Manitoba

10 infants infected with syphilis as outbreak worsens

At least 10 babies have become infected with syphilis as the outbreak of the highly contagious, sexually transmitted disease continues to grow in Manitoba, the province says.

Women infected with the disease can pass it on to their unborn baby during pregnancy or childbirth

Babies born with congenital syphilis could experience deformed bones, severe anemia, enlarged liver and spleen, jaundice, brain and nerve problems — including blindness or deafness — meningitis and skin rashes, according to Dr. Michael Isaac. (Shchipkova Elena/Shutterstock)

At least 10 babies have become infected with syphilis in the past six months as the outbreak of the highly contagious, sexually transmitted disease continues to grow in Manitoba, the province says.

Part of the blame for the growing problem is the methamphetamine and opioid epidemic in Manitoba, says Dr. Michael Isaac, acting chief provincial public health officer.

In seven of the cases involving infants, the mothers were using illicit substances or injecting drugs, Isaac says.

"We've noted that some of the moms with congenital syphilis have been using crystal meth and injecting drugs, so that certainly could be exacerbating the situation," he said.

Women who are infected with the disease can pass on the infection to their unborn baby during pregnancy or childbirth. This is called congenital syphilis and can lead to birth defects or stillbirth, the province said in a news release on Monday.

"So there is definitely a population that we're not reaching that we need to do a better job of reaching in terms of trying to access prenatal care and providing good harm-reduction services to them," he said.

There has been a syphilis outbreak in Manitoba since 2014 but lately, throughout North America, there has been a significant increase in the number of cases, Isaac said.

In Manitoba, there were 118 cases in 2014. That jumped to more than 350 in 2018.

"This number will increase as case investigation reports continue to be completed," Isaac said, adding the increase in women went from 16 to 168 in that same time.

The majority of congenital syphilis cases have been reported in the Northern Health region and Winnipeg Regional Health Authority, but the risk is high across the province, he said.

In the past, the majority of syphilis cases occurred in men having sex with other men. However, over the past three years that has changed, Isaac said.

"This is of particular concern because, historically, when cases increase in women, cases of syphilis in newborns increase as well," he said.

Congenital cases are rare and have been very rare in the past in Manitoba …  so the risk level has changed.– Dr. Michael Isaac

Babies born with congenital syphilis could experience deformed bones, severe anemia, enlarged liver and spleen, jaundice, brain and nerve problems — including blindness or deafness — meningitis and skin rashes, Isaac says.

"Congenital cases are rare and have been very rare in the past in Manitoba," Isaac said.

The first case was discovered in 2015, then another in 2017. However, in late 2018 and early 2019 there was a large increase, especially in the last six weeks, he said, "so the risk level has changed."

People are advised to use condoms during intercourse to avoid the transmission of syphilis. (Shutterstock)

A lack of prenatal care and substance use have been identified as factors in these cases, according to the province, which says there are tests to determine whether a person, including a pregnant woman or a newborn, has syphilis. 

All women are urged to seek regular prenatal medical care and get at least one test for syphilis and other sexually transmitted infections.

Syphilis and congenital syphilis can be treated with antibiotics, but if left untreated can cause death. The earlier women are tested and treated during their pregnancy, the less likely an unborn child will be severely affected.

To that end, the province is working with community-based organizations and harm-reduction experts to "beef up" the prenatal care for all women, but with a particular focus on those living with addictions, Isaac says.

"We need to provide good treatment and harm reduction services to them and make sure they feel supported and then link them to care," he said.

"Enhanced testing and treatment initiative have and are being implemented across the province, including increased testing in pregnancy."

If a pregnant woman or her partner have multiple sexual partners or sex without barrier protection, or use intravenous drugs, more frequent testing is recommended.

Syphilis is known as the great imitator because of the wide range of symptoms that infected individuals may develop — symptoms that can easily be confused with other conditions or diseases,  the province says in the news release.

Symptoms of the disease range in severity, depending on the stage of the infection. Painless or tender lesions on the genitals are usually the first signs. Hair loss, a rash, swollen glands and muscle and joint pain may also occur.

The infection can progress to include a reddish pink rash on the torso and extremities, wart-like lesions and tumour-like inflammation on parts of the body.

Several Canadian provinces, including Alberta, Quebec and Newfoundland and Labrador, have reported congenital syphilis cases in recent years, the province said.

As well, the Centre for Disease Control and Prevention in the United States is reporting the highest rates of congenital syphilis cases in decades.

More information about the symptoms, causes and treatment of syphilis is available on the province's website.

Women infected with the disease can pass it on to their unborn baby during pregnancy or childbirth. 1:53

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