syphilis, the centuries-old sexually transmitted scourge, is surging in canada
rates of syphilis had already been climbing in canada when the pandemic struck. covid made things worse
5 minute read
dr. jared bullard, a pediatric infectious disease specialist at the university of manitoba, says that cases of congenital syphilis are likely being underreported in canada.
nik thavisone
dr. zain chagla used to see maybe one case of syphilis per month as a consultant to sexual health clinics in hamilton, ont.
about six years later, and the mcmaster university infectious diseases specialist is now seeing two to three referrals for syphilis a week, “and i only see the complicated ones.” complex cases involving meningitis, inflammation of the membranes around the brain and spinal cord, stroke-like syndromes and vision loss. “syphilis can affect any organ, not just the genitals, as is traditionally thought.”
when chagla recently wondered on twitter, “is anyone else seeing a lot of syphilis,” the answer was a succinct “yes.” the centuries-old sexually transmitted scourge “is out of control in saskatchewan right now,” one colleague responded, while another reported thunder bay is seeing more cases now than the last several years combined.
in january, doctors in montreal were advised by public health bulletin to test every pregnant woman in their care for syphilis, because of a small but worrying rise in congenital syphilis, where treponema pallidum, the bacterium that causes the infection, is spread from mother to fetus before birth. if left untreated, syphilis in pregnancy can lead to miscarriage, stillbirth or infant death soon after birth. babies born with syphilis can have deformed bones, enlarged liver and spleen and nerve and brain problems. if caught in time, penicillin can prevent transmission of syphilis from mother to baby.
sponsored by:
obesity matters
advertisement
canada used to see fewer than 10 cases of congenital syphilis a year. in 2013, a single case was reported. last june, a national congenital syphilis surveillance study began asking pediatricians and other doctors who see children to report each month whether they had seen a confirmed or suspected case in the preceding month. so far, 101 cases have been reported. the number is likely an underestimate of the true burden, said co-principal investigator dr. jared bullard, section head of pediatric infectious diseases at the university of manitoba.
babies born with congenital syphilis have so far been concentrated in the prairie provinces, half in alberta, a quarter or so in saskatchewan. but rates in manitoba have increased dramatically, b.c. is “on the up slope side of things” and doctors in eastern canada, including the maritime provinces are now reporting the occasional case, “which is new,” bullard said. “about five, 10 years ago, i don’t think they were seeing anything.”
rates of syphilis had already been climbing in canada when the pandemic struck. covid made things worse. public health units pivoted to covid, “which was important, but there is an opportunity cost,” chagla said. programs offering access to sti testing, contact tracing and treatment slowed, or ground to a halt. much of the access to clinics outside of primary care shut down, chagla said. doctor visits turned virtual; it becomes tougher to bring up delicate topics through a screen. syphilis is also “the great mimicker,” chagla said. while it’s easily cured with penicillin, it can often look like something else. “even those who got care may have been misdiagnosed with other issues, especially atypical groups like the elderly,” he said.
advertisement
syphilis is now hitting older people. it’s hitting all groups. there were 9,382 confirmed cases in canada in 2020, up from 1,749 in 2011, according to a new report on the rising syphilis rates in canada. while gay, bisexual and other men who have sex with men still represent a higher proportion of cases, syphilis is shifting towards heterosexual populations, particularly women. rates have increased in every age group, especially in females aged 15 to 39. canada reported a 740 per cent increase in infectious syphilis in women from 2016 to 2020, with the highest rates among women of childbearing age. and with that increase has come a parallel increase in babies with syphilis.
“every case of congenital syphilis reflects a failure of our healthcare system to identify and treat a treatable condition,” said dr. carsten krueger, an infectious diseases fellow at cheo in ottawa.
a baby born with syphilis can either look completely normal or be exceptionally ill, said dr. ameeta singh, an infectious diseases expert at the university of alberta. babies can have a massively enlarged liver and spleen, leaving the belly severely swollen, a severe rash on the palms and soles, and bone changes. but penicillin treatment is like magic, she said. “often within a month many of those abnormalities resolve.”
advertisement
“we’ve been lucky,” bullard said. “we haven’t seen any children who have made it out of the first year of life without receiving treatment. but that’s the worry — we don’t want to miss them.” untreated, changes to bones, skin and soft tissue structures can be irreversible. kids can be left with learning and developmental issues.
“that’s why we’re really diligent about trying to screen as many women in pregnancy as we can, because we want to know about these kids up front,” bullard said.
there’s not one, but many reasons behind the surge: indigenous and marginalized communities that face barriers to accessing health care, or are reluctant to seek care because of historical discrimination; a rise in dating apps for people seeking casual, anonymous sex; a rise in drug use; poverty, homelessness, addiction issues.
other high-income countries — australia, the united kingdom, new zealand and the united states — are seeing similar trends.
rapid testing that can give preliminary results within five minutes, so treatment can be started immediately, a “low threshold” for screening, broader public awareness campaigns and more screening among heterosexuals are needed to bring rates under control again, singh said.
advertisement
“it’s important that those who are sexually active, particularly with new partners, or multiple partners, at all ages, keep this in mind if they develop puzzling symptoms,” chagla added.
symptoms include an often painless sore or ulcer at the point of contact — the genitals, the mouth — anywhere from three to 90 days after infection. if untreated, the infection moves into the secondary stage: people develop fever, swollen lymph glands, a rash. at that stage, eyes and ears can become involved, causing partial or complete loss of vision, balance and dizziness problems. if that stage isn’t treated, people can enter a latent stage and, years or even decades out, develop complications of the brain and nervous system, “so problems with dementia, problems walking,” singh said.
• email: skirkey@postmedia.com | twitter: sharon_kirkey
our website is the place for the latest breaking news, exclusive scoops, longreads and provocative commentary. please bookmark nationalpost.com and sign up for our newsletters here.
share story
