Syphilis rates on the rise in Quebec as condom use declines

Syphilis rates in Quebec may not be as high as Alberta’s, but public health officials are warning that rates of the sexually transmitted scourge are already “worrisome” here, and steadily climbing for the fourth year in a row.

Earlier this month, Alberta’s medical officer of health declared a provincial outbreak of syphilis, after a provincial report showed a sharp increase of 187 per cent of reported cases last year compared to 2017. A total of 1,536 infectious syphilis cases were reported in that province in 2018; a rate of 35.7 cases per 100,000 people. That is the highest rate reported in that province since 1948.

According to the latest available data for Quebec, the syphilis rate here is holding steady at about 11 cases per 100,000 people. Doctors reported 918 cases of syphilis in 2017 and 938 cases last year.

That is high, considering that back in 1998, Quebec tallied only three cases of syphilis in total, said Karine Blouin, a scientific adviser with the Institut national de santé publique du Québec (INSPQ).

“We expect that in 2019, it will go up a bit again, and it’s already high at almost 1,000 cases” a year, said Blouin, who specializes in epidemiology of infections transmitted sexually and through the blood.

Blouin describes the syphilis rate in Quebec as “endemic, elevated and worrisome.”

Indeed, some clinicians in Quebec say they are diagnosing syphilis with surprising frequency in their offices. In May, Dr. Réjean Thomas, the medical director of Clinique l’Actuel, a sexual health clinic in Montreal, sounded the alarm on Facebook.

“I have never treated so many cases of syphilis in all my life,” Thomas wrote. “At l’Actuel alone, we have treated more than 60 people in a single month. Get yourself tested.”

Many people infected with syphilis experience no symptoms, and symptoms can take two or three weeks after infection to develop. The first symptom is usually a chancre, which is a round, usually painless sore, usually in the genital area. This symptom will disappear on its own after a few weeks, even if left untreated. Two to three weeks after infection, a rash may appear on the chest, stomach, genital organs, palms or the soles of the feet, which can last two to six weeks. More chancres may appear at this stage, as well as other symptoms such as fever, headache, muscular pain, loss of appetite and fatigue.

Syphilis is transmitted sexually, through contact with a syphilis-related lesion on or in the genital organs, anus or mouth. Risk of contacting syphilis can be substantially reduced by using a condom during sexual relations.

Syphilis can be cured with one dose of penicillin. If left untreated, it can cause tissue damage, and serious damage to the organs, including the eyes, skin, bones, liver, kidneys and heart. If syphilis infects the brain, it can cause personality changes and cognitive impairment.

While about 90 per cent of those infected with syphilis are male, the number of syphilis cases among women in Quebec has also been growing recently. Twenty-one women were diagnosed with syphilis in 2015, 41 in 2016, 69 in 2017 and 91 in 2018. That means the rate went from 0.5 to 2.1 per 100,000 for women over those years.

Since the majority of women affected are of childbearing age, there is a further concern about congenital syphilis (babies born with the infection), she noted. There were three cases in 2016, one in 2017 and one in 2018, as compared to five cases in total over the first 15 years of this millennium.

The rate for men is around 20 per 100,000 for men in Quebec.

“As for why it’s come back, well certainly back in the 1990s condom use had really increased because of the fear of HIV and AIDS. Behaviour has changed in the last 20 years,” Blouin said.

Condom use has diminished, possibly because of the availability of new and better HIV treatment options and transmission prevention measures, she said.

“The prophylactic treatments to prevent transmission of HIV are very effective in preventing transmission of HIV, but in the absence of condoms it won’t prevent the transmission of other sexually transmitted infections,” she said.

While Quebec’s syphilis resurgence was initially concentrated in the Montreal region, it has now spread to most other regions of the province.

Other STIs, especially chlamydia and gonorrhea, are also on the rise in Quebec and elsewhere, although part of that increase may be due to better detection methods. New strains of gonorrhea that are antibiotic-resistant are also cause for concern. Meanwhile, rates of HIV diagnoses have been falling slightly in recent years in Quebec.