‘Plenty of syph’: chief medical officer of health says syphilis risk sidelined by Covid

In 2019, before the world was consumed by the Covid pandemic, chief medical officer of health (CMOH) Dr. Deena Hinshaw declared a syphilis outbreak, warning of infection levels not seen since 1948.

In justifying a shift to reduced public health measures for Covid as the virus’s spread is treated as an endemic, Dr. Hinshaw said other public health issues such as syphilis and opioid addiction have not been getting the full attention they deserve.

“The longer we look at Covid as the only thing that matters, the more we’re allowing other risks, for example, babies dying from congenital syphilis and falling behind in vaccines or other vaccine preventable diseases, or routine challenges,” Dr. Hinshaw said in a radio interview with Corus on Thursday.

A report released by the province last month shows 2,509 new cases of infectious syphilis in 2020 for a rate of 56.7 cases per 100,00 people — a 7.5 per cent increase over 2019 and more than 10 times the rate in 2014.

In response to the 2019 outbreak, the province created the Syphilis Outbreak Response Committee, which included workers from Alberta Health, Alberta Health Services and the First Nations Inuit Health Branch of the AHS Zone Public Health executive staff.

That committee had reported to the CMOH, but its work was put on hold during the Covid pandemic.

“We need to emphasize for all Albertans: Sexually Transmitted Infections (STIs) are a risk to anyone who is sexually active, particularly people who have new sex partners and are not using protection,” Dr. Hinshaw said at that time. “I encourage anyone who is sexually active to get tested regularly. Anyone in Alberta can access STI testing and treatment for free.”

The province expects syphilis spread to continue to rise as normal activities resume. The committee plans to target four areas: testing and management; preventing congenital syphilis; enhanced surveillance; and primary prevention and health promotion.

Throughout the pandemic, the health authority continued syphilis case management, with government support to the Boyle Street Services Society for syphilis testing and treatment for street-involved and vulnerable people.

But much of the surveillance and other epidemiological resources were redirected toward Covid in 2020.

Edmonton, North zones lead province’s infection rates
The government is currently planning its communication strategy to specific populations in local geographic areas with the highest rates of syphilis.

Edmonton and North zones have the highest infectious syphilis rates, with 125.4 cases per 100,000 population in the North Zone and 85.2 cases per 100,000 in Edmonton, although rates have declined in the latter.

Calgary saw a 91.8 per cent increase in cases compared to 2019, with 397 new cases reported.

The disease is also impacting pregnant people and infants. From 2016 to 2020, there were 121 congenital syphilis cases, 28 of which were stillborn. Sixty-one of the congenital syphilis cases were in the Edmonton Zone.

Up to 40 per cent of babies with infected mothers are stillborn.

The infectious disease has been on the radar for more than a decade as cases crept up. In 2011, Alberta Health Services raised some eyebrows when it launched the award-winning “Plenty of Syph” awareness campaign, which satirized the dating site PlentyOfFish.com.

While dating sites and apps have been one focus of public education, there is no one single source of infection.

An Alberta Health Services presentation from February lists exposure and contributing factors that include inconsistent condom use, a new partner or multiple partners and/or anonymous sex, opioid and other substance use and addiction, having HIV or other sexually transmitted infections, stigma, mobile dating app use, a history of incarceration and participation in transactional sex.

Meanwhile, chlamydia, gonorrhea and HIV have all been declining across the province.

With the syphilis committee back to regularly scheduled work, the government is working on targeted outreach, especially within vulnerable and hard-to-reach populations.

Alberta is not alone in seeing syphilis increases; rates are rising across Canada and internationally.