syphilis in n.s.: seriously dudes, just use a condom

nova scotia public health officials announced an outbreak of syphilis today after preliminary data revealed 82 cases in 2019.this is compared to 50 cases in 2018 and 38 cases in 2017. the cases have been diagnosed in patients as young as 20 and as old as 65 and beyond. there is also an increased proportion of women, at 20 per cent compared to 10 per cent in 2018 and 5 in 2017.syphilis is a bacterial sexually transmitted infection (sti) that is contracted through unprotected oral, anal or vaginal sex. it can be treated with antibiotics at the beginning, but if left untreated can cause serious damage to the brain, heart and other organs, even death.symptoms can appear between 10 to 90 days after the initial infection, and include muscle aches, rashes, fatigue and open sores at the point of infection.the nova scotia health authority (nsha)  cannot say with certainty the exact cause or causes of the outbreak. however, a letter was sent to doctors that states the most common causes of syphilis is men having sex with men, unprotected sex with multiple partners or sex with someone who has unprotected sex with multiple partners.“we know that there is a national trend where syphilis cases are increasing in both men and women,” said dr. jennifer cram, regional medical officer of health. “part of our public health work in nova scotia is to gather more data to better understand what has been driving the increase in cases locally. this will help inform further decisions around strategies to decrease transmission. if you think there is a chance you could have syphilis talk to a healthcare provider to get tested.”nova scotia previously declared a syphilis outbreak in 2009, which reached its peak in 2013 with 84 cases.in 2018, the halifax sexual health clinic (hshc), the only place in mainland nova scotia that offers anonymous sti testing, lost five family doctors. a weekly drop-in blood testing clinic was suspended. today, the clinic does sti testing once a week.“we’re doing full sti testing, swabs, blood. we’re really working under capacity,” said kate calnan, executive director of hshc. “we have the infrastructure to host 28 clinics a week but we’re only hosting 12 to 13.”calnan is unsure how large a role, if any, the clinic’s staffing situation plays in the current outbreak, noting that the previous outbreak was largely confined to central halifax regional municipality (hrm). one theory she has is message fatigue – the occasional lull in safe sex education. as far as the hshc goes, the fight for more resources is an ongoing process.“we’re labelled as a walk-in clinic even though we’re not,” said calnan. “and as a result, physicians here make lot less money than they would elsewhere.”of course, the best way to avoid the disease is to practice safe sex with a condom or oral dam.“safer sex practices and getting tested for syphilis can help decrease the number of syphilis cases we are seeing in nova scotia currently,” said dr. gaynor watson-creed, deputy medical officer of health, nova scotia in a statement. “knowing your status for sexually transmitted infections, including syphilis, is really important for your health and also the health of others.”to date, there has been no reported cases of congenital syphilis, which occurs in unborn babies. however, with the outbreak affecting more women this time, pregnant women will be offered two syphilis tests instead of just one.“the previous outbreak in nova scotia was largely driven by men having sex with men, and a lot of it had to do with online social applications and the fact that nobody uses condoms for oral sex and this is quite easily transmitted through oral sex,” said dr. todd hatchette, a physician with the nsha in infectious diseases.last year, alberta declared an outbreak of syphilis with a total of 1,536 infectious cases reported in 2018; a rate of 35.7 cases per 100,000 people. that is the highest rate reported in the province since 1948. quebec also had nearly 1000 cases in 2018, called an endemic and largely blamed on lack of condom use. saskatchewan has also seen a rise in syphilis cases in recent years.“i don’t think we completely understand what the risk factors are here in nova scotia,” said hatchette. “in other places in canada the risks are driven by substance use, like crystal meth and that sort of thing but i don’t think that information is available here at this point.”canada has aligned with the un’s goal of eliminating stis and blood borne infections as a health concern by 2030.