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Let’s take a look at the number of reported new cases of infectious syphilis in Canada since 1993 (see Figure 1).
In 2010, British Columbia, Alberta, Ontario and Quebec had the highest number of new cases of infectious syphilis. In 2010, the Northwest Territories, Ontario and Quebec had the highest rates of syphilis—all above the national average. Unlike other STIs, such as chlamydia and gonorrhea, for which rates of new cases tend to be highest among 15-24 year olds, syphilis is more commonly diagnosed in people who are somewhat older; incidence rates (new cases) are highest among those between the ages of 20 and 60. Trends: Since 1996 there has been an ongoing syphilis epidemic, in two successive but overlapping waves. Populations: A large proportion of cases are among gay men and other men who have sex with men (MSM). Trends: After having only 1 case of infectious syphilis between 1993 and 1999, an outbreak occurred between 2000 and 2003, reaching a high of 22 cases in 2001. Trends: An outbreak in Alberta started in 2003 and reached a high of 279 new cases in 2009. Trends: Only three cases of syphilis were reported between 1993 and 2007 but this grew to 47 cases in 2008 and 41 cases in 2009.
Trends: The number of syphilis cases has been increasing since 2006, reaching a high of 36 cases in 2010.
Sex: In 2010, about one-quarter of cases was among females and three-quarters of cases were among males. Trends: The number of new cases began increasing in 2002 and shows no signs of slowing down, reaching a high of 539 cases in 2010. Trends: Between 1993 and 2009 there were fewer than 10 cases per year, but in 2010 this grew to 34 cases. Trends: The number of new cases of syphilis has seen no significant change over time, ranging from 0 to 8 per year since 1993.
The responses of public health and community-based organizations in many parts of Canada to the syphilis outbreaks in their region may be partly responsible for the decreasing or stabilizing rates in some parts of Canada. In British Columbia, efforts to stem the syphilis outbreak have been led by the British Columbia Centre for Disease Control (BCCDC).
An HIV testing campaign developed by Hassle Free Clinic in Toronto ran in late 2011 and early 2012 in Toronto and Ottawa. In terms of a government response, the Ontario Ministry of Helath and Long-Term Care has created a Syphilis Working Group, which has enhanced surveillance and epidemiology activities, provided educational opportunities to health units and funding for awareness and health promotion activities. In 2004 a campaign was launched in Ottawa, Toronto and Montreal to improve awareness of syphilis. In 2011, the New Brunswick government developed print materials and a video encouraging condom use and testing.

In Nova Scotia, as in many provinces, public health has sent out regular reminders to all physicians about the syphilis outbreak and about the importance of testing.
For the past 10 to 12 years, the number of new cases of infectious syphilis reported each year in Canada has been increasing. Production of this Web site has been made possible through a financial contribution from the Public Health Agency of Canada. Please note that some content on this website contains language, information and images related to sexuality and drug use, and may not be intended for people of all ages.
TORONTO, CANADA - MAY 31: Leon Draisaitl does the V02 Max test during the the NHL Combine testing May 31, 2014 at the Westin Bristol in Toronto, Ontario, Canada.
TORONTO -- Health Canada is warning consumers about an Internet-based company that is trying to sell home testing kits for HIV and a number of other sexually transmitted infections. The department says Canadians should be advised that there are no HIV test kits licensed for home use in this country. It says CuraHerbDistributor is trying to sell kits that reportedly test for HIV and other STDS such as syphilis, gonorrhea, chlamydia, hepatitis B and C, and herpes simplex. Health Canada says the products haven't been evaluated for safety and effectiveness and could provide people who use them with false results.
The department says it is working with the Canadian Border Services Agency to prevent importation of all CuraHerbDistributor test kits. This is concerning for people working in HIV because syphilis can increase the risk of an HIV-negative person becoming infected with HIV and of an HIV-positive person passing HIV to others. This article provides an overview of outbreaks that have occurred across the country and of responses from public health and community sectors. In the years prior to 2000, there were fewer than 200 new cases of syphilis reported each year. Below are some key facts about the syphilis epidemic in different regions throughout Canada. The first phase of the campaign focussed first on heterosexuals, and the second phase on gay men and other MSM.
Health officials also enhanced screening of the general population in affected regions and among high-risk populations, including expectant mothers. They promoted condom use and regular testing for syphilis through posters, flyers, factsheets, a website, banner and print ads, and a video.
The campaign was developed jointly by gay community organizations, AIDS service organizations (ASOs) and public health units in those three cities. The AIDS Coalition of Nova Scotia has been doing outreach to popular websites for gay men and other MSM. Learning more about the syphilis epidemic in your region is critical to developing an effective response.

Alberta Sexually Transmitted Infections and Blood Borne Pathogens Strategy and Action Plan, 2011-2016.
Portrait des infections transmissibles sexuellement et par le sang (ITSS) au Québec. Correspondence with Amy Lea, Communicable Disease Consultant, Department of Health and Social Services, Government of the Northwest Territories.
The last year for which the Public Health Agency of Canada (PHAC) has compiled the number of new cases and the rate of infectious syphilis for each province and territory is 2010.3 For the sake of easy comparison, we have indicated those 2010 numbers. It included a website, online ads on Priape, Manhunt and Facebook, print advertisements, posters, buttons, coasters, and condom pack inserts. The blitz was promoted through a website, gay media, mobile uploads, billboards and business cards. RÉZO, a community-based organisation in Montreal, offers syphilis, HIV and other STI testing in conjunction with public health on site at their location, in bars and saunas, and also through its sex work outreach program. Images were posted in saunas and bars, and public service announcements (PSAs) ran on PrideVision.
Campaigns to raise awareness about syphilis and encourage regular testing have been launched in different parts of the country and may be contributing to declining rates of syphilis cases in those areas. There were outreach activities with key opinion leaders, peer outreach workers, syphilis education sessions and incentives for testing.
Some people praised the campaign, and the Alberta government credits it in part for the drop in the number of syphilis cases in the province. In some cases, these men are testing positive for HIV and syphilis within a year of each other.
If you or your organization is interested in launching a syphilis campaign of your own, learning more about the various syphilis campaigns highlighted in this article is a good place to start. Community outreach workers provided a $10 monetary incentive for being tested and $20 for returning for test results. However, many prevention advocates and behavioural researchers described the campaign as stigmatizing, homophobic and sexphobic, and questioned whether it was likely to promote behaviour change. However, in some parts of the country, where the rates among men to women are closer to equal, outbreaks may be caused by injection drug use, and Aboriginal people and young people may be at higher risk.
To learn more about key messages you can provide to clients or patients regarding syphilis transmission, prevention, testing and treatment, go to CATIE’s syphilis information page.

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