Why are syphilis cases rising in Montreal? Dr. Christopher Labos explains

Montreal Public Health has reported a spike in cases of syphilis despite the disease being relatively easy to prevent.

Dr. Christopher Labos spoke with CTV News Montreal anchor Mutsumi Takahashi about the disease and why it is seeing a comeback.

Watch the interview above. Some of the questions and answers have been edited.

Mutsumi Takahashi

When we hear syphilis, I think of 18th-19th century Europe. That's what comes to mind. But it's still very much with us.

Dr. Christopher Labos

Yeah, it really is. Now, what's interesting is that syphilis cases were decreasing in the latter part of the 20th century, so from the 1950s onwards, and there was a very genuine belief that right around the late 1990s, early 2000s, because cases were decreasing, we might be able to eliminate it entirely, at least from North America.

But the past few years have seen a slow resurgence of it, along with a lot of other sexually transmitted infections. I think partly because young people may not be taking sexually transmitted infections as seriously as some of us did, you know, 10-20 years ago.

Mutsumi Takahashi

But it is fairly easy to treat when it's caught early enough.

Dr. Christopher Labos

Yeah, it really is. It's a course of antibiotics. It's penicillin, and that was really sort of the dividing line. The reason why syphilis cases were going down throughout much of the 20th century was because of the invention of penicillin and the fact that you could treat it with a very simple course of antibiotics.

Mutsumi Takahashi

So what happens when syphilis is left untreated?

Dr. Christopher Labos

There's actually multiple phases to syphilis. When you get into the tertiary or the late stage, it affects the nervous system, and can cause permanent neurological damage; it can actually be very, very severe.

So the early phases may not seem that bad to people, and that's probably why people aren't taking it as seriously anymore, but once you get into the permanent neurological damage, you can be chronically disabled for for the rest of your life.

Mutsumi Takahashi

There is also something called congenital syphilis.

Dr. Christopher Labos

That's when a pregnant woman catches syphilis then passes it on to the baby, and that obviously causes a lot of problems to the baby. It can result in stillbirth or congenital malformations. That is one of the things that should be tested for routinely as part of prenatal care. When you start seeing cases of congenital syphilis, it's because people have started falling through the cracks and are not getting the prenatal care that they should be getting.

Mutsumi Takahashi

So what are the symptoms of syphilis? Is it easy to see early?

Dr. Christopher Labos

Well, that's that's the funny part. In the early stages, there may not be many symptoms, and that's possibly why a lot of people may not even go to the doctor. The original canker sore of syphilis is actually painless, and so if you don't know what it is, if you can't recognize it, you may not even go to go to the doctor.

It's when the infection stays in your system for years and then reawakens much later that you can often get the long-term neurological damage that I mentioned. So that's the real danger is that if you don't have access to a good doctor who can do the appropriate swab and test it and get the correct diagnosis, you may not realize you have syphilis, and it can stay in your system for years.

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Mutsumi Takahashi

So then, what can be done in terms of prevention?

Dr. Christopher Labos

We need STI clinics, sexually transmitted infection clinics. If you can screen and treat these cases early, these people then don't go on and spread it to others. That's why when we're talking about the elimination of certain diseases like syphilis, we could possibly do that. We just need to have enough doctors, nurses, and testing facilities to test people when they get symptoms and to make it easy for them to get appointments at these clinics so that they can be given their course of antibiotics to eliminate the infection. That's how you get rid of syphilis, you treat it eventually goes away.

Mutsumi Takahashi

But on the other hand, Christopher, when you say that, it's very, very difficult to detect, people might not even know they have it. So then why would they think to go to try to detect it?

Dr. Christopher Labos

So that's the thing. A lot of times, people don't know, they don't know if it's something or not. When you make it hard for people to get an appointment, they might say, 'well, let me wait a couple of weeks. Let me see if it goes away on its own,' and the original canker lesion will, even without treatment, it will go away on its own.

So that's the problem.

You need to have a health-care system that is responsive enough so that people can make appointments. If it's nothing, you send them home, but if it's serious, that's when you can do the treatment, and that's one of the problems of making it harder and harder for people to access medical care if they don't have a family doctor or don't have a good walk in clinic in their area. You don't treat the easy stuff, and the easy stuff starts to fall by the wayside, and that's when you get syphilis cases going up.