Syphilis rates are soaring to near-record levels across the Prairies, and Alberta has declared a provincewide outbreak of the sexually transmitted infection, but data from the federal public-health agency does not show the scope of the problem.
The newest published figures from the Public Health Agency of Canada on the national number of syphilis cases date from 2016, while the agency’s latest provincial breakdown of the infection is a year older.
A lot has changed since 2016. However, public-health experts say delays gathering and analyzing data from Canada’s provinces and territories means long waits for the national picture, which can result in health systems being slow to respond.
Alberta was the latest jurisdiction to declare an outbreak of syphilis after two years of rapid increases. Health officials in parts of Saskatchewan and Manitoba have also warned of new outbreaks. There has been a sudden spike in cases across the country in recent years as experts struggle to stop the resurgence of an infection that was once nearly extinct.
An “alarming increase” in Manitoba’s rate of syphilis began in 2017 when cases rose to 253 from about 200 in 2016, according to the province’s top medical officer. The yearly rate increased by 212 per cent in 2018 to 791 cases.
“The trajectory has gone substantially higher,” said Brent Roussin, Manitoba’s chief public-health officer. “We haven’t seen numbers like this in our recent history. We see it in every region in our province. The hardest hit areas are the core of Winnipeg and the northern region.”
According to data collected for The Globe and Mail by the Canadian Institute for Health Information, hospital admissions due to syphilis have increased, where data was available, in every province and territory over the past 12 months, except for British Columbia. The non-profit and independent organization was asked to gather the data because of the absence of timely federal numbers. Because patients with syphilis often don’t go to hospitals for help, the data provide an incomplete picture of the continuing levels of infection.
The federal health agency said in a statement that its lack of timely data is not hampering its ability to respond to syphilis outbreaks reported across the country in 2019.
“The availability of national data depends on reporting from multiple sources. The Public Health Agency of Canada validates data received to ensure our reports are accurate. It is not uncommon for national reports to be based on previous years’ data,” the agency said in a statement.
However, the dearth of current figures could affect the response to a flare-up, experts say. “Lack of access to timely data is a major reason we are behind the eight ball in responding quickly to these outbreaks,” said Nathan Lachowsky, an assistant professor at the University of Victoria’s School of Public Health and Social Policy.
Because diagnosed STI cases such as syphilis must be reported to a local health authority, to a provincial public-health group and then finally to the federal agency, delays happen, according to Dr. Lachowsky. The data also must be verified to ensure no double counting, he said, and not all provinces gather data in the same way.
Dr. Lachowsky added that federal and provincial officials need to find new ways to gather data on existing public-health issues. He cited a program from the federal agency where blood and data are collected directly from communities affected by HIV.
“We need more of these kinds of active surveillance to help understand what's happening when these outbreaks occur, which requires funding and political will. We do this often for food-borne illnesses, but it is not something that we've done as much of in sexual health,” he said.
Ameeta Singh, a clinical professor of infectious diseases at the University of Alberta, has been on the front lines of her province’s syphilis outbreak. She said she “has some sympathy” for the federal agency’s data delays.
“Most provinces and territories are not providing them with timely data. The way things are set up now, it’s virtually impossible for them to provide timely national data,” she said. It can take months after the end of the calendar year for the provinces to collate data.
Less than 20 years ago, syphilis seemed close to eradication, with cases across Canada falling to the low hundreds because of successful safe-sex campaigns and easy access to antibiotics. Since then, syphilis has made a comeback and is closing in on infection rates not seen since the 1940s.
The increase in syphilis, which left untreated can cause major neurological damage including blindness and paralysis, has been linked to poverty, increasing drug use and communities already at risk due to the opioid crisis. In recent years, declining condom use and hook-up apps have also been identified as possible reasons for spiralling infection rates.
In B.C., infections increased from 687 in 2017 to what is expected to be a record 919 cases in 2018, once the final number is confirmed.
Troy Grennan, with the BC Centre for Disease Control, said tracking in 2019 indicates this year’s number will be the same or higher. “We’re definitely not levelling off,” he said of the syphilis rate. “This is something we need to be concerned about, we need to address it, we need to talk to our patients about this and encourage regular things like condom use.”
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