Syphilis making an unwelcome return
Sexually transmitted disease is seeing numbers spike in Ottawa
The message to folks in the community is if you are sexually active with more than one partner, consider getting tested on a routine basis.
The sexually transmitted disease that some believe infected historic figures such as Henry VIII, Vincent Van Gogh and even Adolf Hitler, is spiking in Ottawa, reflecting an epidemic that has spread across North America in recent years.
Ottawa Public Health says there has been a 76 per cent increase in the number of cases of infectious syphilis in the capital over the past 12 months, from 37 in June of 2014 to 65 in June of this year. All of the cases were men, and 90 per cent report they are men who have sex with other men.
While the numbers are relatively small, the trend line is alarming enough that Ottawa Public Health is warning people to get tested if they are at risk, are pregnant, or are considering becoming pregnant.
“The message to folks in the community is if you are sexually active with more than one partner, consider getting tested on a routine basis,” said Dr. Paul MacPherson, an infectious disease specialist at The Ottawa Hospital who says he has been seeing a lot of syphilis cases in recent months. “I knew there was an increase before public health reported it.”
MacPherson said it is important to remind doctors to consider syphilis testing when they see symptoms such as unexplained rashes in patients who are sexually active with more than one partner. Until the 1990s, he said, “nobody around here was seeing syphilis. Then we had our first spike (around 2006) and it really took everybody off guard.”
He advises clinicians: “If in doubt, do the test.”
Among those Ottawa Public Health is advising to get screened are people who: have a sexual partner who has been diagnosed with syphilis; have multiple sexual partners, especially men who have sex with men; are sexually active and have symptoms consistent with syphilis; or a woman who is pregnant or considering becoming pregnant.
Syphilis can be detected through a blood tests and, in most cases if caught early, is easily treated with penicillin.
What makes it so prevalent at a time when drugs are available to treat it, is that it is highly infectious and can be spread through sexual contact that is not penetrative, meaning condoms don’t necessarily prevent it. Its symptoms — which include a canker or sore at the site of infection and, later, a rash which is typically on the abdomen, palms of hands and bottoms of feet — can be subtle or, in some cases virtually nonexistent in the early stages.
Patrick O’Byrne, a public health nurse with Ottawa Public Health and a University of Ottawa nursing professor who researches sexually transmitted diseases, said that people often don’t know they have syphilis, which makes them less likely to get treated and increases the rate of infection in the community. Compared with HIV, he said, where there is a 1 per cent risk of infection when an uninfected person has sex with an infected person, the risk of getting syphilis under the same circumstances is 60 per cent.
National surveys indicate condom use is not decreasing in Canada, O’Byrne said, but that might not be enough to stop the spread of syphilis.
If untreated and undetected, syphilis can have catastrophic long-term effects, attacking the heart, liver, eyes and brain.
Macpherson authored an article in the Canadian Medical Association Journal published in 2013 in which he writes about three men treated at The Ottawa Hospital for neurosyphilis, which he said can occur decades after infection. One 40-year-old man was admitted to the psychiatric ward who talking excessively “with senseless conversation,” who doctors believed was bipolar and having a manic episode. He also had neurological symptoms affecting use of one of his hands, his strength and ability to walk.
The patient was eventually diagnosed with neurosyphilis and treated with penicillin intravenously for two weeks. His condition improved significantly, but he did not fully recover. He lives in a group home and is “unable to do any of his instrumental activities of daily living.”
There have been debates about what is causing the recent surge in syphilis cases, said Macpherson, whether it is something about the nature of the infectious disease, or whether it is behavioural. But Ottawa Public Health is doing the right thing by getting the word out to the public that syphilis is not a disease of days gone by, but one that is alive and well and can do real damage if untreated.
In a paper about GayZone — Ottawa’s gay men’s STI/HIV testing clinic — published in the Canadian Journal of Public Health in 2014, O’Byrne and others suggested more services and extended hours might help reduce sexually transmitted diseases in the city.
Lauren Dobson-Hughes, president of Planned Parenthood Ottawa, said sexually transmitted diseases, which are all on the rise in Ottawa, should be a priority for Ottawa Public Health, which is facing an ongoing budget squeeze and has cut funding to partners including Planned Parenthood in recent years.
“The fact that STIs are on the rise tells us we are not doing something right,” she said. Dobson-Hughes said OPH should make sure its own sex education is align with the updated Ontario sex education.
Donna Casey, spokeswoman for Ottawa Public Health, said budget cuts have not affected sexual health services.