Submitted for Class work in Public Health Class University of Lethbridge

1. A CASE ON SYPHILIS
SUBMITTED FOR PUBLIC HEALTH ISSUES IN CANADA
MOSES SERIKI
11/15/2017

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Contents
SYPHILIS – What is it?..................................................................................................................................3
How it spreads:.............................................................................................................................................3
DIAGNOSIS AND TREATMENT................................................................................................................4
EFFECTS OF SYPHILIS................................................................................................................................4
The Primary Stage........................................................................................................................................4
The Secondary Stage ...................................................................................................................................5
The Latent Stage ..........................................................................................................................................5
The Tertiary Stage........................................................................................................................................5
A Look into Syphilis in Canada......................................................................................................................6
Preventing Syphilis..........................................................................................................................................9
Syphilis not Associated with Sex: Pregnant Mothers and Newborns ..........................................................9
What to do now about Syphilis.....................................................................................................................10
Works Cited ...................................................................................................................................................11

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SYPHILIS – What is it?
Syphilis is a sexuallytransmittedbacterial infectionthat has been on a slow but steady rise in Canada
(Government of Canada, 2015). The incidence of infectedand reportedcases has beenon a rise recently
from 2001 in Canada. This disease is classifiedas a communicable Sexually TransmittedInfectionwith
an acronym STI as it is commonlyused (CATIE, 2015).
One major danger of this disease is that people may have syphilis and not know it. Some people develop
visible symptoms of the syphilis infection, but others don’t. This disease has great affiliationto Human
Immuno Virus (HIV) if it is not treatedearly.
Prior to 2001, Syphilis cases were rare inCanada, but the incidence has been on the rise more recently
than ever before acrossthe country. The attack rate and outbreaks began occurringinurban centers across
the country (Government of Canada, 2015). More cases have beenreportedinBC than any other province
in Canada. The populationat riskhas beenprimarily among men who have sexwith men, many of whom
are taking antiretroviral drugs to treat HIV, (Johnson, 2017). The age of men affectedby this disease is
men between 20 to 39 years oldin Canada. More cases have been reportedwithmen in this category
(Government of Canada, 2015).
Recentlyin the province of BritishColumbia, researchers are proposingabiological reasonbehind the
"astounding" increase insyphilis cases. They are caught in a school of thought “saying high-risksexual
behavior doesn't explainthe outbreaks that are happening”. Although, the prevalence of this disease cases
continues to grow, suggestingthat people are not consistentlyusingsafer sexmethods (Government of
Canada, 2015).
How it spreads:
This disease canbe transmittedthrough oral, genital, or anal sexwith an infectedperson. Accordingto the
Government of Canada website (2015), it is saidthat pregnant woman with syphilis can pass this bacteria
on to her unborn child. The result of this is usually birthdefects or death. Although less common, it can
also be transmittedthroughsharing needles or through brokenskin.
The disease is also communicable by the use of sharing drug use equipment (Smart Sex Resources, 2016).
Sharing needles and other form of injections mayalso expose someone to the riskof spreadingthis deadly
disease. This practice is commonwith the Lesbian Gay Bisexual and Transgender (LGBT) community.

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Using or sharing needles to inject hormones is also consideredahigh riskactivity that can lead to having
syphilis (CATIE, 2015).
DIAGNOSIS AND TREATMENT
The primary diagnosis of Syphilis is through a simple bloodtest and is easilytreatedwith penicillinor
other antibiotics (Government of Canada, 2015). Syphilis has two major modes of which it is contracted.
It is infectious andnoninfectious stage. When this disease is not treatedearlyenough, it is communicable
at the first three stages before it gets to the fourthlate stage when it is more cumbersometo treat. The
stages are from the Primarystages, secondarystages, Latent Stages and Tertiary stages.
As mentionedearlier, the disease Syphilis is usuallycommunicable during the first three stages. It's
potencyof transmissionare higher during the primary and secondarystages, and early in the latent stage.
At this stage, it responds to treatment without much ado. When it remains untreated, syphilis may
progress to the tertiarystage. The Tertiary stage of syphilis can cause damages to the central nervous
system, the cardiovascular system, eyes, skinand other internal organs. Untreatedsyphilis could increase
the riskof contractingand transmittingHIV (Public HealthAgency of Canada, 2008).
The biggest challenge of the syphilis disease is that not everyone infectedwiththe bacteriawill develop
symptoms. This makes it a very dangerous disease. From a public health perspective, it is important to
know if you are at risk and how to take preventative action (Smart Sex Resources, 2016).
EFFECTS OF SYPHILIS
Syphilis comes witha great deal of various symptoms. These symptoms can easilybe confusedwith those
of other conditions byhealthcare professionals. The reasonis because; the prevalence of the disease has
not been high in Canada until recently (Government of Canada, 2015).
The PrimaryStage
With the primary syphilis, it couldstart with a painless open sore where the bacteriafirst enteredthe
body. This couldbe the genital area, throat, anus, or swollenglands may be present inthe groin.
Sometimes the symptoms couldmanifest veryslowly and can occur withina few days or a couple of
months after infection. Hence, because sorecouldbe painless, individuals affectedmay not pay much

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attentionto the infection. In Canada, most people do not report cases of primarysyphilis because theyare
not aware they are infected. In some cases, the sore mayheal over the periodwithout any treatment.
While this is very commonwith the disease infection, the infectionwill remainand progress to secondary
syphilis (Sexual Health Ontario, 2017).
The SecondaryStage
This stage starts with a rash on one or multiple areas of the body. These rashes can appear from time to
time even after the original sore has healed. Sometimes the rashmay not be itchywhich makes it more
dangerous because it still does not puts pressure onthe infectedindividual to carry out a medical checkup.
The rash may appear to be rough, reddishbrown spots onthe palms of the hands or appear at the bottom
of the feet. Most times, infectedpeople maymisinterpret them for birthmarks because it appears faints on
the skin (Sexual HealthOntario, 2017) .
With the secondarysyphilis, the symptoms can overlap with those of the primary stage and vary
considerably. These symptoms include patchy hair loss, rashon the soles of the feet, the palms of the
hands, or elsewhere onthe body, fever, malaise, swollenglands, and flat grayish-white sores inmouthand
on genitals (Government of Canada, 2015).
If the immune system of the infectedindividual is strong, treatments maynot be requiredas such but if
the immune system fails at the time of protractingthe disease, it is important to treat as soonas possible.
Without the right treatment, the infectionmayprogress to the latent stage of syphilis (Sexual Health
Ontario, 2017).
The Latent Stage
At this stage, the disease exists but not yet developed or manifested. It can be said that it is hidden or
concealedinthe body. The latent stage of syphilis is a periodof time when there are no visible signs or
symptoms of syphilis. If you do not receive treatment, youcan continue to have syphilis in your body for
years without any signs or symptoms (Centers for DiseaseControland Prevention, 2017). Hence it is
important to do regular checkup to catch the existence at this stage (Government of Canada, 2015).
The TertiaryStage
At this stage, it affects bodysystems and can affect vital organs in the body. Syphilis can cause damage to
the body, affectingthe brain, bloodvessels, heart, and bones. When it is untreated, syphilis can eventually

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lead to death. Accordingto the CDC website, Tertiary syphilis is very serious and would occur 10–30
years after your infectionbegan. It can also lead to high chances of contractingthe HIV. The transformed
syphilis to HIV oftenmakes HIV difficult to treat. (CDC, 2017),
A Lookinto Syphilis inCanada
Syphilis was first noticedinCanada is 1924. (Public HealthAgencyof Canada, 2008). The overall
reportedrate of infectious syphilis increasedinthe last decade that is from 2007 to 2017. The rate of
increase was by 568.2%. It was reportedthat the rate of infectionwas commonamong men than women
in Canada. Men between the age group of 20 - 39 were mostlyaffectedwhile women had an age range of
20 - 24.
In Canada, outbreaks have been reportedinthe last decade in places like Vancouver, Edmonton, Ottawa,
Montreal, Winnipeg, Toronto and the Yukon areas. Most recently, outbreaks have been reportedin
Northwest TerritoriesandNova Scotia. The rate increase was highly significant betweenmen who have
sexwith men and the bisexuals’ community. Although, a proper ratio has not been establishedbecause
most people do not willingly give informationas regard to their sexuality. The male to female ratio is
much higher in some jurisdictions like Quebec, Ontario and BritishColumbia
Source: (Public HealthAgency of Canada, 2008)

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In 2008, people above 30 years oldaccountedfor 73.6% of the populationaffectedbysyphilis. In
mean, the highest reportedrate of infectious syphilis was shared between 25 to 29 years oldand 30 to
39 year olds (13.3 per 100,000). Together, these age groups accountedfor almost 40% of the reported
cases inmen in 2008 (PublicHealthAgency of Canada, 2008). In women, the highest reportedrate was
in 20 to 24 years olds (3.6 per 100,000).
Public HealthAgency of Canada, 2008, reportedthat Cases in menare more commoninthe case of
syphilis. In 2008, Menaccountedfor 86.1% of the populationof infectious Syphilis that were reported.
But before then, cases were stable between genders from 1993 to 2001. Cases spikedup in Canada from
2001. This coincidedwithwhen the LGBT rights came into play among provinces until it was finally
adopted nationally in July 20, 2005 (Historical Canada, 2005).
Source: (Public Health Agency of Canada, 2008)
While in 2016, Albertarecordedwithinits province and reportedthe highest outbreakof syphilis. Numbers
show that syphilis cases inAlberta as at 2014 was 150 cases and the number doubledin 2015 to 350
reportedcases. As at April 2016, 123cases of syphilis have been reported. More cases were reportedin

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Edmonton than other citiesinAlberta (MarionWarnica, CBC News, 2016). Marionalso reportedthat
provinces like BritishColumbia, Saskatchewan and Newfoundland have also reportedspikes insyphilis
cases with more cases inthe male gender. It was also found that men who had sexwith men were about
86% of the cases reported.
FIGURE 1: ReportedRates ofInfectious Syphilis, 1993 - 2008
Source: (Public HealthAgency of Canada, 2008)
Source: (Public HealthAgency of Canada, 2008)

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Although Syphilis is on the rise incomparisonto previous historical years, its numbers are still
comparably small in connectionwithother forms of STDs like Gonorrheaand Chlamydia. See this
table belowto see the comparison.
In conclusionas regardto syphilis in Canada over a 10-year period, Canada has witnesseda 40%
decrease insyphilis rates in women and a 128% increaseinsyphilis rates inmen, which is consistent
with trends seenin other Westerncountries (Statistics Canada, 2015).
Preventing Syphilis
The upstream measure to prevent syphilis is to practice safer habits in the community. The best way to
prevent syphilis is to practice safe sex. In modernsocieties, using condoms duringany type of sexual
contact is a good idea. Furthermore it may be helpful to avoid having sec with multiple partners, avoid
sharing sex toys and above all get screened for sexuallytransmittedinfections andtalk to your partners
about their results (Honor Societyof Nursing(STTI), 2017).
Syphilis not associated withSex: Pregnant MothersandNewborns
Mothers infectedwithsyphilis are at high riskfor mishaps suchas miscarriages, still births, and in most
cases of premature birth. There is also high riskthat an infectedmother will pass the disease to her
fetus. This is known as congenital syphilis (HealthLine, 2014).
Congenital syphilis is a form of syphilis that is acquired by the child and can be life-threatening. Babies
born with congenital syphilis are seento have deformities, developmental delays, seizures, rashes,
fever, swollenliver or spleen, jaundice and infectious sores (HealthLine, 2014).

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When a baby has congenital syphilis and it is not detectedat birth, the babies stand the riskof
developing late-stage syphilis. This can lead to damage to their bones, teeth, eyes, ears, brain etc. Hence
proper checkand regular checkup is recommendedfor mothers that have at one time or the other been
diagnosed with syphilis (HealthLine, 2014).
What to do now about Syphilis.
The nature of the disease suggest that everyone can go test for syphilis especiallyif one has had
unprotectedsexwith someone before, or maybe pregnant, or man that has had sexwith another man.
Others may be someone who engaged unprotectedsexwith multiple partners. Since this disease can
have an incubationperiodof up to 10years, it is imperative to have for all to do the test in Canada.
Government can also intervene by providing great educationabout the subject around the community
that it is mostlyprevalent, that is the LGBT. Safer measures of sexual practices couldbe taught on how
to pleasure themselves. Other measures are abstinence which is very unpopular.

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Works Cited
CATIE. (2015). Syphilisis Serious and its here. Retrievedfrom catie.ca/syphilis:
http://www.catie.ca/syphilis
Centers for Disease Control andPrevention. (2017). SexaullyTransmittedDiseases (STDs). Retrieved
from cdc.gov/std: https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm
Government of Canada. (2015, July29). Syphilis. Retrievedfrom Government of Canada:
https://www.canada.ca/en/public-health/services/diseases/syphilis.html
HealthLine. (2014). Syphilis. Retrievedfrom https://www.healthline.com:
https://www.healthline.com/health/std/syphilis#overview1
Honor Societyof Nursing(STTI). (2017, August). Does syphilisaffect men differentlythanwomen?
Retrievedfrom Sharecare.com: https://www.sharecare.com/health/stds-sexually-transmitted-
diseases/syphilis-affect-men-differently-women
Johnson, L. (2017, January 17). Risky behaviournot only cause of syphilisoutbreaks, new study
proposes. Retrievedfrom cbc.ca/news: http://www.cbc.ca/news/canada/british-
columbia/syphilis-hiv-study-1.3939462
MarionWarnica, CBC News. (2016, April 26). Social media blamedfor Alberta's gonorrhea and
syphilis 'outbreaklevels'. Sexually transmitted infectionrates in theprovince arethe highest they
have beenin 3 decades. Retrievedfrom CBC News Edmonton:
http://www.cbc.ca/news/canada/edmonton/social-media-blamed-for-alberta-s-gonorrhea-and-
syphilis-outbreak-levels-1.3554228
Public HealthAgency of Canada. (2008). Reports onSexuallyTransmitted Infections in Canada.
Retrievedfrom phac-aspc.gc.ca: http://www.phac-aspc.gc.ca/std-mts/report/sti-its2008/PDF/10-
047-STI_report_eng-r1.pdf
Sexual HealthOntario. (2017). Syphilis: What it is, How you prevent it if you think you have it .
Retrievedfrom sexualhealthontario.ca:
https://sexualhealthontario.ca/en/syphilis?gclid=CjwKCAiA6K_QBRA8EiwASvtjZbuKS9CB8n
gvjdADm15BEUfi7yrjc1oYRd9h0aq1k3-25qx23bafxxoCZQYQAvD_BwE#STIS-1
Smart Sex Resources. (2016). Napoleon May be History But Syphilis is not. Retrievedfrom
syphistory.ca.
Statistics Canada. (2015). Infectioussyphilis in Canada:2003-2012. Retrievedfrom Statistics Canada:
https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-

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disease-report-ccdr/monthly-issue/2015-41/ccdr-volume-41-02-february-5-2015/ccdr-volume-
41-02-february-5-2015-2.html