Outreach, prevention needed as syphilis epidemic surges in Sask.: experts

There's a syphilis epidemic surging in Saskatchewan. Medical health experts say this public health crisis can be brought under control with the proper outreach and education among the public and health-care providers.

Saskatoon syphilis infections increased by 929% over 5 years

In this May 23, 1944 file photo, the organism treponema pallidum, which causes syphilis, is seen through an electron microscope.
In this May 23, 1944 file photo, the organism treponema pallidum, which causes syphilis, is seen through an electron microscope. (The Associated Press)

Late show host Stephen Colbert recently joked about Alberta's "horrifying" syphilis rates, warning the province's neighbours in Saskatchewan to "watch out."

The U.S. comedian didn't realize that Saskatchewan is already struggling against its own surging syphilis epidemic.

The old pathogen, once under control, has made an aggressive comeback, said Dr. Johnmark Opondo, a medical health officer in Saskatoon. 

Syphilis infections in Saskatoon have increased by more than 900 per cent during the last five years — jumping from 38 known cases in 2016 to 391 so far in 2021. Three cases total were reported in 2013.

The infection is transmitted sexually, with most recent cases stemming from people who have multiple partners. 

It's also affecting babies. 

"By the time you start seeing congenital or infant cases, you know, we're really in a bad epidemic. Things are really down the road," Opondo said. 

Dr. Johnmark Opondo, a medical health officer in Saskatoon, said people need to know syphilis can be controlled with rigorous testing and tracing. (CBC)

There have been six confirmed congenital syphilis cases from 2018 to 2020. 

If untreated, the illness can have devastating consequences for developing fetuses, leading to mental impairment or issues with skin, teeth or eyes, he said. It can also cause death.

Two Saskatchewan newborns died from complications of infectious syphilis last year. 

"It  really has serious impacts on the next generation. Babies who might be exposed to syphilis suffer long-term lifelong diseases which can be preventable. That is the tragedy, that this can be prevented." 

Outreach key in controlling syphilis 

The infection is manageable and easily treated if it's caught early, but there are barriers preventing access to care. Some people also avoid traditional health-care because of stigma. 

"It's embedded in poverty and chronic social problems," he said. "This chronic poverty and this chronic stress exposes people to a lot of risk and a lot of risky behaviour, whether it's drug use, whether it's other coping strategies." 

Oponodo said syphilis is spreading fast in vulnerable populations already dealing with challenges like unreliable housing or income, mental health, HIV and addiction — all which are stigmatized.

The Saskatchewan Health Authority's sexual health clinic in Saskatoon provides STI testing in the heart of the city. The majority of clients, between the ages of 13 and 50,  don't have access to stable housing or are involved with the correctional or social services systems, said Robin Veszi, manager for the street and sexual health departments in Saskatoon.

Veszi said the clients don't have the privilege of a family doctor who does regular checkups. 

"We might be their only point of contact," she said. "We need to make sure [treatment has] been given correctly at the right time frame, so along with that comes a lot of follow-up testing."

She said this is key to making sure they're cured and preventing reinfection. She said outreach in the community is critical for prevention and early detection.

Staff who could be doing outreach have become overwhelmed by monitoring current cases and tracking data. 

​"Robin's team was sort of raising the red flag and saying, we're seeing more and more congenital syphilis​," Lisa Munroe said. "So we were trying to figure out why this is occurring and then how we can then stop it.​" 

Monroe is a primary health care manager of an area that focuses on preventing childhood illness in core and downtown Saskatoon. They were already running prenatal and postnatal programs in Saskatoon's core, so she said it made sense for them to do more syphilis-focused education and outreach in the neighborhood. 

She said there is a challenge in reaching people who either don't know they're infected or don't know about the risks, so the focus is on proactive education with expecting moms could be at-risk. 

"How can we not only get them tested, but how can we support them to have a healthy pregnancy throughout?" She said.

Munroe said her team focuses on STI testing and treatment, but also transportation, food or housing. 

Numbers spiking across the province

Syphilis is not just a Saskatoon concern. Provincial numbers have also spiked, from 140 cases documented in 2018 to 925 so far in 2021.

Opondo said sexual health is critical and encourages anyone with multiple sexual partners to get tested frequently. Infections like syphilis aren't obvious. Opondo describes the pathogen in its early stages as an insidious, silent operator. People often pass it on without knowing that they have it, and sometimes it can appear to be something else.

A person can also catch syphilis more than once. 

OPINION | Babies are being born with congenital syphilis in Sask. This is a public health emergency

Veszi is concerned that cases are being detected among adults far too late. 

"We're seeing people presenting with syphilis to their optometrists. We are seeing people at their OBGYNs." 

Opondo said this means Saskatchewan health-care providers also need to refresh their knowledge on syphilis and other sexually transmitted infections. 

He said they must recognize potential symptoms, but also know how to talk to people about testing and awareness without judgment. 

He said testing is quick and easy, and can be found in the heart of Saskatoon by contacting places like Saskatoon's sexual health clinic, OutSaskatoon and Saskatoon Sexual Health.