The NWT syphilis outbreak is two years old. Has anything changed?

Two years ago, the Northwest Territories declared a syphilis outbreak. That outbreak remains ongoing and public health officials say complex factors mean things won’t change soon.

The NWT started seeing a resurgence of cases at the beginning of 2019 and by August of that year declared an outbreak, as did neighbouring jurisdictions like Alberta and Saskatchewan. Rates remain high in these provinces alongside Manitoba and Nunavut.

The declaration of an outbreak was triggered not by hitting a specific number of cases, but rather by an increase in case numbers beyond expectations over time.

In 2010, the NWT was seeing around 10 syphilis cases per year. By 2019, there were around 100 cases per year.

Reported case numbers have declined in the NWT and across Canada during the Covid-19 pandemic.

However, Dr Andy Delli Pizzi – the NWT’s deputy chief public health officer – told Cabin Radio “that could very well be due to people not accessing care and not getting tested.”

Dr Delli Pizzi said 33 people were diagnosed with syphilis in the NWT in the first six months of this year.

The 2021 data shows 80 percent of the territory’s cases are in the Yellowknife region. This year’s cases are split quite evenly along gender lines, with 55 percent in males and 45 percent of cases in females (data is not provided for other gender identities).

Syphilis is affecting people from the ages of 20 to 60 in the NWT, the data suggests, but the highest rates are in people aged 30 to 39.

Why is the outbreak ongoing?

Delli Pizzi said enhanced surveying of people diagnosed with syphilis shows around 60 percent have unstable housing. (Note: A week after this report was first published, the GNWT said the 60-percent figure is actually closer to 20 percent. Here’s our updated reporting on that error.)

“Syphilis is very preventable, but the factors that lead to syphilis infection really are complex,” he said.

“The risk factors are things like not using condoms, having multiple sex partners, or if your partner is having multiple sex partners. 

“But really there are also more complex factors. The idea that a large proportion of people with syphilis in the NWT are under-housed illustrates the importance of the social determinants of health: the conditions that we live in, that we work in, that we learn in, and grow in. 

“And so things like income, and stable housing, and social networks are protective. They contribute to healthy relationships. Without those protective determinants, when they’re stripped away, sometimes people are more likely to … have poor health outcomes of all kinds, including sexually transmitted infections.”

Delli Pizzi said part of the increase in syphilis infections could be due to how sexual behaviours have changed over the past decade. Dating and hookup apps, he said, allow people to “meet each other quite effectively” and create more opportunities for sexual relationships.

He expressed concern that “chem sex,” which he defined as “sex using substances to enhance sexual experiences or relationships that can impair people’s judgement,” could be leading to riskier sexual behaviours.

What has the GNWT done to combat the outbreak?

Just over half a year after the syphilis outbreak was declared, Covid-19 reached the NWT.

Health officials said the pandemic meant a lot of communications resources were directed at Covid-19 and are being rebooted now for the syphilis outbreak. (Essential functions, like case and contact management, continued throughout.)

Delli Pizzi said a big part of the response is to ensure STI testing is accessible and socially accepted, so people feel safe talking to their healthcare providers about STIs. 

In terms of concrete actions, public health says it now tests people three times during pregnancy for syphilis and treats people who have come into contact immediately rather than waiting for test results to come back. Around 60 percent of contacts typically test positive.

The test involves a swab if someone has an ulcer caused by the bacteria that causes syphilis, or a blood test if the infection has progressed past the ulcer stage and symptoms are different, such as a rash on the palms of the hands or soles of the feet. If left untreated for years, the infection can cause heart problems and affect organs and blood vessels.

The infection can be cured with an intramuscular injection of a long-acting penicillin, which typically works within seven days.

Lorie-Anne Danielson, acting chief operating officer for the Yellowknife region of the NWT’s health authority, said poster campaigns are being augmented by harm reduction kits – which include condoms and other items to make drug usage and sex safer – in places like local bars and clubs.

Danielson said the territorial government’s nurse outreach team, which was organized to provide front-line health assistance to shelters during the Covid-19 outbreak, has been “super effective” at reaching “individuals that are part of the homeless population to ensure they have education or access to treatment with regards to syphilis in particular, but all STIs in general.”

Now that demand on public health from Covid-19 has decreased, Danielson says the authority is beginning to “do much more outreach.”

“A lot of our resources were impacted by the pandemic, but we’re trying to regroup and make sure that we have available screening and testing and treatment options in a variety of different settings,” she said.

“We would encourage everyone to make sure that if you’re visiting your doctor, you do have current information on file, because that’s been a big challenge that that we faced.”