Health-care workers are struggling to keep up and identify people infected with syphilis as the Edmonton area recorded the highest number of cases in the province last year, a University of Alberta infectious disease expert says.
Over the last several years, syphilis cases have been steadily increasing. In 2014, there were 161 reported cases of the sexually transmitted infection, while in 2020, there were 2,509, according to data from the Government of Alberta.
The Edmonton Zone continues to have the greatest number of cases in the province, with 1,229 reported in 2020 compared to just 45 in 2014. In 2019, 2,302 cases were reported in Alberta, prompting the province to declare a syphilis outbreak.
Dr. Ameeta Singh said Alberta is experiencing syphilis rates not seen since the 1940s and the case counts are “very concerning.”
“What we’re doing with syphilis right now, from an STI services perspective, is we’re kind of putting out fires in a way,” said Singh, who also works at an Edmonton clinic for sexually transmitted infections.
“We’re struggling to keep up with finding people who have been infected, treating them, trying to find their partners, treating those partners.”
The COVID-19 pandemic has exacerbated that problem.
“Our nurses, our frontline workers who find and test and offer treatment for most patients with STIs, including syphilis, are part of notification nurses in the province as well as nurses at the STI clinics,” Singh said.
“What’s happened during the pandemic is that many of those nurses have been taken away to work on COVID responsibilities, which is understandable, during the height of the pandemic.”
The pandemic’s public health measures have also restricted movement through clinics while the activity of an outreach team offering testing and treatment in the community has also been limited.
It’s “very likely” there are cases that have gone undiagnosed because of the pandemic.
“We really need to start opening up our services to allow for people to start to come in now get tested and treated,” she said.
In Alberta, Singh said about a quarter of the cases are among gay and bisexual men who have sex with men.
“So what that means, of course, is that the remainder are heterosexual persons,” Singh said.
“Fifteen per cent of the cases are among pregnant women. And about a third of the cases report sex with anonymous partners and 50 per cent report injection drug use.”
Congenital syphilis cases on the rise
Singh said there has also been a “significant rise” in cases of congenital syphilis, where the infection is transferred to a baby from a pregnant mother. Since 2015, Singh said there have been 135 cases of congenital syphilis with about 30 infant deaths.
“The expected number of cases should be zero,” she said. “In Canada today, we should not be seeing any cases of congenital syphilis because we know how to prevent and treat this infection.”
An individual can be tested for syphilis and other STIs through a blood or urine test and penicillin is the treatment of choice, often through a single injection, Singh said.
“Pregnant women who access prenatal care are offered testing for syphilis, and if treatment is provided early in pregnancy, it can prevent the severe consequences to the infant,” Singh said.
“But the trouble is that many of the women who have delivered infants with congenital syphilis have not been presenting for prenatal care until later on in the pregnancy.”
Other STIs decreased in 2020 compared to 2019. HIV had 190 reported cases in 2020, compared to 253 the previous year. For chlamydia, the most common STI in Canada, there were more than 14,000 cases in 2020 compared to more than 18,000 in 2019. Gonorrhoea also decreased to 4,893 cases in 2020 from 5,333 cases in 2019.
Addressing root problems
There are a number of factors contributing to the rise in syphilis cases, Singh said, such as the use of mobile dating apps. There has been a “significant association” between stimulant drug use, particularly methamphetamine, and syphilis.
“Stimulant drugs not only stimulate the sex drive but also disinhibit behaviour and make it more likely that people will engage in risky sexual behaviour,” she said.
Singh said more needs to be done to prevent individuals from getting infected in the first place by addressing the social determinants of health.
“I don’t think that enough is being done to support housing. We continue to see a huge number of people who are affected by homelessness, addictions and mental health issues, poverty. Indigenous people are disproportionately affected by this,” she said.
“Until we address some of these root problems, I don’t think that we’re going to make inroads into managing this.”