Syphilis is on the Rise!

Syphilis is one of the sexually transmitted infections (STIs) caused by bacteria. If left untreated, it can cause serious health problems; however, treatment is available with antibiotics. Yet cases of syphilis are on the rise in Canada.

A CBC article states that “chlamydia, gonorrhea and syphilis were all rising steadily in Canada in the years before the COVID-19 pandemic, federal data shows.”  While rates of chlamydia and gonorrhea dipped starting in 2020, likely due to reduced testing during COVID-related restrictions, syphilis maintained its upward trend after a briefer lull and remains a major concern for public health officials.”

The increase in case numbers is alarming.  What, then, needs to be done to reverse the rising rates of syphilis?

What is Syphilis?

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.  It is spread by unprotected vaginal, anal, and oral sex.  It is highly contagious when sores or the rash are present and can cause permanent damage without treatment.  It can also present asymptomatically and, therefore, be spread unknowingly, even through the sharing of sex toys.  This is why testing for syphilis and any STI is so imperative for prevention and treatment.

Testing for Syphilis

Testing for syphilis is either a simple blood test or swab of a sore or chancre.  It is both easy to test and then to treat with antibiotics.  It is very important that you tell your sexual partners if you test positive so that they may get tested as well.  There were over 6000 cases of syphilis in 2018 in Canada. And as of 2022 this number has more than doubled to almost 14000.   This increase has also resulted in the resurgence of congenital syphilis, where the bacteria responsible for causing syphilis are passed through the placenta to a developing fetus.  Just a decade ago, syphilis infections among infants were nearly eradicated in Canada, but 117 cases were recorded in 2022, a 15-fold increase from just eight nation-wide cases of syphilis reported in infants five years earlier.

Prevention

As with all STIs, the only absolute way to prevent transmission is to abstain from any sexual activity.  But there are things that can be done to help reduce the risk of transmission when engaging in sexual activity.

• Get tested regularly, after new sexual partners or if a condom or barrier breaks during use
• Use a Dam (Oral Barrier) every time you have oral/vaginal or oral/sex
• Use a condom every time you have vaginal or anal sex
• Don’t share sex toys or clean them before sharing
• Condoms should be used to cover the penis during oral sex
• Talk with your sexual partners about both of your sexual health

Some of the biggest roadblocks in prevention are the following:

• Removing the stigma surrounding STIs
• Increasing awareness of testing and treatment options
• Navigating socio-economic barriers for ease of access to healthcare options
• Having health practitioners integrate screening for sexually transmitted and blood-borne infections into routine medical care

Next Steps

The good news is that syphilis is both preventable and treatable.  So, what are next steps to make sure the messages surrounding prevention and treatment are shared across the nation?  A Federal/Provincial/Territorial committee on STBBI (the Syphilis Response Steering Committee, within the Pan-Canadian Public Health Network) identified the following needs:

• Collaborate with FPTIg partners to address surveillance gaps to assess the burden of infectious and congenital syphilis, and to better understand the social and structural determinants of health, health inequities, and risk factors contributing to the epidemiology of infectious and congenital syphilis in Canada.
• Facilitate the development of educational and awareness strategies to improve guidance and messaging to Canadian health care practitioners in order to improve early detection, treatment and care of infectious and congenital syphilis.
• Facilitate the development of targeted educational and awareness messaging for populations at increased risk through the identification of approaches (e.g., using behavioural sciences, supporting community-led solutions etc.).
• Explore mechanisms to improve linkages with populations at risk, underserved communities and hard-to-reach populations for prevention, early detection, enhanced access to testing and treatment (e.g., rural and remote, northern communities, populations who are marginalized or racialized).
• Discuss and explore research opportunities pertaining to the areas identified in Appendix B. This may require broader engagement with FPTIg partners and Public Health Agency of Canada programs to assess their needs and prioritize research as necessary.

 

We need to take a multi-faceted approach to address the current public health crisis Canada is experiencing with the growing numbers of syphilis.