Syphilis in Immigrants and the Canadian Immigration Medical Examination

Background Immigrants to Canada must undergo screening for syphilis. This study presents the results of syphilis screening from 2000 to 2004 and describes its impact on Canadian syphilis reporting and epidemiology. The study identifies migrant groups at risk of syphilis disease. Methods All permanent resident applicants 15 years of age or older; younger individuals who have syphilis risk factors, and long-term temporary resident applicants are required to have non-treponemal syphilis screening done. Reactive results were confirmed. Immigration-related syphilis screening results were analyzed for year, migrant origin, migrant age and classification. Results A total of 2,209 individuals were found with positive syphilis serology from the screening of 2,001,417 applicants. The sex ratio of positive cases was M:F = 1.4. Rates per 100,000 applicants were: refugees 286, refugee claimants 267, family class 187, temporary residents 85, and economic class 63. Age and geographic distribution reflected sexual transmission, known international prevalence, and the Canadian processes of immigration. Conclusions Certain immigration class applicants from syphilis high-prevalence source countries are a significant source of syphilis notifications in Canada. Identifiable populations and the immigration application medical processes represent global public health policy and program opportunities at the national level.