In 2010, I took a leap of faith and left critical care for a sexual health nursing position in public health. Little did I know at the time the steep learning curve it was to move from a client-centered approach to a population health approach. 13 years later, I am still passionate and leading a sexual health and harm reduction team in a northern Ontario community working with individuals who are disproportionately impacted by sexually transmitted and blood-borne infections (STBBI).
Sexually transmitted infections (STI) are among the most common communicable infections and continue to be a significant and ever-increasing public health concern in Canada (Public Health Agency of Canada, [PHAC], 2019).
According to PHAC:
Chlamydia rates have increased by 33.1% over the past decade (PHAC, 2019)
Gonorrhea rates have almost tripled (181.7% increase) over the past decade (PHAC, 2019) with an increase in antibiotic resistance, which poses a serious threat to effective treatment (PHAC, 2021, -b.)
The national Infectious syphilis rate in 2021 was 166% higher than the 2017 rate (males at 96% increased than the 2017 rate; females at 729% increased than the 2017 rate) (PHAC, 2021, -a.).
Infographic 1
Infectious syphilis and congenital syphilis in Canada, 2021
(PHAC, 2021, -a.)
Syphilis is of considerable public health importance in Canada and has many associated complications if left untreated. Gay, bisexual, and other men who have sex with men (gbMSM) continue being affected by syphilis and other STBBI (PHAC, 2023). However, in recent years, there has been a significant increase in reported cases of syphilis among heterosexual populations, particularly among females, resulting in the reemergence of congenital syphilis at a record number (PHAC, 2023). News stations have recently highlighted the rising syphilis rates of congenital syphilis, such as this recent CTV News clip, which examines the issue nationally:
Video 1
Why cases of congenital syphilis among babies skyrocketing across Canada.
(CTV Television Network, 2023)
To guide Canada's efforts to reduce the health impact of STBBI and to contribute to global efforts, a PanCanadian framework was developed and has been endorsed by federal, provincial and territorial ministers of health while respecting the flexibility required to address the different needs and priorities of jurisdictions (Center for Disease Communicable Diseases and Infection Control, [CDC], 2018).
In our district, various efforts have been primarily to reach the gbMSM population; however, we are now seeing rising rates among other populations, such as women whose health and lives are affected by syphilis. Throughout my career in sexual health and harm reduction, I am most familiar with the Ottawa Charter for Health Promotion strategies for developing personal skills and creating supportive environments. I aim to expand my knowledge about strengthening community action and reorienting health services to combat growing syphilis infections. I am excited to review current evidence to learn more about the issues driving increased syphilis rates and what initiatives or interventions may be implemented to reduce rates of syphilis, particularly females, in my community. My concerns include strategies involving community partner involvement and engagement and the barriers due to limited health resources available and accessible to people living in Northern Ontario. Despite this challenge, I look forward to building upon my foundational knowledge of health promotion concepts and learning how to apply this knowledge in my current role.
References
Centre for Communicable Diseases and Infection Control. (2018). A summary of the Pan-Canadian framework on sexually transmitted and blood-borne infections. Can Commun Dis Rep, 44(7/8).179-81. https://doi.org/10.14745/ccdr.v44i78a05
CTV Television Network. (2023, March 31). Why cases of congenital syphilis among babies skyrocketing across Canada [Video]. Youtube. http://www.youtube.com/watch?v=H68_ng9zku4
Public Health Agency of Canada. (2019). Report on sexually transmitted infection surveillance in Canada, 2019. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/report-sexually-transmitted-infection-surveillance-canada-2019/pub1-eng.pdf
Public Health Agency of Canada. (2021, -a.). Infectious syphilis and congenital syphilis in Canada, 2021 [Infographic]. Retrieved September 29, 2023, from http://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-11-12-november-december-2022/infectious-congenital-syphilis-canada-2021.html
Public Health Agency of Canada. (2021, -b.). National surveillance of antimicrobial susceptibilities of Neisseria gonorrhoeae annual summary 2019. http://www.canada.ca/en/services/health/publications/drugs-health-products/national-surveillance-antimicrobial-susceptibilities-neisseria-gonorrhoeae-annual-summary-2019.html
Public Health Agency of Canada. (2023). Syphilis guide: Key information and resources. http://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis.html
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