The Alberta government should open more sexual health clinics and threaten to revoke liquor licences of bars that don't have condom dispensers to address a rising rate of syphilis infection, the province's top doctor says.
In a report released this month, the office of Alberta chief medical officer Andre Corriveau said Alberta's outbreak "shows no signs of abating."
Alberta's 2009 rate of infection was 7.4 per 100,000 residents - the highest of any province and the most Alberta has seen since its rates first spiked around 2003.
Most alarming are Alberta's 13 suspected or confirmed 2009 cases of congenital syphilis in newborns. The rest of the country had just one such case.
Alberta's rate has increased only slightly since 2007, leading officials to believe they've stopped the spread.
"But what we want is to get rid of the problem, to make the numbers go down dramatically. And we're not there yet," said Martin Lavoie, one of the province's senior medical officers of health.
The government has been late in responding to doctors warnings, said Liberal Opposition Leader David Swann, a physician. "There's been an abject failure to get what is really a very treatable, preventable disease under control."
The battle against sexually transmitted infections took a blow two years ago with the departure of Ameeta Singh, the head of the province's STI prevention programming. The departure left a leadership vacuum. Dr. Singh, now an instructor at the University of Alberta, said "it has been very difficult to initiate any new program" since she and others left.
"It was never a situation where there was absolutely no leadership. Well, that being said, of course we did lose capacity," after Dr. Singh's departure, Dr. Lavoie acknowledged.
Meanwhile, the disease has spread among vulnerable groups - it thrives in the sex trade, among drug users, and among mothers who can't or don't access prenatal care.
Infection is spreading most rapidly among heterosexuals, but men who have sex with men continue to experience a high rate. Aboriginal women experience the highest rate of infection.
The rates are highest in Fort McMurray, the home of oil-sands development. Remote work camps make it difficult for workers to get tested, said Barbara Anderson, Alberta Health Services' manager of STI programming in the northern half of the province.
The report recommends extending hours of operation at STI clinics, include the one in Fort McMurray, and opening new clinics in Jasper and Banff, the province's two ski destinations that are popular among tourists. It also recommends targeted advertising and a law requiring bars and restaurants to have condom dispensers.
Syphilis can be transmitted through unprotected vaginal, oral or anal sex. It causes painless sores in affected areas and occasional rashes throughout the body, and increases a person's chance of contracting the human immunodeficiency virus (HIV). Syphilis is, however, curable.
"This is a very sinister disease that has devastating results - but is easily treated if discovered," Dr. Swann said.
Infants are at high risk. Prenatal screening would routinely catch a syphilis infection, but of the 26 infants born in Alberta in the past decade with congenital syphilis, only three mothers had any prenatal care.
Children with the infection have a 40-per-cent chance of dying during or shortly after birth. Those who don't die suffer other complications.
Canadian infection levels fluctuate in severity. Rates are high in the sparsely populated territories, though the actual number of cases is low. Atlantic Canada has few or no cases, while Ontario, British Columbia and Quebec average about five cases per 100,000.
Health Minister Gene Zwozdesky met last week with some of the province's health officials to establish a strategy. He was not asked about whether they might change the law to require condom machines. "That was not on my radar," the minister said in an interview, adding that he nevertheless wants "to be very aggressive" on the file.
"I think the release of this report is a good start," said Dr. Singh, the one-time leader of Alberta's anti-STI programs. "What I think we need to see now is the action plan."
2: Total cases of syphilis in Alberta in 1999
267: Total cases in 2009
13: Number of Alberta infants born with confirmed or suspected cases of congenital syphilis in 2009
1: Number born everywhere else in the country
40: Per-cent chance an infant born with syphilis will die during or shortly after birth