Alarming rise in newborns with syphilis sign of gaps in access to care, doctors say

For much of his medical career, Dr. Ari Bitnun rarely had to consider the symptoms that indicated a baby was sick with syphilis.

- MEGAN OGILVIE

Rashes, often on the palms and soles of the feet. Poor weight gain and growth. Persistent nasal discharge, sometimes bloody. Swollen liver and spleen.

He made sure the medical students he taught had a clear understanding of the infection and the importance of prenatal screening to catch asymptomatic cases, as well as the dangers that syphilis posed when passed from mothers to babies during pregnancy.

But for decades, he and other doctors in Canada didn’t often see real-world cases of babies with syphilis. It seemed to be a disease of the past, reduced to a rarity by advances in medicine and prenatal care.

“You never saw congenital syphilis,” said Bitnun, an infectious disease physician at the Hospital for Sick Children. “It was something you learned about but didn’t see.”

Now, he says, that’s changed.

Cases of congenital syphilis in Ontario have recently spiked to numbers not seen in decades, setting off alarm bells for experts who say the rapid increase signals a dangerous gap in public health.

In 2022, the last year for which figures are available, there were 27 cases of early congenital syphilis in the province — up from five in 2020, according to data from Public Health Ontario. Between 2014 and 2019 there were only one or two cases each year, and 2013 saw no recorded case. 

“All of a sudden, it was all over the place,” said Bitnun, director of the Congenital & Perinatal Infection Clinic at SickKids. “We’re getting calls all the time from pediatricians about a baby born to a mom who didn’t get treated properly.”

Once in decline, cases of syphilis are soaring in Ontario, mirroring trends seen elsewhere in Canada and around the world.