Receiving a positive syphilis test result during your immigration medical exam can be stressful, especially if you're concerned about how it may affect your application. However, a positive result does not automatically lead to refusal. With timely and appropriate treatment and the proper medical documentation, most applicants can proceed with their immigration process successfully.

Below is an overview of the follow-up procedures, treatment expectations, and documentation needed after a positive syphilis result in the immigration medical exam.

Key Takeaways

➤ A positive syphilis test does not automatically block your immigration application if treated and documented properly.
➤ Screening is mandatory for most applicants aged 15 and older, including permanent residents, work permit holders, and international students.
➤ Panel physicians confirm whether the infection is active or previously treated before determining treatment.
➤ Timely treatment (usually penicillin) and follow-up testing are essential to clear the infection and meet IRCC requirements.
➤ Complete medical documentation of treatment and test results is required to continue the immigration process smoothly.

Understanding the Syphilis Test for Immigration

Canada requires all immigration applicants to undergo a comprehensive medical examination to protect public health and ensure that newcomers do not pose a risk to the community. Immigration, Refugees and Citizenship Canada (IRCC) authorizes designated panel physicians to conduct these exams under standardized medical protocols.

Who Must Complete a Syphilis Screening?

Syphilis testing is mandatory for all applicants aged 15 and older. Younger applicants may also be tested if they have certain risk factors or clinical signs, such as symptoms suggestive of syphilis, a history of another sexually transmitted infection, potential exposure through childbirth, or past needle sharing.

The screening involves a simple blood test performed by an IRCC-approved physician. The sample is analyzed in accredited laboratories using standard diagnostic algorithms to confirm whether a current or past infection is present.

Syphilis screening is routinely required for applicants in the following categories:

Permanent residence applicants (including those applying through Express Entry, Provincial Nominee Programs, or family sponsorship)
Work permit holders planning long-term stays
International students
Refugee applicants and protected persons
Family-class immigrants

Your panel physician will confirm whether the test applies to you based on your immigration category and personal medical history.

What Happens After a Positive Syphilis Test Result?

If your immigration syphilis screening comes back positive, the panel physician will take immediate steps to confirm whether you have an active infection and to determine the necessary treatment. Understanding this process can ease uncertainty and help you take the right next steps.

Confirming the Diagnosis

Panel physicians follow standardized diagnostic protocols when a screening result is positive. This usually involves a sequence of blood tests using either of two algorithms:

A non-treponemal test (such as the Rapid Plasma Reagin, or RPR) followed by a treponemal test for confirmation, or
A reverse algorithm, where testing begins with a treponemal assay, followed by a quantitative non-treponemal test.

Because treponemal tests can remain reactive for years even after successful treatment, further evaluation is necessary to determine whether the infection is active or represents a previously treated case.

Your physician will:

Review your medical history and any prior treatment for syphilis
Conduct additional tests to distinguish between active and past infection
Perform a physical examination to identify any symptoms or disease stage
Order confirmatory laboratory tests to validate the initial result

This comprehensive assessment guides treatment decisions and determines whether immediate therapy is required.

Recommended Treatment

If an active infection is confirmed, your treatment will follow the Canadian Guidelines on Sexually Transmitted Infections.

Antibiotic Therapy

Benzathine penicillin G is the first-line treatment for infectious syphilis and is typically administered by injection.
The number of doses depends on the infection stage: one dose for early-stage infections and multiple doses over several weeks for later stages.

Follow-Up Care

Repeat blood tests at scheduled intervals to confirm that treatment was successful.
Ongoing clinical monitoring to ensure you are no longer infectious
Complete documentation of all treatment details (dates, dosages, medications) for inclusion in your immigration medical report.

Under Canadian immigration medical standards, untreated active syphilis is considered a potential public health concern and can lead to medical inadmissibility. However, a positive result does not automatically mean refusal. Immigration medical officers assess whether the infection is active, treated appropriately, and fully documented before making any decision.

If You're Allergic to Penicillin

Penicillin remains the preferred and most effective treatment for all stages of syphilis. For non-pregnant individuals who cannot receive penicillin, alternatives such as doxycycline or ceftriaxone may be used, depending on the clinical situation.

However, azithromycin is not recommended due to documented antibiotic resistance. Penicillin (or desensitization followed by penicillin therapy) is required for pregnant applicants; no other antibiotic is a reliable substitute.

Your panel physician will follow national STI treatment guidelines to select, administer, and document the appropriate therapy in your medical record.

Medical Inadmissibility: What You Need to Know

In Canada, immigration applications are evaluated based on three medical criteria:

Danger to public health
Danger to public safety
Excessive demand on health or social services

Understanding how these rules apply to syphilis and immigration helps applicants see that a positive test result does not automatically lead to refusal.

When Is Syphilis Considered a Public Health Risk?

Under Canadian immigration medical standards, untreated syphilis and active pulmonary tuberculosis are classified as communicable diseases that can pose a risk to public health. The IRCC evaluates whether an applicant's condition could endanger others based on how easily it spreads and its potential impact on the population.

The determining factor is whether the infection is active and untreated, meaning it remains contagious. Once syphilis has been properly treated and documented, the applicant is no longer considered infectious, and this ground for medical inadmissibility no longer applies.

Timely treatment and complete medical documentation are key to ensuring your immigration process continues without delay.

Cost Considerations and "Excessive Demand"

For syphilis and immigration cases, medical inadmissibility due to excessive demand is highly unlikely. This rule applies only when an applicant's expected healthcare costs exceed $135,810 over five years (approximately $27,162 per year, as of 2025).

Treatment for syphilis is:

Affordable: Standard antibiotic therapy costs far below the excessive-demand threshold
Short-term: Most infections resolve within weeks to months after treatment
Low maintenance: No long-term or high-cost care is typically needed

Because of these factors, cost-related inadmissibility is extremely rare. The main concern for IRCC is confirming that the infection is no longer active or transmissible, not the cost of treatment.

The Treatment and Documentation Process

IRCC requires detailed information about your medical treatment. Your documentation package should include:

Treatment records showing all dates, medications, and dosages administered
Laboratory test results demonstrating successful treatment and clearance of infection
Physician's letter confirming treatment completion and current health status
Follow-up blood test results showing you are no longer infectious

Your panel physician will guide you through the proper submission process for your case and ensure that all documentation meets IRCC requirements.

How Long Does Treatment Take?

Timing is important for your immigration application. Immigration medical exam results are valid for 12 months from the exam date. Follow-up serology is often performed at scheduled intervals (for example, 3, 6, and 12 months).

Start treatment promptly and work closely with your panel physician to ensure all follow-up testing and documentation are completed within your medical exam's validity period. If treatment or testing extends beyond 12 months, your panel physician can advise on updating IRCC.

Expected timelines by infection stage:

Primary syphilis: Usually one injection, with follow-up testing at 3, 6, and 12 months to confirm cure
Secondary or latent syphilis: May require three weekly injections, with more extended monitoring

Key timing tips:

Begin treatment immediately upon diagnosis to maximize your exam validity window
Schedule follow-up tests promptly to stay on track
Keep your panel physician informed of any delays or complications

When Should I Talk to an Immigration Lawyer?

While most positive syphilis cases are resolved through standard medical treatment and documentation, you may benefit from consulting an immigration lawyer if:

You receive a procedural fairness letter from IRCC
Your application is refused on medical grounds
You have complex medical circumstances beyond straightforward syphilis treatment
You're unsure about documentation requirements or submission procedures
You need help responding to IRCC requests within tight deadlines
Your case involves multiple complicating factors

Immigration lawyers with medical inadmissibility experience can review your medical reports, assess IRCC's position, and develop strategies to address concerns effectively.

What to Do After a Positive Syphilis Test?

If your syphilis test comes back positive during your immigration medical exam, follow these steps to stay on track:

Confirm the result: Your panel physician will perform additional tests to determine if the infection is active or past-treated.
Start treatment promptly: Follow the recommended therapy (usually penicillin) as prescribed by your IRCC-approved physician.
Document everything: Keep detailed records of dates, medications, dosages, and follow-up blood tests.
Submit to IRCC: Your panel physician will ensure all documentation is properly sent through e-medical to meet immigration requirements.

Following these steps ensures that your treatment is complete, documented, and submitted efficiently, keeping your immigration process moving smoothly.

Complete Your Immigration Medical Exam with Confidence

At GTA Immigration Medical Markham, we make immigration medical exams simple, fast, and stress-free. Our IRCC-approved panel physicians guide you through every step, from routine screenings to follow-up care, ensuring your medical documentation meets all Canadian immigration requirements. With on-site testing, e-medical submission, and multilingual support in Cantonese and Mandarin, you can trust us to handle your exam efficiently and professionally.

Book your appointment today and experience Markham's trusted immigration medical clinic!

What Happens if a Syphilis Test Is Positive for Immigration?