Protect your baby, yourself and your community by following these guidelines
A message from Dr. Helena Swinkels and Dr. Unjali Malhotra
Cases of syphilis are increasing in BC, both in the general population and in Indigenous communities, but transmission of syphilis from mothers to babies may be prevented by following the new provincial guidelines for syphilis testing in pregnancy and childbirth.
The new guidelines are preventive and proactive and should be considered routine pregnancy-related care for everyone, whether Indigenous or non-Indigenous. While syphilis is an uncommon infection and can be cured with antibiotics, it needs to be taken very seriously, as the effects of infectious syphilis can be severe if not caught early. As physicians, we do understand that getting tested can be challenging for people who may have experienced sexual trauma; routine sexual and reproductive health check-ups are often an emotionally distressing experience. However, taking care of your sexual health is one essential aspect of your overall wellness and cannot be ignored. If you have experienced sexual trauma, and it is affecting your ability to take care of your sexual health, please read this message to learn about ways you can make your health care experiences less difficult.
What is syphilis?
Syphilis is a sexually transmitted infection (STI) that may start with a sore on the genitals or mouth then progress to a skin rash and spread throughout the body (affecting the heart or brain), at which point it can potentially be life-threatening. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. You can find sores on or around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth. Syphilis is also transmitted from pregnant women to their babies while in the womb or during delivery (this is called congenital syphilis, and it is a very serious and potentially fatal disease in infants). For more information, visit the BC Centre for Disease Control's (BCCDC) website.
Protect your baby
With treatment, syphilis during pregnancy can be cured, preventing syphilis-related miscarriage, premature birth, low birthweight, stillbirth and/or death shortly after birth, as well as potential lifelong problems with eyes, ears, teeth, bones, organs, blood, and joints. S
ymptoms of congenital syphilis can be curtailed with early treatment. Detailed information on syphilis and pregnancy can be found on the BCCDC website.
Why new guidelines in pregnancy?
When people hear about syphilis, they may think about it being a disease of the past. Historically, it was one of the diseases brought to North America by the colonizers, and was spread primarily through sexual contact. As it was not treatable at that time, the disease devastated many lives in the Indigenous communities, and as it could be passed from mother to child during pregnancy, it caused further serious illness and death.
After effective treatments became available, the spread of the disease was greatly reduced. However, having unprotected sexual contact with a person who has the disease continues to put people at risk of syphilis infection.
Rates of infectious syphilis in BC are the highest they've been in 30 years (919 in 2018), mostly affecting gay and bisexual men, also known as men who have sex with men (MSM). This is not the only group being affected, with heterosexual partners infecting each other as well.
There has also been an increased rate of infection – almost 40 per cent – among women of childbearing age, and at least two babies in BC have been born with congenital syphilis. This risk prompted the provincial health officer to declare a syphilis outbreak in July 2019.
We all hold responsibility for the next generation, and the new guidelines are one important way to fulfill this responsibility. In addition to testing ALL pregnant women in the first trimester or at the first prenatal visit, the new guidelines recommend a syphilis test at the time of delivery or any time after week 35 for those planning home births. The main goal of the new guidelines is to find and treat maternal and congenital syphilis as early as possible.
This extra test is just one tool to respond to the outbreak. A number of different programs and interventions have been put in place in recent years related to the increase in syphilis in BC and programs to control the outbreak in other groups are being reviewed and enhanced.
Self-care includes taking the time to get tested!
Self-care includes nurturing your spirit, which means taking care of your mind and body, as well as taking care of your family and community. It also means you get to be in charge of something important to your overall health and wellbeing. You are valuable and you (and your baby, if you are pregnant) are worth taking the time to get tested.
Our sexual health message on World Sexual Health Day talked about how some people find it embarrassing to get tested for STIs. They worry about others finding out or that they will be judged by the health professionals conducting the testing. The following tips can make it easier to get tested:
• Take a friend with you to the clinic or doctor's office.• Consider visiting a clinic that specializes in STI services. Find them here: http://www.bccdc.ca/our-services/our-clinics/sexually-transmitted-infections-clinics.• Take matters into your hands with online access to screening: https://getcheckedonline.com/Pages/default.aspx.
• Take a friend with you to the clinic or doctor's office.
• Consider visiting a clinic that specializes in STI services. Find them here: http://www.bccdc.ca/our-services/our-clinics/sexually-transmitted-infections-clinics.
• Take matters into your hands with online access to screening: https://getcheckedonline.com/Pages/default.aspx.
Remember, you and your baby are worth it!