July 16, 2019, the Chief Medical Officer of Health, Dr. Deena Hinshaw, declared a provincial outbreak of infectious syphilis and the activation of the Alberta Outbreak Investigation Coordinating Committee (OICC). A total of 1,536 cases were reported in 2018, a 10-fold increase since 2014. Alberta has not seen such high levels of syphilis since 1948. The infection has moved into the heterosexual population, with exceptionally high rates in the Edmonton Zone and North Zone. As a result, we are now seeing more females with syphilis, resulting in 21 cases of congenital syphilis reported between 2014 and 2018. Accompanying this are the continued high rates of chlamydia and gonorrhea.
The OICC is working to develop a coordinated strategy and actions to increase awareness and reduce the number of syphilis cases in Alberta. The committee is working closely with primary care and community partners including the Alberta College of Family Physicians to identify interventions to combat the rising rates of syphilis. However, as family physicians, there are immediate actions that can support the syphilis outbreak response.
- Consider Syphilis testing whenever screening for
chlamydia and gonorrhea
- Only ~50% of persons tested for chlamydia and gonorrhea also had a syphilis test
- Ensure pregnant patients are engaged in
pre-natal care
- Only 67% of women had prenatal screening consistent with provincial guidelines (Alberta Prenatal Screening Guidelines)
- Assess risk of sexually transmitted infections (STIs)
with your patients (Canadian
Guidelines on Sexually Transmitted Infections – Primary Care and Sexually
Transmitted Infections) by taking a sexual health history and asking
questions about:
- Known contact with someone with an STI
- New or multiple or anonymous sexual partners
- Previous history of an STI diagnosis
- Involved in non-monogamous relationship
- Occurrence of sexual assault
- Understand the epidemiology of syphilis in your
zone (Interactive Health
Data Application and Alberta STI and HIV
2018 report). Risk factors include:
- Transient population
- Men who have sex with men
- People who use drugs
- People with mental health issues
- People who exchange sex for goods/services
- Counsel on safer sex and risk reduction
- Consistent and correct condom use
- Testing for STIs
- Refer patients to accurate information (e.g., SexGerms)
- Completion of Notification of STI forms
- Contact Alberta Health Services (AHS) Sexually Transmitted Infections Central Services (STICS) at 780-735-1466 or toll free 1 888 535 1466 for forms, free STI medication and consultation
- Refer to STI Notifiable Disease Guidelines
Albertans are encouraged to consider their risk for an STI and to seek assessment and testing. A wide sweeping response across multiple health disciplines and community agencies, among others, is needed to address this outbreak. Family physicians represent a critical link to identify risk and screen for syphilis and other STIs.
Have the conversation. Assess the risk. Screen.
