PREPARED BY:
Lora Piccinin, Manager of Infectious Disease Prevention/Talaya Harrold, PHN/HPS
DATE:
February 20, 2020
SUBJECT:
Syphilis in Windsor and Essex County
BACKGROUND
Sexually transmitted and blood-borne infections (STBBI) account for the largest burden of all Diseases of Public Health Significance (DOPHS) in Windsor and Essex County (WEC), representing 71% of all reported cases. According to the Health Protection and Promotion Act (HPPA), health care providers have a duty to report cases of STBBI’s to public health, including HIV/AIDS, Chlamydia, Gonorrhea, Hepatitis B, Hepatitis C, and Syphilis.
Local data shows that Syphilis is a significant concern. Syphilis is transmitted through oral, genital, and anal sex with an infected person. Syphilis can also be passed on to an unborn child, sometimes causing birth defects or death. Syphilis is normally diagnosed through a blood test and is treated with penicillin or other antibiotics. If left untreated, syphilis can progress through four stages of infection, with symptoms ranging from sores and rash to multi-organ system damage. Before 2001 syphilis cases in Ontario were rare, but rates have been on the rise. As noted in the Summary of Syphilis in Windsor and Essex County report, from 2017 to 2019, there has been a 134% increase in the crude incident rate of local Syphilis cases. During this same period, there was a 25.6% provincial increase, although the overall rate in Ontario remains higher than in WEC.
Infection of the brain and spinal cord, known as Neurosyphilis, has also been found to be of significant concern as noted in the Summary of Neurosyphilis in Windsor and Essex County report. This complication of Syphilis can result in symptoms such as headaches, dizziness, dementia, a change in personality, and difficulty coordinating muscle movements. In 2019, Neurosyphilis cases comprised nearly 10% of all Syphilis cases in WEC. This number has been steadily growing, with 5.5% and 3% of cases in 2018 and 2017 respectively. In addition to the increased number of Neurosyphilis cases, there has also been a shift in the age of those being diagnosed. From 2010 to 2018, all Neurosyphilis cases were over 45 years of age, however in 2019, half of the cases were diagnosed in individuals 20-44 years of age.
Individuals at a higher risk of contracting Syphilis and Neurosyphilis include those engaging in unprotected sex, men having sex with men, and individuals having sex with anonymous/multiple partners. To reduce the risk of contracting and transmitting Syphilis and other STBBI’s, individual are encouraged to engage in safer sex practices such as wearing a condom and are further encouraged to get tested.
CURRENT INITIATIVES
Currently, nurses in the Infectious Disease Prevention and Clinical Services departments provide follow up of all laboratory confirmed cases of Syphilis in WEC through the provision of direct clinical services and/or by working with primary health care providers in the treatment of cases. In addition to testing and treatment, nursing staff facilitate the process of contact tracing and confidential partner notification in an effort to decrease further transmission of Syphilis and other STBBI’s.
The WECHU continues to increase community awareness of the risks associated with contracting Syphilis and other STBBIs, especially among those who engage in unprotected sex and also through physician engagement strategies that support our local health care providers in the testing, diagnosis, and treatment of Syphilis cases. Initiatives to date include media segments led by our Nurse Practitioner (NP) and educational sessions for health care providers at various Windsor Essex County Community Health Centre sites. Additional NP led sessions are planned for the University of Windsor and St. Clair College student health services as well as Family Health Teams. In addition, Dr. Ahmed (MOH) provided an educational session at the Windsor Essex County Medical Society 2019 Annual Meeting,
A public awareness campaign is also under development. Currently data is being collected to explore clients’ baseline knowledge, risk factors and perceived barriers to engaging in safer sex practices in relation to Syphilis. This data will be utilized to direct our public messaging and communication strategy moving forward.
Approved by:
Theresa Marentette, CEO