A RETURN TRULY WITHOUT WELCOME
STD’S comeback across Canada a surprise
EDMONTON • Syphilis, a sexually transmitted disease once practically consigned to the annals of history in Canada, is on the rise and causing concern among health professionals.
The number of cases in the country has risen 151 per cent in recent years, leading eight provinces, including Ontario, Alberta and British Columbia to declare outbreaks. But, back in 1997, syphilis had been essentially eradicated in Canada.
“This is a cross-continent thing we’ve been observing over the past number of years,” said Dr. Chris Sikora, Alberta’s medical officer of health.
The increasing numbers may be due to social changes, such as an increased use of dating apps, more casual sex and multiple partners, Sikora said, adding it’s also fuelled by other factors — at least in some jurisdictions — such as the use of methamphetamines.
While syphilis initially appears as a painless sore on the mouth, genitals or anus, it’s contagious and the symptoms can progressively worsen. It can lie dormant for years and, without treatment, can cause damage to the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.
Over the years, it’s believed syphilis affected prominent people such as the painter Vincent van Gogh, philosopher Friedrich Nietzsche and famed American gangster Al Capone.
While experts say there are no solid projections for the number of cases expected in the new year, the most recent data shows there were 6,311 cases in 2018, up from 2,399 in 2014, according to a Public Health Agency of Canada report released in November.
Countrywide, the highest rates are among 30- to 39-year-olds. While the gross numbers vary wildly, per capita numbers show an enormous swing from 234 cases per 100,000 people in Nunavut to 2.5 cases per 100,000 in New Brunswick. The national average sits around 11 cases per 100,000, with Alberta, B.C. and Ontario clustered around there.
“Each part of Canada is kind of experiencing its own version of the epidemic,” said Nathan Lachowsky, a public health professor at the University of Victoria. “Unfortunately we have effective testing ... and yet we still have an epidemic.
“There’s no reason why it shouldn’t be able to go away.”
Alberta is one of the provinces that’s witnessed a large increase. There were 1,536 cases reported in 2018, up 187 per cent from the previous year. And as many as 1,753 new cases have been diagnosed to date in 2019. That compares with just 161 cases in 2014.
While there isn’t much detailed data in the province, Dr. Ameeta Singh, a clinical professor in the division of infectious diseases at the University of Alberta, said the fact the disease is spreading rapidly is a concern.
“In the initial part of this outbreak, many of the cases ... were among gay and bisexual men,” she said. “In the last two years or so there’s been a definite shift to heterosexual persons.”
Lachowsky also said the lack of data makes it difficult to understand the contagion. Researchers have to rely on test reports, which take time to publish and don’t give any insights into the non-tested community. “It’s not very nimble in terms of understanding what’s shifting on the ground,” he said.
This coincides with another troubling trend: the rise in congenital syphilis, which is when a child is born with the infection. In 2018, across the country, there were 17 confirmed cases of congenital syphilis — the highest rate in 25 years, according to the Public Health Agency of Canada.
So far in 2019, there have been 38 cases of congenital syphilis in Alberta alone.
But why? What is going on?
U of A’s Singh said it can be attributed to a few factors. One of them, at least in Alberta, is the use of meth, which stimulates sex drive and can therefore be associated with risky sexual behaviours. “Meth is a very important component of what is happening,” she said.
As well, the outbreaks could be linked to casual sex and multiple sex partners, which can in turn be partly explained by shifting cultural values and the availability of dating apps.
In a recent commentary in the Canadian Medical Association Journal, Singh wrote that a “recent rise in the use of smartphone-based dating applications, which make it easier to meet sex partners, has been linked to increased likelihood of risky sexual behaviours among people of all sexual orientations.”
Additionally, the use of HIV pre-exposure prophylaxis, which can prevent HIV infection, has led to a reduction in condom use among men who have sex with men, in turn pushing sexually transmitted infection (STI) rates higher.
The increased numbers could also be linked to more frequent testing, Sikora said, noting syphilis testing requires a blood test.
Lachowsky said that testing is important. “If people are only peeing in a cup ... then they’re not getting tested for syphilis,” he said. “We cannot let our foot off the gas in terms of managing this.”
The federal government announced a five-year action plan on STIS and bloodborne illnesses, including syphilis, HIV/AIDS and hepatitis C in July. The plan is to reduce the rates and improve access to treatment and testing.
While the numbers are statistically high compared to recent decades, they don’t even compare to the ravages of syphilis through history, a disease that’s associated with facial deformities and dementia if left untreated. Research indicates that in 18th-century England, at least one city had syphilis
NO REASON
WHY IT SHOULDN’T BE ABLE TO GO AWAY.
rates as high as eight per cent. That compares with about 0.02 per cent in Canada in 2018.
Among scholars, there’s actually a debate about where and how syphilis became a thing; the first noted outbreak was in 1495 as the French army sacked Naples, Italy. That year may look familiar — Christopher Columbus sailed off in 1492. One theory is that Columbus’ soldiers brought the infection back to Europe from the Americas. Another is that it existed previously in the Old World, but hadn’t really been distinguished from leprosy.
In the early 1900s, it was still common for people to deliberately contract malaria in an attempt to fight syphilis. The hope was that the high fevers would relieve symptoms of syphilis, and then malaria could be cured with the drug quinine. Before that, mercury would be applied to the skin, or people would be fumigated with mercury.
These days treatment’s pretty straightforward, with antibiotics. Prevention and regular testing can also help curb the rising numbers, and doctors across Canada are urging people to get tested at least annually, and more regularly if their sexual behaviour puts them at increased risk.