An ongoing syphilis outbreak is proving challenging for northern Manitoba health care providers.
Officials say there have been 21 confirmed cases of the bacterial disease in the region since September 2014. This compares to the usual range of zero to four cases.
Dr. Michael Isaac, medical officer of health for the Northern Health Region (NHR), says tracking and containing the spread of the disease has been difficult for a variety of reasons.
“I’d say that we are seeing sustained community transition, and despite our efforts are not seeing our case count go down,” he said.
Syphilis is a challenging infection to contain during an outbreak, as it has a relatively long incubation period and individuals who have contracted it may not display symptoms for up to three months.
“There’s a lot of time for them to spread the disease to other people,” said Isaac.
But the northern context has presented its own set of challenges, as the infection is spreading into populations that have not been typically associated with a high risk of syphilis.
Isaac explains how outbreak management is typically conducted: “In outbreaks, you try and target interventions to specific subgroups.”
Core populations at the highest risk of infection and transmission are identified and targeted for treatment, education, and prevention.
From there, the spread of the disease can be traced and gradually brought under control from the inside out.
“If you know where syphilis is being mainly transmitted, you can intervene in a more targeted way, in terms of offering testing, issuing condoms, more messaging, etc,” Isaac said.
However, the case for the North is far less clear-cut. Previously, Isaac had indicated that 40 per cent of cases emerging in the region are in women, as opposed to urban Winnipeg, where women make up only five per cent of syphilis patients.
“Our outbreak is most definitely a heterosexual outbreak, and we haven’t been able to identify those specific places or risk factors at this point in time,” Isaac said, “where we can really do a targeted intervention that could snuff out the outbreak. We’ve had a very aggressive response to treating the outbreak itself, but we’ll have to wait and see what our numbers actually show.”
There are some elements working in the NHR’s favour.
In urban settings, tracking down potentially infected contacts has been complicated by casual dating apps and social media.
“Apps like Tinder or Grindr, people can go on them, find people in their vicinity who want to have sex, and they may not ever know that person’s identity, or their name, which makes it extremely difficult for contact tracing,” said Isaac.
Yet despite urban complications, Isaac notes that use of those apps is not nearly as prevalent in northern Manitoba.
“We haven’t seen the same degree of social media use up here in the North,” he said. “We did have one or two cases who had mentioned it, but for us that hasn’t been a major driver.”
Regardless, with nearly all predictable indicators absent from the northern outbreak, authorities are left to control the disease on a case-by-case basis. “Right now, the biggest risk factor we have is geography,” Isaac said. “Gillam and Thompson are the primary communities affected.”
For now, the NHR has implemented an “enhanced surveillance” strategy, which involves extensive interviews with both patients and contacts the patient may have made while infected.
Along with testing and treatment, the NHR will also undertake informing past sexual partners who may be at risk.
Despite the Canada-wide increase in syphilis cases, Isaac is unaware of any federal program to help curb the outbreak.
Isaac recommends individuals engaged in “risky” sex should get tested every three months, not only for syphilis, but all sexually transmitted infections (STIs). However, Isaac makes it clear that a low-risk lifestyle does not make an individual immune.
“We’re moving away from a risk-based approach in terms of testing for STIs, because it can be very difficult to know your own risk,” he said. “It’s obvious if you have multiple sexual partners. But we do know, for example, some females thought that they were in a monogamous relationship, but in fact they weren’t. So they thought their risk was low, when in fact it wasn’t.”
There is good news for those who test positive for syphilis, however.
“Fortunately for us, syphilis is not resistant,” said Isaac. “It’s very easily treatable, through a single dose of penicillin, which we inject.”
Kacper Antoszewski is a staff writer for the Thompson Citizen.
What is syphilis?
Syphilis is a bacterial infection spread through sexual intercourse or congenitally from an infected mother to a developing fetus.
How can I tell if I have syphilis?
Syphilis develops in three stages:
• Primary: Syphilis begins as an often-painless chancre sore on the contacted area (mouth, genitals, rectum, etc), which appears between two to ten weeks after exposure. This is the first outward sign of infection
• Secondary: The infection spreads to other parts of the body. An itchless rash may appear on the body, along with additional chancre sores. Other, less common symptoms include aching, fatigue, joint pain, and patchy hair loss. The rash may disappear within two to six weeks.
• Latent: The virus remains in the body without symptom for up to 30 years, and may not progress to the tertiary stage. After one year, the bacteria is no longer infectious.
• Tertiary: 30 to 40 per cent of syphilis patients reach the tertiary stage. The virus re-activates, and attacks the body in a variety of areas, whether the heart, lungs, brain, or any other area. Symptoms depend on the attacked area. Once the syphilis has reached this stage, the infection can still be cured, but the damage done is irreversible.
What is the test for syphilis?
• Patients presenting with chancre sores are swabbed at the sore. Once a sore is present, the detection of syphilis is immediate.
• Patients who believe they have had contact with an infected person, but do not present symptoms, can be administered a blood test. A blood test will not detect an infection for two weeks after exposure.
What should I do if I think I have syphilis?
• Do not have sex until you are tested
• Report to your nearest health care centre
• Inform your health care centre of any sexual partners
How is syphilis treated?
Syphilis, if detected prior to tertiary damage, is easily treated through single injection of standard antibiotics
