Syphilis cases in B.C. youth have nearly doubled, health officials say. But some may not know they have it

Syphilis has nearly doubled in numbers for young people in B.C. over the last five years, and health experts say it's important for youth to get tested as the sexually transmitted infection (STI) can often come with unnoticeable symptoms. 

Among young people age 20-24, the numbers have nearly doubled since 2018, rising from 96 cases in 2018 to 181 cases in 2022, according to the BCCDC.

Among those age 15-19, the numbers went up from 14 cases to 30 cases, peaking in 2021 with 35 cases.

"Getting diagnosed, knowing that you need to go and seek care is really important," said Dr. Jason Wong, a public health physician at the B.C. Centre for Disease Control (BCCDC).

Experts attribute the uptick to several factors, including a decline in condom use and the rise of infectious syphilis in the general population. BCCDC data shows a 27 per cent increase in syphilis cases from 2021-22 among the general population. 

They also say people could be unaware they have been infected because syphilis doesn't always come with noticeable symptoms.

While young people constitute a minority of the population diagnosed with syphilis, without proper knowledge and preventative measures, experts say the STI can continue to spread among partners and cause serious health issues, including infertility and hearing and vision loss.

Why the increase?

Experts say there could be numerous reasons for the increase, including young people not knowing how to prevent an infection or how it is spread.

Aileen Gandhi, patient care co-ordinator at the Surrey Youth Clinic just southeast of Vancouver, says some young patients believe it's not possible to contract an STI through oral or anal sex.

"That's a huge learning curve for some of our youth clients," Gandhi said.

Young people have also expressed that condoms break, are not the right size, or do not work — which is why it's important to explain the importance of using protection, Gandhi added.

Wong says not using condoms can increase one's risk of contracting syphilis.

Men diagnosed with STIs were about three times more likely to never use condoms compared to men who have not been diagnosed, according to a 2020 McMaster University study.

When the number of infections increases, one's chances of getting exposed to it are higher — which is partially the case with syphilis, says Wong.

What are the symptoms and risks?

Most STIs, including syphilis, can be treated today, but testing for the infection can help prevent long-term consequences, says Adele Lane, manager of population and public health at Fraser Health Authority.

A syphilis infection occurs in stages: in the primary stage, a painless sore can develop on the genitals, anus or inside the mouth. The sore will often go unnoticed but the infection will continue to progress. 

In the secondary stage, a non-itchy rash may occur on parts of the body including the chest or stomach. Other symptoms include fever and hair loss.

If the infection is not treated, it progresses to a latent stage, which means a person may not have any symptoms. The latent period can last up to 30 years or more, according to the BCCDC website. 

Females can also pass an STI to fetuses and newborn babies, which can be fatal especially in the case of syphilis, Lane says. The number of babies born with syphilis in Canada grew from seven in 2017 to 96 in 2021, according to figures from the Public Health Agency of Canada (PHAC).

Syphilis can also cause other issues such as vision or hearing loss if left untreated.

A safe space for education, treatment

Gandhi says it can be intimidating for young people to seek medical help for sexual health, as they sometimes face stigma from family and friends for sexual activity.

She says youth clinics are an example of a safe, confidential space to seek information and support, including getting tested and treated for STIs.

She says if a diagnosed person doesn't feel comfortable telling their partner about the STI, public health nurses can anonymously contact and notify that partner, helping prevent the infection's spread and resulting health issues.