This evidence brief (Public Health Ontario, 2025) reviewed peer-reviewed and grey literature, and surveyed 31 of 34 Ontario public health units (PHUs), to identify effective public health case and contact management approaches for syphilis in women of childbearing age and pregnant people, with a focus on preventing congenital syphilis.
Only 2 relevant peer-reviewed studies were found. One (Munro et al., 2017; n=131 pre + 24 intervention) showed an electronic referral pathway with a designated coordinator improved initial contact from 64% to 96% (p<0.001). A Florida electronic notification system (Matthias et al., 2019) resolved missing pregnancy status in 63/76 (82.9%) women over 9 months. Ontario PHU survey: 93.5% had pregnancy-specific syphilis policies; 44% of maternal cases linked to congenital syphilis (2020–2022) were lost to public health follow-up. Between 2014 and 2023, congenital syphilis cases rose from ~1.5/year to 23 cases in 2022.
- Peer-reviewed evidence base is extremely thin (only 2 relevant studies identified from 397 screened); no formal quality appraisal of included studies was performed. - Survey results are descriptive only; proportional uptake of specific strategies by PHU could not be reported. - Approaches from other jurisdictions may not transfer directly to Ontario given differences in health system structure and funding.
Prioritize documenting pregnancy status for all women of childbearing age with syphilis, and flag pregnant cases for same-day, high-priority follow-up — this single step underpins every downstream intervention to prevent congenital syphilis. Designating a single staff member for pregnant syphilis cases and building formal referral pathways to sexual health and prenatal care appear to improve treatment uptake and reduce loss to follow-up, even without robust RCT evidence.
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