Return of the 'cursed disease'

A surge in the number of reported cases of syphilis in 2008 is prompting an awareness campaign, particularly among Toronto's gay community.

AIDS activists in Toronto are hoping a campaign featuring a green sea monster clutching a man in distress will slow the spread of infectious syphilis among gay and bisexual men in Canada's largest city. 

Funded in part by Toronto Public Health, and created pro bono by Due North Communications, the campaign has taken the form of postcards, posters, brochures, condom loot packs, online banner ads, newspaper ads and subway ads, and has now been extended to all of Ontario. 

"It's a response to a dramatic rise in new syphilis infections," says Duncan MacLachlan, spokesman for the AIDS Committee of Toronto. "We hope this campaign is going to help stabilize that rise and actually lower it."

In the ad, a creature with fins and sharp teeth holds tightly onto a frightened man. "Attack of the Cursed Syphilis," it reads. "It's lurking in the depths. Watch out!"

Centrepiece of the Toronto AIDS committee syphilis awareness campaign. (From AIDS Committee of Toronto website)

A panel at the bottom notes that syphilis is spread through skin-to-skin contact, hits people with HIV "harder and faster," and urges people to get tested.

"Syphilis is no fun," says MacLachlan, who caught the disease in 2008 and saw it advance quickly but has now been successfully treated.

"We are not trying to scare people but we are trying to motivate people to respond."

The specific objective is to encourage sexually active people to get tested for syphilis as part their regular blood work and for gay men who are HIV positive, in particular, to get tested every three months.

MacLachlan says the ad campaign drew inspiration from a poster for the 1954 film, Creature from the Black Lagoon. 

The intent is to be reminiscent of those 1950s' horror films while sending a clear message that syphilis is not just out there lurking, but actually on the rise.

Big cities, big problems

Canada had relatively few reported cases of syphilis in the 1990s. But then the numbers spiked in 2001 and again in 2008. The Public Health Agency of Canada said there were 1,394 cases of infectious syphilis reported in Canada in 2008, 444 of which were in Ontario.

That total number was roughly 12 times higher than the 115 cases reported for all of Canada in 1997. 

In recent years, there have been noticeable outbreaks of syphilis in Vancouver, Calgary, Ottawa, Montreal and Toronto, affecting sex trade workers, their partners and clients, heterosexuals and men who have sex with men.

In Toronto, according to city statistics, there was a 1,000 per cent increase in the rate of new reported infectious syphilis cases between 2001 and 2008.

Shortly after that first spike, the Toronto AIDS committee launched a big awareness campaign in 2003, which resulted in a decline in syphilis rates in Toronto.

"But in 2005, we started seeing increases again annually," says MacLachlan. "In 2008 and 2009, we saw dramatic jumps."

According to the committee, the campaign has resulted in an increase in testing at the Hassle Free Clinic, an independent sexual health clinic in Toronto that describes itself as one of the busiest of its kind in Canada.

The AIDS committee will have to wait until next year to determine if this current campaign, which ends in September, has brought about any decline.

The HIV connection

MacLachlan says the majority of new cases of infectious syphilis in Toronto are among gay and bisexual men. 

Duncan MacLachlan, the gay men's outreach co-ordinator for the AIDS committee of Toronto. (Courtesy Duncan MacLachlan)

A disturbing trend is the "fast progression" of infectious syphilis among HIV positive men, he says. 

Being HIV positive makes a person more susceptible to syphilis, and having syphilis can make a person more vulnerable to HIV. 

Syphilis can advance through its five stages in six to 10 months in people with HIV, as opposed to 10 to 30 years in others.

"I experienced that first hand in 2008," says MacLachlan. "I had no symptoms in the first stage, I had no symptoms in the second stage, and I developed tertiary syphilis in less than three months."

Syphilis is most infectious in the primary, secondary and early latent stages.

But left untreated, it does its most damage when it becomes a tertiary infection, when it can affect the brain, blood vessels, heart and bones, and can also be fatal

An estimated one in four gay men in Toronto is HIV positive and MacLachlan says a "disproportionate number" of the men who are getting infectious syphilis are in that category.

Get tested

Described as the sexual scourge of the 19th century, syphilis was nearly wiped out in the Western world in the 1950s through the widespread use of penicillin.

A bacterial infection, syphilis can cause open sores and rashes and is diagnosed through a blood test and treated with antibiotics.

Not everyone infected, however, will develop symptoms, which is why MacLachlan's committee as well as the Public Health Agency of Canada are urging sexually active people to get tested on a regular basis. 

Syphilis can be transmitted through oral, genital or anal sex. A pregnant woman with syphilis can pass it on to her baby, sometimes causing birth defects or death. It can also be transmitted through injection drug use or through broken skin on the body.

To prevent syphilis, the Public Health Agency recommends using condoms for all sexual activities, including oral sex, and not sharing needles. 

It is also discussing how better to spread the word about the rise and dangers of syphilis, perhaps by using social media and other new communication techniques.