Syphilis, an age-old sexually transmitted scourge, is on the rise in Canada

Syphilis rates had already spiked in Canada when the pandemic hit. COVID made things worse

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Dr. Zain Chagla used to see maybe one case of syphilis a month as a consultant at sexual health clinics in Hamilton, Ontario.

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About six years later, and the infectious disease specialist at McMaster University now sees two to three referrals for syphilis a week, “and I only see the complicated cases.” Complex cases involving meningitis, inflammation of the membranes surrounding the brain and spinal cord, stroke-like syndromes and loss of vision. “Syphilis can affect any organ, not just the genitals, as traditionally thought.”

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When Zagla recently wondered on Twitter, “is anyone else seeing a lot of syphilis,” the response was a succinct “yes.” The age-old sexually transmitted scourge “is out of control in Saskatchewan right now,” replied one colleague, while another reported that Thunder Bay is seeing more cases now than in recent years combined.

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In January, doctors in Montreal were advised by a public health bulletin to test all pregnant women under their care for syphilis, due to a small but concerning rise in congenital syphilis, where treponema pallidum, the bacterium that causes the infection, is transmitted from mother to mother. fetus before birth. If left untreated, syphilis during pregnancy can lead to miscarriage, stillbirth, or infant death soon after birth. Babies born with syphilis may have deformed bones, an enlarged liver and spleen, and nerve and brain problems. If taken in time, penicillin can prevent the transmission of syphilis from mother to baby.

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In Canada, there were fewer than 10 cases of congenital syphilis per year. In 2013, only one case was reported. Last June, a national congenital syphilis surveillance study began asking pediatricians and other physicians who see children to report monthly whether they had seen a confirmed or suspected case in the previous month. So far, 101 cases have been reported. The number is likely an underestimate of the true burden, said co-lead researcher Dr. Jared Bullard, chief of the pediatric infectious diseases section at the University of Manitoba.

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  1. Doctors advise testing for syphilis as Quebec cases begin to rise

  2. Dr. Rupeena Purewal is part of a provincial task force trying to stop syphilis in its tracks.

    A Saskatchewan task force has been set up to stop the spread of syphilis

Until now, babies born with congenital syphilis have been concentrated in the Prairie provinces, half in Alberta, about a quarter in Saskatchewan. But rates in Manitoba have risen dramatically, British Columbia is ‘on the upswing’ and doctors in eastern Canada, including the Maritimes, are now reporting occasional cases, ‘which is new’ , Bullard said. “About five, 10 years ago, I don’t think they saw anything.”

Syphilis rates had already spiked in Canada when the pandemic hit. COVID made things worse. Public health units have turned to COVID, “which was important, but there’s an opportunity cost,” Chagla said. Programs providing access to STI testing, contact tracing and treatment have slowed or stopped. Much access to clinics outside of primary care has been closed, Chagla said. Doctor visits have gone virtual; it becomes more difficult to approach delicate subjects through a screen. Syphilis is also “the great imitator,” Chagla said. Although it is easily cured with penicillin, it can often look like something else. “Even those who received care may have been misdiagnosed with other conditions, especially atypical groups like the elderly,” he said.

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Syphilis now strikes the elderly. It strikes all groups. There were 9,382 confirmed cases in Canada in 2020, up from 1,749 in 2011, according to a new report on rising syphilis rates in Canada. While gay, bisexual, and other men who have sex with men still account for a higher proportion of cases, syphilis is moving toward heterosexual populations, especially women. Rates increased in all age groups, particularly among women aged 15 to 39. Canada has reported a 740% increase in infectious syphilis among women from 2016 to 2020, with the highest rates among women of childbearing age. And this increase has been accompanied by a parallel increase in the number of babies with syphilis.

“Every case of congenital syphilis reflects a failure of our healthcare system to identify and treat a treatable disease,” said Dr. Carsten Krueger, infectious disease researcher at CHEO in Ottawa.

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A baby born with syphilis can either look completely normal or be unusually sick, said Dr. Ameeta Singh, an infectious disease specialist at the University of Alberta. Babies can have a massively enlarged liver and spleen, leaving the belly very swollen, a severe rash on the palms and soles of the feet, and bone changes. But the penicillin treatment is like magic, she says. “Often within a month, many of these abnormalities disappear.”

“We were lucky,” Bullard said. “We haven’t seen a single child who came out of their first year of life without receiving treatment. But that’s the worry, we don’t want to miss them. Left untreated, changes to bones, skin, and soft tissue structures may be irreversible. Children can end up with learning and developmental problems.

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“That’s why we’re really diligent about trying to screen as many pregnant women as possible, because we want to know more about those kids,” Bullard said.

There are not one, but many reasons behind this increase: Indigenous and marginalized communities who face barriers to accessing health care or who are reluctant to seek care due to historical discrimination; an increase in dating apps for people looking for casual, anonymous sex; an increase in drug use; poverty, homelessness, substance abuse issues.

Other high-income countries – Australia, the UK, New Zealand and the US – are seeing similar trends.

Rapid tests that can give preliminary results in five minutes, so treatment can be started immediately, a “low threshold” for testing, wider public awareness campaigns and more testing among heterosexuals are needed to bring back rates under control, Singh said.

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“It’s important for those who are sexually active, especially with new or multiple partners, at any age, to keep this in mind if they develop puzzling symptoms,” Chagla added.

Symptoms include an often painless sore or ulcer at the point of contact – genitals, mouth – three to 90 days after infection. If left untreated, the infection progresses to the secondary stage: people develop fever, swollen lymph nodes, skin rash. At this stage, the eyes and ears may be involved, causing partial or complete loss of vision, balance problems, and dizziness. If this stage is left untreated, people can go into a latent stage and, for years or even decades, develop brain and nervous system complications, “so dementia issues, walking issues,” he said. Singh.

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