Winnipeg is seeing its largest outbreak of infectious syphilis since it began counting cases electronically in 1991, a medical officer of health with the Winnipeg Regional Health Authority says.
Dr Joss Reimer says more than 60 cases have been recorded. Compared to many Canadian urban centres, that number is not particularly striking, but it’s quite high for Winnipeg, she notes.
Infectious syphilis is transmitted sexually, caused by the bacterium Treponema pallidum. It is highly contagious, with exposure resulting from close contact with an infected person’s genitals, rectum or mouth. Left untreated, infectious syphilis can transform into what is known as neurosyphilis, which can affect brain function and lead to blindness, hearing loss and stroke.
The majority of cases in the current Winnipeg outbreak are men, and two-thirds are men who are having sex with men, Reimer says.
“At least half of them are also reporting that they are using social media or online methods of meeting sexual partners,” she adds. “I am not sure I would say that social media is a cause, but it certainly seems to be related to this outbreak in some way.”
Toronto has also seen a surge in syphilis since 2003, with 779 cases reported in 2011. In the same year, Berlin reported more than 3,500 cases, and Sydney, Australia, saw nearly 1,500 cases in 2009.
In BC, syphilis cases rose from 151 in 2010 to 372 in 2012, with men who have sex with men accounting for 95 percent of new cases. In 2013, BC recorded 561 new cases of syphilis, according to the BC Centre for Disease Control.
Online hookups present new challenges for outreach to those who may be infected, Reimer says. “Because social media has become a larger part of everything in our life — not just how we find sexual partners, but how we communicate with people in general — it’s been more difficult because there’s no physical location we can go to, to provide education, testing and treatment to people who may be exposed.”
Either people know the identity of those they’re having sex with but can reach them only online or they don’t know the real identity of their sexual partners, only the handles they use on a particular platform, she says. Online follow-up has also proven to be tricky, she says, because people may ignore the messages being sent by the health authority, they may think it’s spam, or they may no longer be on the media platform they used to connect with sexual partners.
Jody Jollimore, the senior program manager at Vancouver’s Health Initiative for Men (HIM), says he’s not sure where the syphilis cases are coming from, but he, too, says that online hookups can make infections like syphilis easier to pass around.
“It allows guys who want to have condomless sex, or who want to have group sex, to find other guys who want to have condomless or group sex,” he explains. “What that means is that the [infection] is passed around among a smaller group of individuals, so guys can get the sex they want, but it also means that group is much smaller and therefore it’s easier to pass on [an infection] like syphilis.”
Reimer says paid advertising, like banners on popular hookup sites like Grindr and Squirt, has been one approach Winnipeg has adopted. Another involves outreach workers and nurses, who have profiles on some of the common social media sites and can connect with people online to provide information about their potential risk.
She also wants to work on outreach to people who may be exposed to syphilis multiple times to try to reduce their risk and the risk to their hookups.
Jollimore agrees that a multipronged approach is key. One of the challenges with syphilis is that it’s a bit difficult to craft a simple prevention slogan, he says. “A lot of people want you to say, ‘Wear condoms,’ but condoms don’t always protect you from syphilis is the reality,” he says. “Our message has been ‘Syphilis is easy to get and it’s easy to get rid of,’ and we’ve been trying to tell people to get tested.”
Jollimore points to a partner notification tool on HIM’s website, which allows people diagnosed with syphilis to contact partners or hookups by email or phone number.
Encouraging physicians to test for syphilis is another critical aspect of tackling the outbreak, he adds, especially if it’s simply a question of adding the test to regular blood work.
Jollimore says there’s been a lot of media coverage about syphilis in the last couple of years but notes that syphilis was a relatively rare phenomenon among all populations only a few years ago. “The fact that we have had an outbreak more recently means that we have to do some work reminding people that syphilis is still a problem.”
Reimer recalls two separate syphilis outbreaks in Winnipeg that overlapped with one another between 2003 and 2008: the first occurred mostly among heterosexual people and was associated mainly with some of the bars in Winnipeg’s core, while the second involved primarily men having sex with men and was linked to bathhouses.
For more info, visit checkhimout.ca/syphilis.
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