Public health officials declare provincewide syphilis outbreak

Public health officials have declared a syphilis outbreak in Nova Scotia and are encouraging more frequent testing to curb the spread of the sexually transmitted disease.

There were roughly 82 cases of syphilis in the province in 2019, up from 50 cases in 2018, an increase of 60 per cent.

But unlike an earlier provincial outbreak between 2009 and 2013 that was concentrated in the Halifax area, the disease is now occurring provincewide.

"We're not really saying that any region of the province is particularly spared, which is different again than the 2013 outbreak that was largely in the city," Dr. Gaynor Watson-Creed, Nova Scotia's deputy chief medical officer of health, said Monday.

"We're now seeing this is something that's occurring across Nova Scotia."

'The great imitator'

Syphilis is transmitted through sexual contact, including vaginal, oral and anal sex.

Initial symptoms occur within a few weeks to a few months after infection. They include a sore at the point of infection, a mild fever, and a rash on the palms of the hands and soles of the feet. 

But those symptoms are easy to miss.

"The problem is the sore is actually painless, so they may miss it. Particularly if they can't see it, if it's in a region that they can't see," Watson-Creed said.

Problems can arise when someone carries the disease for years and it begins to damage the heart and the brain.

"Historically, in medicine it's been called the great imitator because it can look like so many things and and often look like almost nothing at all," Watson-Creed said.

Prevention and testing

Watson-Creed said cases of all sexually transmitted infections (STIs) are on the rise across Canada.

She said the last Nova Scotia outbreak of syphilis was contained through practising safer sex and especially through regular syphilis testing by people who had unprotected sex with multiple sexual partners.

"Even if you identify it late, it's not too late to treat and so it is a very treatable disease," she said.

Syphilis tests are accessible through sexual health clinics and family doctors, including walk-in clinics. Treatment consists of a single injection of penicillin.

Watson-Creed believes that fatigue around safe-sex messages may be part of the reason syphilis is making a return.

"Those messages can get old for people quite quickly, particularly if they're not regularly certainly reminded of them and if they don't think that they're at risk," she said.

Women at risk

While the previous syphilis outbreak in Halifax primarily affected men having sex with men, the disease is now affecting more women.

For this reason, all pregnant women will now be offered two syphilis tests during their pregnancies, instead of just one.

"We're looking now to see if we can detect any of those cases early. So again, we can have those babies in treatment," she said.