'Alarming' increase in sexually transmitted infections found across Canada

Rates of chlamydia and gonorrhea across Canada have jumped, according to the latest figures compiled by CBC News, which comes amid a new surge in syphilis.

CBC News asked each provincial and territorial government for up-to-date figures for the three most common sexually transmitted infections that are nationally reported due to their public health importance: chlamydia, gonorrhea and syphilis.

The figures show there were more than 126,700 chlamydia infections and 28,300 cases of gonorrhea diagnosed in 2017, the most recent year for which data is available.

The number of syphilis cases in Canada actually dipped for the first time in a decade during that same year — to about 4,300. But public health officials worry that decline may be short-lived, given recent increases reported in Alberta, Saskatchewan and Manitoba.

Last month, Alberta declared a provincewide outbreak of syphilis, with rates of the STI reaching a level not seen since 1948.

The federal government also recently announced more than $32 million in funding for research into STIs and blood-borne infections, writing that "rates of sexually transmitted infections in Canada have increased over the last decade — chlamydia increased by 49 per cent, gonorrhea by 81 per cent, and syphilis by an alarming 178 per cent."

These increasing rates of STIs across Canada are part of a global trend, says Dr. Rita Shahin, associate medical officer of health with Toronto Public Health.

But global efforts to contain the spread of STIs, such as interventions aimed at reducing risky sexual behaviour, haven't been sufficient, according to the World Health Organization, as behavioural change is a complex challenge, particularly for marginalized populations.

It's a problem that Dr. Ibrahim Khan and the nurses he works with have seen firsthand. 

In Saskatchewan, both the Fort Qu'Appelle and Battleford regions currently have clusters of syphilis in local reserve communities, he said.

"Since this outbreak has started, we have seen that a number of our teams — internally and externally — in the communities are overwhelmed," said Khan, a regional medical health officer for Indigenous Services Canada's First Nations and Inuit Health Branch. 

"Syphilis infection, if it's a case or a contact, requires a very meticulous, very labour intensive followup."

Complicating things, he said, is the fact that clients may have multiple conditions and co-infections.

"You're just not dealing with syphilis. You're dealing with HIV, you're dealing with hepatitis C, you're dealing with addiction, you're dealing with other mental health issues. So it becomes very overwhelming for our staff on the ground and the staff in the regional office."

By declaring an outbreak, Khan hopes to be able to continue to offer regular health-care services while also increasing awareness of STIs among those most affected: people who have condomless sex with new or anonymous partners.

'I care about my health'

When Tim Lagman was first diagnosed with chlamydia and gonorrhea about three years ago, he said he was shocked by the symptoms and didn't know how to get treatment.

But now, as a volunteer peer outreach educator, the 26-year-old fights what he calls the stigma associated with condom use by speaking openly about safe sex, such as at Pride events in Toronto.

"I think that condom usage is just a way for two people to say, 'I care about my health. I also care about your health,'" Lagman said. "I don't want either one of us to feel the burning sensation in the morning after."

Spectre of resistant gonorrhea

While most STIs can be cured today, one thing that is on the public health radar is antibiotic-resistant gonorrhea. 

"The concern is that we may be running out of antibiotics in the next few years, potentially, as resistance increases," said Shahin.

Other factors that may be contributing to increasing rates, Shahin said, include: decreasing condom use, the rise of online dating apps, lags in sexual health education, and an overall increase in STI testing.

In particular, the introduction of new tests for pharyngeal and rectal forms of gonorrhea and chlamydia may have led to additional testing, Shahin said.

Testing and treatment remain important, she said, in large part because of the long-term consequences of STIs. Untreated syphilis, for example, can lead to:

• Neurological illness.

• Blindness.

• Hearing loss.

• Damage to the heart and other major organs.

And STIs such as gonorrhea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility, according to WHO. 

Shahin said she also worries about the scarring of Fallopian tubes harming fertility of those aged 15 to 29, a potential consequence of repeated chlamydia infections that go untreated.

And congenital syphilis sees the STI passed to the baby in utero, she said, which can cause a number of deformities, as well as cognitive impairment. 

Canada has endorsed the United Nations' goal of working toward the elimination of sexually transmitted and blood-borne infections as a health concern by 2030.