Sask. Health Authority declares syphilis outbreak

Dr. Khami Chokani, a medical health officer in Prince Albert for the SHA, speaks to media on Dec. 19, 2019. (Jayda Noyes/Daily Herald)

In only four months, 21 cases were confirmed in the area of P.A. and surrounding communities

The Saskatchewan Health Authority (SHA) has declared a syphilis outbreak in north-central Saskatchewan, including in the Prince Albert area.

According to a press release issued Thursday, an outbreak has been declared for the area that includes Prince Albert, Big River, Shellbrook, Spiritwood, Birch Hills, Christopher Lake and surrounding communities. Syphilis is a sexually-transmitted infection (STI) spread from person to person through direct contact with a syphilis sore.

The outbreak was declared because, in the four months from August to November, 21 cases were confirmed. The average number of annual cases in the region is seven or fewer.

“That has prompted us to declare an outbreak so that we can pull our resources together (and) work together with other health care professionals,” said Dr. Khami Chokani, medical health officer in Prince Albert with the SHA.

The aim, he said, is to investigate why the outbreak has occurred and identify what gaps might exist or challenges people might be facing.

“We want people to be safe,” he said.

“It is primarily spread through person-to-person contact. It is also spread from the mother to an unborn baby. That is what is driving us more than anything else because the age group that is predominately affected is that reproductive age group. It puts… our unborn population at risk.”

The outbreak is the third declared in Saskatchewan this year. One was declared in the North Battleford-Lloydminster area in June, and Indigenous Services Canada reported 83 new cases across the province’s 82 Indigenous communities this year, a 2,000 per cent increase since 2017.

The local outbreak has hit people of all ages, from 25 right up to 65, Chokani said.

“It’s a whole spectrum. It’s hitting anybody who is sexually active.”

One thing many of the cases here and elsewhere have in common is it is increasing in young people and women of child-bearing age having unprotected sex with multiple partners.

According to a report from the Saskatoon StarPhoenix from just one week ago, 43 per cent of syphilis cases this year were women, compared to just seven per cent in 2017.

The leading risk factor in new cases in the province is a previous STI. But Dr. Ibrahim Khan said he’s worried by a newer trend driving syphilis infections: sex fuelled by crystal meth.

“We also saw crystal meth play a role,” Khan said. “When you use meth, you usually aren’t too worried about using a condom.”

Some of those trends are playing out in Prince Albert, too.

Chokani said that in over 90 per cent of cases, the person infected did not use a condom. About 46 per cent had been using a drug.

“We do know that some drugs — the side effect is inhibitions are lowered,” he said.

“We’re going to be doing a look back. Us having an outbreak will allow us to investigate what has been going on and what has caused this. Because we just don’t go from six cases in a year to 21 in four months.”

Saskatchewan’s outbreak follows similar trends across Canada and in the United States. The Public Health Agency of Canada estimates syphilis rates in Alberta, for example, increased by more than 800 per cent this year.

It’s also not the only STI on the rise; rates of gonorrhea in Saskatchewan have increased by more than 80 per cent since 2016. In the 2017-18 federal budget, $4.3 million was allotted to fight the spread of STIs in Saskatchewan.

Heather Hale, executive director of Saskatoon Sexual Health, said the silver lining of the rising figures is that more people are getting tested and catching the illness early. Her centre has seen a 72 per cent increase in the number of tests conducted compared to the same period last year.

“If you’re doing more testing, that usually means you’re going to have more incidents,” Hale said.

For people at risk, the best step is to seek medical advice — either from a local physician or any sexual health clinic.

Getting tested is important, Chokani said, as for many people, syphilis can be asymptomatic.

“It can remain like that for decades and only reappear several decades later. A feature of infectious syphilis is a sore, and it is painless and disappears in seven to ten days whether you put treatment on it or not,” he said

“Because it disappears does not mean you don’t have an infection. Now the infection has the opportunity to spread and stay within your body.”

Chokani said a frustration is that even when people do get tested, they sometimes aren’t available for a follow-up. Tracking down people who have gotten tested has also reportedly been difficult in other jurisdictions.

Syphilis is treatable, Chokani said, but you have to know you have it. The testing is a simple blood test, and treatment is a pair of injections. It can take 21 days after treatment to be cured of the infection.

He added that the health authority estimates that each positive case had at least four other contacts, meaning the current 21 cases could have impacted as many as 84 people.

“Voila – that is a challenge. When you go see your family physician or nurse practitioner, give them some contact information you know you can be gotten ahold of at because it’s really, really important,” he said.

Chokani believes part of the reason it can be so hard to track people down is because they don’t want to know their results.

“Even when they’re given their results, they’re not coming back for their treatment,” Chokani said.

“We’re not saying don’t have sex, have it, but be safe take all the precautions that are necessary for you to be safe.”

“We are humans, it is difficult to expect that people will always be abstinent. but what we can ask is people always be safe. if there is a doubt, a question, go get yourself tested. There’s nothing better than knowing what it is and getting yourself treated. When you have it treated, great, you’re good to go.”

— With Daily Herald files from Jayda Noyes and StarPhoenix files from Zak Vescera