Alberta declares syphilis outbreak

Edmonton at epicentre as rate of infection climbs to 1948 levels

With syphilis rates at their highest in Alberta since 1948, the province’s chief medical officer of health declared an outbreak Tuesday and pledged to address the alarming spike in sexually transmitted infections.

The Edmonton area is at the outbreak’s epicentre, with almost two-thirds of the 1,536 cases across the province reported in the region in 2018.

That’s almost a tenfold increase over 2014, according to health officials.

“This is not just a small fluctuation, this is a significant change in a single year. And it’s getting worse. We’re expecting even higher rates in 2019,” Dr. Deena Hinshaw, Alberta’s chief medical officer, said at a news conference Tuesday to address the outbreak.

A total of 977 cases of infectious syphilis were reported in 2018 in Edmonton, according to a provincial government report measuring rates of sexually transmitted infections (STIS) and HIV.

Calgary by comparison had 206 cases in 2018.

“It is vitally important that everyone who is sexually active in Alberta take responsibility for having safer sex and get tested, especially if you have new or multiple partners,” said Dr. Laura Mcdougal, senior medical officer of health at Alberta Health Services.

Untreated infectious syphilis can lead to serious long-term health complications.

While there are not always symptoms in the early stages, it can present as a painless ulcer, progress to general symptoms like a fever, and even lead to eye problems or dementia in late stages, said Hinshaw.

“It rolls through the body in stages,” said Hinshaw.

Health officials are also extremely concerned about rates of congenital syphilis, which occurs when a baby is infected during pregnancy.

This can cause brain and nerve damage, among other serious medical problems.

There were 22 cases of congenital syphilis across the province between 2014 and 2018, one of which was a stillbirth.

Of those, 13 were reported in the Edmonton area, eight in 2018 alone.

The current caseload in the city is still “concerning and alarming” and “requires action,” Mcdougal said.

There were 70 infectious syphilis cases for every 100,000 people in Edmonton in 2018.

In Calgary, there were 13 cases for every 100,000 people, 19 in central Alberta, 43 in northern Alberta, and 10 in the southern portion of the province.

While Edmonton’s caseload represented a 305-per-cent increase over its 2017 numbers, it’s still unclear why so many cases are concentrated in the area, Hinshaw said.

“That’s one of the things the outbreak coordinating committee will be looking into,” said Hinshaw.

Over the next three months, the coordinating committee will focus on a strategy to increase STI prevention, testing and surveillance to reduce the overall number of syphilis cases across the province.

Young people between the ages of 15 to 29 are most at risk of acquiring syphilis, but all ages are represented in rates of reported cases, Hinshaw said.

Social challenges such as homelessness could also be risk factors, but more work needs to be done to understand why rates of syphilis are rising, she said.

“This is a trend that we’re seeing across Canada and the world. The question of exactly why — there’s not any one single factor.

“When an infection gets into a network of people it can spread quite quickly. It’s hard to understand why it is higher at the moment in Edmonton and the north than in Calgary,” Hinshaw said.

Most STIS do not show symptoms right away, which is why routine testing is so important.

At the same time, there is often a stigma surrounding testing that creates a barrier for people who are seeking care, said Mcdougall.

It is imperative that pregnant women get screened for the infection, she said.