Multisector approach required: education, clinical suspicion, detailed surveillance, rapid testing, discreet screening, addressing social determinants of health.
Epidemiology and Risk Factors
Cyclic Nature: Syphilis shows cycles of infection due to changing behaviors and partial immunity.
High-Risk Populations: Includes gay and bisexual men (gbMSM), women (notably congenital syphilis cases), and substance users.
Dating Apps: Increased use linked to risky sexual behaviors across all orientations.
PrEP and Condom Use: PrEP use in gbMSM reduces HIV fears but also condom use, increasing STI risks.
Substance Use: Methamphetamine and other drug use associated with risky behaviors.
Demographic Shifts
Rise in syphilis among middle-aged adults (40-59 years), linked to social changes and erectile dysfunction treatments.
Data and Surveillance Challenges
Lack of Comprehensive Data: Canada lacks timely national STI data, impacting intervention.
Missing Ethnicity and Orientation Data: Impedes targeted interventions due to stigma concerns.
Testing and Screening
High Clinical Suspicion: Syphilis mimics other conditions; regular screening advised for high-risk groups.
Web-Based Testing: Piloted in British Columbia; could enhance screening access.
Educational and Testing Initiatives
Education Campaigns: Need for accessible education on transmission methods.
Remote Access to Testing: Limited in some regions; point-of-care testing under evaluation.
Collaborative Efforts Needed
Combined Approach: Public health education, practitioner involvement, rapid testing, and accessible screening essential in controlling syphilis rates.
Conclusion
Combating syphilis resurgence requires comprehensive, coordinated public health strategies involving education, surveillance, testing, and addressing social determinants.