Syphilis bites back

Toronto’s gay community is in the middle of a major syphilis outbreak, a trend some health professionals fear is indicative of a drift away from safer sex practices.

In October 2002, there were 122 cases of infectious syphilis in the region, compared with just 23 cases the same time last year.

“It’s a six-fold increase,” says Jo-Ann Ackery, manager of the provincial government’s STD program in the southwest Ontario region.

Syphilis is a bacterial infection that is transmitted through unprotected vaginal, anal and oral sex with an infected person. It can cause small chancres (painless sores) on the genitals and mouth and, left untreated, severe fever symptoms and damage to the brain, liver and arteries. Once detected, the infection is easily treated with penicillin.

More than 90 percent of the cases recorded by the end of last summer involved men, with 40 percent of that group defining themselves as men who have sex with men. But despite appearances, gay sex is not necessarily linked to the spread of syphilis.

“It may not be anything in particular to the type of contact [between men]. Once the disease is introduced into a particular group, it may spread very quickly in that group. It may be that just one or two people are having a lot of sex and spreading the infection,” says Dr Rita Shahin, associate medical officer of health with Toronto Public Heath.

Ed Lee, medical director for the Hassle Free Clinic, suggests that the recent increase has a lot to do with behavioural change. Bathhouse culture and the sexual liberation of Internet chat rooms are making it easier for people to hook up and engage in risky sex, he says.

“People are more sexually active and they may or may not be using condoms. Although condoms help to prevent syphilis transmission, they are not guaranteed to. A lot of people don’t use condoms for oral sex and syphilis can be transmitted that way. And certainly people are less vigilant about using condoms for anal sex,” he says.

Though the importance of condom use for anal sex is seen as a given, Lee admits protected oral sex is a tougher sell.

“For oral sex, generally and in the ideal world, use condoms. But at the very least take a look to make sure there are no sores and no discharge,” he says.

Because the disease is so infectious, the outbreak may be far from over. “Approximately 30 percent of those exposed will get syphilis after contact. And because it takes so long for symptoms to appear, people may not know they have it and may have quite a few partners before it is diagnosed,” says Lee.

Syphilis sufferers also have increased susceptibility to more dangerous infections. “Because there is a sore it makes it that much easier to pass on HIV and if someone is not infected, to contract HIV,” says Lee.

The current outbreak is not confined to Toronto. Similar statistics are reported in Ottawa and Vancouver and across the US.

“Generally, we are seeing a rise in STDs. It’s pretty hard to tell why. But since chlamydia, gonorrhea and syphilis can be transmitted through oral sex, we’re wondering if people are getting it that way,” says Ackery.

Stopping the spread of syphilis in the community should be as simple as walking to the nearest doctor’s office. “It’s very easy to get tested. It’s just a blood test. Treatment for primary syphilis is generally two shots of penicillin,” says Lee.

Syphilis has a rich history. East coast mobster Al Capone famously refused treatment for his syphilis while serving time for tax evasion in San Francisco’s Alcatraz prison. By the time dementia appeared, he was already suffering irreversible brain damage. He died from syphilis-related illness in 1947.

* The Hassle Free Clinic is at 556 Church St, second floor. Clinic hours and more info are available at www.hasslefreeclinic.org and (416) 922-0603 for men and (416) 922-0566 for women.