural areas. These are the same populations least likely to have consistent access to early prenatal care.
The geographic spread of syphilis beyond major Ontario cities into smaller towns and rural areas makes this even more urgent, as many of the areas now seeing rising case counts are the same ones with the least robust prenatal care infrastructure.
Is this still happening?
It’s worth noting that the CMAJ study covers data up to the end of 2023, so a fair question is whether the situation has improved since. The short answer is: there is no sign of it.
Alberta Health Services, which declared a syphilis outbreak in 2019, reports that cases have continued to be reported in 2026. Between 2015 and 2025, nearly 21,000 infectious syphilis cases were reported in adolescents and adults across Alberta, and more than 430 babies were born with congenital syphilis over that same period. Alberta Health Services notes the surge reflects a rise in syphilis across Canada and around the world, not an isolated provincial problem.
The CMAJ study may use data from a few years ago, but the crisis it describes is ongoing.
What needs to change?
The research points to a clear need to move beyond traditional prenatal care models to reach people who face barriers to accessing them. That could mean more point-of-care testing options, expanded public health outreach, and proactive screening in community and harm-reduction settings.
“Relying solely on traditional prenatal care models may not be sufficient to reach populations who face barriers to accessing care,” said Dr. Saeed.
Some Ontario public health units have already adopted universal rescreening recommendations, testing again during the third trimester rather than just once early in pregnancy: evidence suggests this approach increases screening rates. But uptake has been inconsistent across the province.
What pregnant people should know
If you are pregnant, syphilis screening is recommended at your first prenatal visit. If you haven’t had a first-trimester blood test that included syphilis, ask your healthcare provider. The test is simple, and treatment, when caught early, is effective and straightforward.
Early detection protects both you and your baby. In a condition this preventable, no one should be falling through the cracks.
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