Image Credit: ADOBE STOCK

While COVID-19 has been understandably hogging all the headlines, there's been another outbreak spreading throughout B.C. since 2019.

Syphilis has been spreading throughout the province and the country for over a decade, spiking in 2019 when the province declared an outbreak.

The sexually transmitted infection is spread through penetrative sex and sexual activities where there is an exchange of body fluids or skin contact, and can cause serious medical problems if left untreated.

“There’s no question overall rates of syphilis across the country are increasing and have been for the last decade,” said physician lead of the HIV/Sexually Transmitted Infection program for the BC Centre for Disease Control, Troy Grennan. “In provincial reports you see it’s going up in all age groups, including younger age groups.”

All health authorities in the province are seeing an increase in cases, with the Northern Health Authority having the highest rate according to the latest data collected by the control centre. Grennan said there was a brief reduction in reported cases during the first few months of COVID 19 restrictions for all STIs, but the numbers quickly rebounded.

There may be multiple reasons why the infection is spreading and none Grennan can know with certainty — he said he “can only speculate”— and there are ways to get a handle on the outbreak. 

“Maybe people have more sexual partners, we don’t really know,” he said. “We know condom use is decreasing in certain groups including younger people based on our data.”

While the infection can be treated with antibiotics, many people infected with syphilis don’t have symptoms and don’t get tested. Grennan speculates things are changing, and perhaps more people are getting screened as a routine health care, including pregnant women, even when they don’t have symptoms.

“The more people start talking openly about this issue, the more we’ll reduce stigma around it and get people treated,” he said. “We’re seeing an increase in awareness and more people are getting educated and starting to get tested.”

The gay male population was historically the most impacted by the infection, but Grennan said because gay men tend to be proactive in their sexual health care, the trend is changing where over 50% of cases in that population are diagnosed and treated.

More than other sexually transmitted infections, syphilis has the potential to cause very serious health complications. The infection goes through stages, starting with a painless ulcer at the sight of entry. The secondary stage and most common symptom is a rash on the body, but in some cases, more serious symptoms can occur.

“You can get a lot of other stuff including liver issues and neurologic involvement from mild headaches to strokes,” he said. “It can affect the eyes or cause auditory syphilis that requires an IV therapy. It’s rare but it can happen. Some enter a latent stage where there are no symptoms but if left untreated 15 to 20 per cent will develop neurologic symptoms, and cardiac and muscle issues.”

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Pregnant people with syphilis can pass syphilis to their babies during pregnancy and birth which is called congenital syphilis and can cause premature birth, low birthweight, death or lifelong physical problems.

Between January and March this year, 527 cases of syphilis were reported in B.C. while there were 474 at the same time last year, an 11.2% increase, according to the first quarter 2023 BCDCC surveillance reports. The highest number of cases were reported in the Vancouver Coastal Health Authority while the Northern Health Authority showed the highest rate.

In the Interior Health Authority, 225 cases of syphilis were reported last year, 96 cases in 2021 and 51 in 2020, with 252 reported cases projected for this year. The region initially had 29 cases reported in 2015 and the cases have been steadily increasing since.

While males represented 67.6% of syphilis cases, this year’s data showed an 86.7% increase in reported cases among females with the highest rate of female cases in the 25 to 29 year age group. The proportion of reported syphilis cases among men who have sex with men continues to decrease.

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Syphilis testing can be done with a blood sample or a swab from the initial sore, and the medications used to treat the infection are free in the province.  Follow up tests are done after treatment at regular intervals for up to two years.

Grennan said for people who are experiencing symptoms or for those having a sexual relationship or multiple partners “it wouldn’t be unreasonable” to get screened every three to six months even without having symptoms.

“The more we talk about this and engage in better health around the issue, the more we’ll destigmatize it. We need education around sexual health and to keep talking more about it.”

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