Once considered a thing of the past, sexually transmitted infections (STIs) are now a public health priority for physicians across North America.
A new report from the World Health Organization (WHO) has found a surge in syphilis cases during the COVID-19 pandemic.
According to the WHO report, between 2020 and 2022, new cases of syphilis increased by 30% among people aged 15 to 49 in the Americas.
Recorded cases in the Americas in 2022 accounted for 42% of new infections worldwide, with a rate of 6.5 cases per 1,000 people.
“It's likely a confluence of factors that has caused this surge,” said Monica Alonso, director of sexually transmitted diseases at the Pan American Health Organization.
Health experts point to factors including lack of awareness, low testing rates, barriers to care, stigma and increased substance use.
Julianne Wotherspoon, executive director of the Regina Family Planning Federation, said one of the biggest challenges is getting STI testing numbers back to pre-pandemic levels, as COVID-19 has caused many patients to miss treatment.
“It's not that we don't know how to identify or treat syphilis, we just have a hard time controlling the numbers,” Wotherspoon said.
According to Canadian government data, Saskatchewan has the highest syphilis case rate of any Canadian province, at 186.6 cases per 100,000 people, compared with the national average of 36.1.
“This is like a really bad car accident that we all just need to watch and know can be prevented,” said Amanda Dela Cruz, associate nurse with Planned Parenthood Regina.
Syphilis can be diagnosed with a simple blood test, but it's difficult to self-diagnose because it often shares symptoms with other infections or has no symptoms at all, which is why de la Cruz calls it “the great imitator.”
Syphilis in adults is usually treated with penicillin if caught early, Dela Cruz said, but if the infection is transmitted to infants, treatment becomes more “invasive.”
“The most devastating effect of syphilis in adults is congenital syphilis, or transmission from mother to fetus,” Alonso said.
The surge in syphilis cases has also led to an increase in congenital syphilis, with cases increasing by nearly 600% in Canada between 2018 and 2022.
Dr. Jared Bullard, a professor of pediatric infectious diseases at the University of Manitoba who studies congenital syphilis, said most of these cases are coming from the Prairie Provinces and territories.
But British Columbia, Ontario and Quebec are also starting to see increases.
Bullard said the spike is “significant” considering provinces like Manitoba hadn't recorded a single case of congenital syphilis for decades, from 1977 to 2015.
“For decades, syphilis was almost unheard of,” Bullard said.
“There are a lot of doctors and health care workers who don't really know what congenital syphilis is, so it's important to educate them.”
Congenital syphilis can cause miscarriage, stillbirth, and developmental problems in babies.
Experts say prenatal care and regular testing should be a top priority to reduce infections.
The Canadian Paediatric Society has developed guidelines for congenital syphilis on how to test for and treat infant patients.
