Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum. Its natural history is well described in medical literature and typically includes primary, secondary, and latent stages. If left untreated, syphilis can lead to serious complications in multiple organ systems. Syphilis can also be transmitted vertically at any time during pregnancy or delivery and may lead to miscarriage, stillbirth, or complications in infants due to congenital syphilis infection.

Cases of infectious syphilis are on the rise in BC. In 2012, BC saw 369 cases (8.1 per 100 000).[1] In the 4-year period from 2018 to 2022, rates of infectious syphilis increased 98%: from 932 cases (18.6 per 100 000) to 1971 cases (36.8 per 100 000).[1]

While gay, bisexual, and other men who have sex with men represented the majority of reported infectious syphilis cases over the past decade, the epidemiology is changing. This change is reflected in the sharp rise in the number and proportion of cases among heterosexual populations, most evidently seen among women.

Infectious syphilis cases among women increased 938% between 2018 (53 cases) and 2022 (550 cases).[1] In 2022, over 90% of women with infectious syphilis were of childbearing age (i.e., 15–49 years old), thus raising concern about congenital syphilis.[1,2] BC reported no congenital cases from 2014 to 2018. However, between 2019 and 2022, 29 congenital syphilis cases were reported: 15 early congenital probable, 11 early congenital confirmed, and 3 late congenital confirmed.[1,3]

Syphilis overview course

In 2019, the Provincial Health Officer declared an outbreak of syphilis in the province.[4] Subsequently, the syphilis team at BCCDC (composed of doctors, nurse practitioners, certified practice registered nurses, and educators) noted a significant uptick in the number of requests for support and education among providers, who were seeing the epidemiological trends reflected in their practices. In response, and to provide equitable access to information and education, the team developed a self-directed online course to support providers involved in the case management and follow-up of syphilis cases and their contacts.

The Overview of Syphilis for Health Care Providers in BC online course is broken into three modules and a tool kit:

Module 1: Introduction to Syphilis. Reviews the impact of syphilis on public health in Canada and BC, as well as the etiology, transmission, and clinical presentation.
Module 2: Testing – Screening and Diagnostic Tests. Reviews available screening and diagnostic tests (serological and lesion specific) that enable the correct diagnosis and staging.
Module 3: Case Management. Reviews the diagnosis and case management process.
Tool kit. Offers additional resources and tools for providers who want to increase their knowledge and capacity to provide effective, strengths-based, person-led sexual health communication.

The course is available on the Provincial Health Services Authority LearningHub.[5] It takes approximately 2 hours to complete and is accredited by the Division of Continuing Professional Development, University of British Columbia Faculty of Medicine, for up to 2.0 Mainpro+/MOC Section 3 credits.

In BC, syphilis is centrally managed at the BCCDC. For information about syphilis screening, case management, or follow-up, contact the BCCDC public health nurse at 604 707-5607 or physician at 604 707-5610. For the most current syphilis surveillance reports, refer to the BCCDC Sexually Transmitted and Blood Borne Infection (STBBI) and Tuberculosis (TB) Report dashboard.[2] For further information about the syphilis overview course, contact sticourse@bccdc.ca [14].
—Monica Durigon, RN(C), MSc
—Barbra Arnold, MD, CCFP
—Rochelle Stimpson, MD, CCFP
—Kirsty Bobrow, MBChB, DPhil, MSc, MMed
—Troy Grennan, MD, DTM&H, MSc, FRCPC
BCCDC

This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.

[15]

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [15].

References

1. BC Centre for Disease Control. Syphilis indicators in British Columbia: BCCDC CPS surveillance report. 2024. Accessed 10 September 2024. www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/STI/BCCDC_website_syphilis_indicators_2024Q2.pdf [16].

2. BC Centre for Disease Control. Sexually transmitted and blood borne infection (STBBI) and tuberculosis (TB) surveillance report. Accessed 10 September 2024. https://bccdc.shinyapps.io/stbbi_tb_surveillance_report [17].

3. BC Centre for Disease Control. Syphilis: Case definition. Accessed 11 September 2024. www.bccdc.ca/health-professionals/clinical-resources/case-definitions/syphilis [18].

4. BC Centre for Disease Control. BC syphilis action plan refresh, 2023–2025. 2023. Accessed 11 September 2024. www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/STI/Syphilis_Action_Plan_Refresh_2023.pdf [19].

5. Provincial Health Services Authority. PHSA – BCCDC – Overview of syphilis for healthcare providers in BC. Accessed 15 October 2024. https://learninghub.phsa.ca/Courses/31222/phsa-bccdc-overview-of-syphilis-for-healthcare-providers-in-bc [20].