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. 2022 Feb 24;48(23):52-60.
doi: 10.14745/ccdr.v48i23a01.

Rising syphilis rates in Canada, 2011-2020

Josephine Aho  1 , Cassandra Lybeck  1 , Ashorkor Tetteh  1 , Carmen Issa  1 , Fiona Kouyoumdjian  2 , Jason Wong  3   4 , Alexandrea Anderson  1 , Nashira Popovic  1
Affiliations

Rising syphilis rates in Canada, 2011-2020

Josephine Aho et al. Can Commun Dis Rep. .

Abstract

Background: Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020.

Methods: Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011-2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed.

Results: The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15-39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016.

Conclusion: Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.

Keywords: Canada; congenital syphilis; gbMSM; heterosexual females; infectious syphilis; pregnant individuals; surveillance.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Total number of cases and sex-specific rates of infectious syphilis in Canada by year, 2011–2020
Figure 2
Figure 2
Rate of infectious syphilis in males and females per 100,000 by age group in Canada, 2011–2020a,b a The rate for 2020 in Figure 2A (males) and Figure 2B (females) does not include data for Newfoundland and Labrador as they did not provide data stratified by sex AND age for this year b Note that the scales of Figure 2A and 2B differ
Figure 3
Figure 3
Rates of reported infectious syphilis cases in Canada, by province and territory, 2020 Abbreviations: AB, Alberta; BC, British Columbia; MB, Manitoba; NB, New Brunswick; NL, Newfoundland and Labrador; NS, Nova Scotia; NT, Northwest Territories; NU, Nunavut; ON, Ontario; PE, Prince Edward Island; QC, Québec; SK, Saskatchewan; YT, Yukon Territory
Figure 4
Figure 4
Number and rate of reported confirmed early congenital syphilis cases per 100,000 live births in Canada, 2011–2020
See this image and copyright information in PMC

References

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