Rising syphilis rates in Canada, 2011–2020

Abstract

Background: Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011–2020. Methods: Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011–2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed. Results: The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15–39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016. Conclusion: Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.

Rapid Syphilis Testing

“…5 Infection rates increased in almost all provinces, but the relative increase in the Prairie provinces was particularly large, increasing by more than 400%. 5 Infection rates are consistently higher for those who are male, but the female infection rate in Canada increased by 773% between 2016 and 2020. 5 Some have attributed the rise to changes in behaviour, such as increased substance use and the increasing use of dating apps, and the corresponding increased accessibility to multiple sexual partners.…”

“…5 Infection rates are consistently higher for those who are male, but the female infection rate in Canada increased by 773% between 2016 and 2020. 5 Some have attributed the rise to changes in behaviour, such as increased substance use and the increasing use of dating apps, and the corresponding increased accessibility to multiple sexual partners. 4 Persistent syphilis infection can cause long-term issues like heart, brain, and nerve damage in adults.…”

“…Syphilis is the third most reported notifiable STI in Canada, following chlamydia and gonorrhea. 5 In 2020, the rate of infectious syphilis in Canada was 24.7 per 100,000 population, up from 5.1 per 100,000 in 2011. 5 Infection rates increased in almost all provinces, but the relative increase in the Prairie provinces was particularly large, increasing by more than 400%.…”

“…5 In 2020, the rate of infectious syphilis in Canada was 24.7 per 100,000 population, up from 5.1 per 100,000 in 2011. 5 Infection rates increased in almost all provinces, but the relative increase in the Prairie provinces was particularly large, increasing by more than 400%. 5 Infection rates are consistently higher for those who are male, but the female infection rate in Canada increased by 773% between 2016 and 2020.…”

Serologic follow‐up of solid organ transplant recipients who received organs from donors with reactive syphilis tests: A retrospective cohort study

“…Concurrent to the drug use epidemic, and influenced by it, syphilis rates have risen considerably in the last decade. Canada has experienced a 385% increase in cases in 2020 compared to 2011 9 . In the United States, a 171% increase in syphilis incidence was noted between 2014 and 2018 2 .…”