Study reveals persistent gaps in Ontario’s prenatal syphilis screening coverage

According to new research in CMAJ, 1 in 5 pregnant people in Ontario did not receive timely syphilis screening, which is critical for preventing syphilis infection in newborns (Canadian Medical Association Journal).

"In a publicly funded health care system, 1 in 5 pregnancies did not receive timely syphilis screening, indicating persistent gaps in coverage," writes Dr. Sahar Saeed, assistant professor, Department of Public Health Sciences, Queen's University, Kingston, Ontario, with coauthors.

Sociodemographic and behavioural risk factors associated with being screened late may be related to an increased likelihood of inadequate prenatal care access."

Dr. Sahar Saeed, assistant professor, Department of Public Health Sciences, Queen's University

Syphilis is a sexually transmitted infection that can be passed from mother to baby during pregnancy or delivery and can result in severe outcomes, including infant death, if untreated with antibiotics. Over the last 10 years, rates of infectious syphilis in females of reproductive age (15 to 39 years) have increased from 2.3 to 53.8 cases per 100 000 and, in parallel, rates of congenital syphilis have increased from 0.3 to 14.5 cases per 100 000 live births.

Global pregnancy care guidelines recommend universal screening for syphilis in the first trimester or at the initial prenatal care visit.

In this study of 551 706 pregnancies in 446 660 people in Ontario, Canada's largest province, between 2018 and 2023, researchers found that 8 % of pregnant people were not screened at all and 79 % were screened in the first trimester. Among pregnancies screened for syphilis, approximately 3 % were screened in the third trimester or at delivery. The authors' findings suggest that late screening may occur in people with the most barriers to accessing prenatal care.

"Relying solely on traditional prenatal care models may not be sufficient to reach populations who face barriers to accessing care. Providing nonjudgmental, comprehensive care in tandem with complementary strategies, such as opportunistic screening and community-based outreach programs using point-of-care testing, is a critical next step," the authors say. These approaches have shown promise in reaching underserved populations and closing access gaps.