Healthy Canadians Podcast: Syphilis – An STBBI on the rise
Many people may not realize they have syphilis. Symptoms can be so mild that they go unnoticed, so regular testing is important if you are sexually active. Rates of syphilis and congenital syphilis are on the rise in Canada.
Host Megan Beahen sits down with Dr. Jared Bullard, Director General of Medical and Scientific Affairs at the Public Health Agency of Canada’s National Microbiology Laboratory, and an Associate Professor and Section Head of Pediatric Infectious Diseases, for a conversation about syphilis symptoms, testing, treatment and the importance of normalizing sexual health practices.
Transcript
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Megan Beahen: Hi and welcome to Healthy Canadians, your space for nuanced conversations and expert insights about the health topics that matter to us all. I'm your host, Megan Beahen. Today I'm talking to Dr. Jared Bullard about syphilis- why it's on the rise and what we can do about it. He is a Professor and Section Head of Pediatric Infectious Diseases at the University of Manitoba, and Director General of Medical and Scientific Affairs at the National Microbiology Lab at the Public Health Agency. He offers a unique perspective, with clinical, laboratory, and public health knowledge of syphilis.
Although Healthy Canadians is brought to you by Health Canada and the Public Health Agency of Canada, what we discuss won't always reflect the official positions or policies of the Government of Canada, but that's okay. These are conversations, not news releases.
Okay, let's talk about syphilis.
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Megan: Hi Jared welcome to Healthy Canadians, thank you for joining us today.
Dr. Jared Bullard: Yeah, it's my pleasure. I'm happy to talk about syphilis, one of my favourite topics.
Megan: Favourite topic! Okay, so we're talking about syphilis and how it's on the rise, why it's on the rise. Let's jump right in. Can you give us maybe a few statistics about how big of a problem it is?
Dr. Bullard: Sure, so I mean syphilis in Canada has been a longer standing issue than I think might have been realized. In Western Canada, we've had problems with syphilis for the better part of about 15 years, primarily in the Prairie Provinces. What has made it interesting is kind of the evolution of where it started and where it went. So initially we were seeing it in our gay, bisexual and men who have sex with men populations, and then gradually what we started to see was it coming over into more of a heterosexual population. So as a pediatrician for me what is particularly relevant about that is that we're seeing it a lot more in women of a childbearing age specifically. So, when you have a woman who gets syphilis in pregnancy there's a risk to the infant as well.
What has changed notably is that some of the provinces outside of the Prairie Provinces are seeing more as well. So, you're seeing more cases in BC and you're also seeing a lot more in Ontario, and in particular in kind of the urban population. So, I think Toronto is where we're seeing a number of cases cropping up, and that's leading to a lot of interest, both in Toronto and then across the country.
Megan: And what is causing this rise?
Dr. Bullard: I think it's a variety of different factors, so when we're talking about the Prairie Provinces in particular, I would say the primary driver has been intravenous drug use, and in particular crystal methamphetamines.
Megan: Okay.
Dr. Bullard: Crystal meth is a pretty unique drug in that it alters people's ability to negotiate for safer sexual practices and so as a result they're hypersexual, they're not necessarily being as careful as they should be and so you're getting a lot more transmission overall. But, it's kind of the usual suspects when you think about sexually transmitted and bloodborne infections. So, we know that there are certain groups who are more likely to experience homelessness, poverty, substance use, and all of those things kind of combine for a perfect storm of allowing syphilis and other STBBI to spread quite effectively. And so, I think that's something that you're seeing in Ontario and Toronto now, but it's been like that for a while in the other the Western provinces.
Megan: So, for people who are listening who don't identify in that population, they're sexually active, they're adults, is this a risk to them as well?
Dr. Bullard: So, what I would suggest is that people in general should normalize their sexual health, right? I don't think necessarily that practitioners are good at talking about it and I don't think that patients who come to see us are always going to bring forward sexual concerns and so one of the most important things we can do is to normalize sexual health testing including for STBBI and syphilis. So, it stands to reason that that even though people often underestimate their risk, sometimes their partners aren't necessarily as truthful as they might think...
Megan: Right, right.
Dr. Bullard: ... and so you can certainly get a variety of different STBBI, and I've seen that a couple of times where I have a person come in and they're like "I have no idea where I got it"...
Megan: Right.
Dr. Bullard: ...and you're kind of like "Well, I have a good sense of where you got it". You're giving me a pretty detailed sexual history and I think that that particular new partner is probably the reason.
Megan: And I want to get into prevention and treatment in a moment, but maybe you could explain to us: what is syphilis?
Dr. Bullard: Absolutely, so syphilis is a bacterial infection that has been around for a very long time and there actually is a lot of debate about its origins. Did it come from the Americas, or did it come from Europe? Most likely it actually came from the Americas and was passed on through Europe. And over the course of centuries, it basically became a pretty well-known disease that you would get, and in particular among I'd say almost the elite in Europe you would see it a lot more. So, when you would see the behaviors of wearing a wig, that was often because hair loss was associated with syphilis. Or the no-nose society in England. Their nose would actually come off as a result of syphilis and so they would have these prosthetic noses.
The bacteria that causes it is called Treponema pallidum, and so it's a type of bug that's a spiral. So, think of it like almost a corkscrew looking bug under the microscope. It's interesting because it's one of the few bugs that's really good at getting into a person through skin and mucosal surfaces so the mouth, the genital tract, etc. And so, once it's in you, it sits there, it makes itself nice and cozy and it reproduces itself. And it's a little different from other bacteria in that it takes a little bit longer for it to make copies of itself. And so that's why often it takes a bit longer to see disease. So, I mean the Treponema they sit there, they grow, and they cause a painless ulcer often in the genital tract, or wherever it's introduced. So, we often think genital tract only, but I've also seen a fair amount of oral ulcers too.
Once it sits there and multiplies enough it actually spreads, and it can go to pretty much any tissue. And so, you can have what's called disseminated disease, or secondary syphilis. And then often that will clear all on its own too, leading to what we call a latent infection, meaning that there's no obvious clinical disease going on, but the bug is still there. It still can be transmitted, it's just not quite as effective. What we're thinking about particularly in Western Canada is the next stage or tertiary syphilis where you see all sorts of soft tissue changes and bone changes that may occur down the road. And that usually occurs maybe decades later, and that goes along the lines of where I was saying the no-nose or the hair loss.
Megan: So left untreated that's what happens, for a long time.
Dr. Bullard: Exactly, so you can see tertiary syphilis. I haven't seen that yet, but I think that we're aware that we are going to start seeing some of that.
Megan: Oh wow. So, if someone has signs and symptoms, what do those look like? And I'm guessing that early on there are no signs and symptoms, probably.
Dr. Bullard: It's very subtle.
Megan: Okay.
Dr. Bullard: So, when you first get infected and you have primary syphilis, if you're lucky, you're going to notice this ulcer on wherever the site that's been introduced, right? So sometimes you'll see a penile ulcer or an ulcer on the outside of the vulva, but more often than not you can have external findings too. So, a lot of the women and birthing parents that I see they don't know they had anything because it's within the vagina or on the cervix, and most people of course can't see their own vagina or cervix.
Megan: Right.
Dr. Bullard: And so, it's pretty subtle. And in addition, I mean we've even had a number of women who come to deliver and the obstetrician notes that, "Well look I can see this sore on delivery", and they often think it's herpes...
Megan: Right.
Dr. Bullard: ...but in the end we find out it's syphilis and there's a big distinction: herpes hurts, syphilis doesn't tend to, right?
Megan: Okay so it's something you would notice visually on your skin and you would not have pain associated with it.
Dr. Bullard: Yeah, and it's a distinct ulcer but doesn't have any pain which is unique to syphilis.
Megan: Okay, and so in terms of passing it along I'm guessing then it's skin-to-skin contact, right?
Dr. Bullard: Absolutely, so any sort of intimate or sexual contact is the best way to transmit this particular bug. And so that's why I said we see it in a variety of different places.
Megan: Okay, so it's not something that like if you bumped into someone in the elevator at work that you'd probably get syphilis?
Dr. Bullard: That is correct yeah, you're going to need some more prolonged contact than a simple casual exposure in the elevator, yeah for sure.
Megan: Okay so tell me also about how does it get passed along to a baby, because I know that is your sort of expertise. How does that happen?
Dr. Bullard: Yeah, so the most common way that it happens is that you have a woman or birthing parent who is unaware that they have syphilis. And so I was talking about the primary syphilis and these ulcers that are often internal, not obvious. And so, babies get born and they're exposed to the treponemes of syphilis for an extended period of time, because birth is very rarely a very fast process. And so, as a result of that exposure to their skin and their mucous membranes, the infant then subsequently can develop what's called congenital syphilis, or being born with syphilis.
And so that's the most common by far. And there are obviously a bunch of different risk factors as well that we know about, right? So, I mentioned one of them is that we have women or birthing parents who don't know that they have syphilis. There's ways to deal with that which we can talk about later, but there's also women and birthing parents who we know had syphilis and we actually treated them appropriately early in pregnancy and subsequently they have reacquired syphilis...
Megan: Oh wow.
Dr. Bullard: ...which has its own unique set of problems. And that's probably something that I should have mentioned as well that syphilis is not one of those infections where you have lifelong immunity. It's very good at figuring out how to get around the immune system so that reinfection is a distinct possibility, and we see it not unusually. So that's the most common way that we see infants getting it.
Megan: So, it comes back though when there's been a reinfection, there's been another contact.
Dr. Bullard: There's been another contact, or often the same contact.
Megan: Same contact, right?
Dr. Bullard: Yeah, so that's one of the major issues is that if you are treated your partners also have to be treated, and that's a huge initiative for public health.
Megan: Right.
Dr. Bullard: They have to track down all the potential contacts, which means that when they find them, they have to get them tested, and they have to be treated appropriately, and there's are certain groups that aren't necessarily good at getting that testing and treatment. And I'm specifically talking about men, but we can talk about that later.
Megan: Oh, we're going to talk about that.
Dr. Bullard: Absolutely.
Megan: So, when an infant contracts it, are they getting it in utero or as the baby is being born?
Dr. Bullard: Great question too, so we see both.
Megan: Okay.
Dr. Bullard: So, in utero infections absolutely do happen and when we see that that's when we see infants who are much more severely affected.
Megan: Okay.
Dr. Bullard: And so often they'll have all sorts of different manifestations. They can have skin findings that look kind of like a secondary, disseminated syphilis. They can have big livers, they can have pneumonias.
Megan: Oh wow.
Dr. Bullard: They can have their bone marrow affected so that they're not producing all the blood cells that they need. They can also have the syphilis in their nervous system, and then bone changes as well. So, in utero infections are often I'd say more severe because it's just a prolonged time. Now the most common manifestation we might see too if it's early enough in pregnancy is spontaneous abortion.
So, these infants might be so severely affected that they're not able to be born and they simply become aborted or still birth. Now, what we see a bit more commonly though is exposure during the birthing process itself. As I mentioned you have these lesions in the genital tract, they're exposed, and in that case, you often won't see any clinical signs in an infant. So that's like a good 60/70% of infants are not going to have anything that tells us that they have an infection.
Megan: Wow. So critical to know and catch it very early on, right? Or obviously ideally to never have the infection, but critical to catch it early on.
Dr. Bullard: Absolutely, and I think that's why we're pretty aggressive about our screening of women and pregnancy and birthing parents.
Megan: Okay, and we'll talk about general STBBI screening in a moment, but I'm wondering if you could tell us a little bit more. You said you work with parents, you work with mothers giving birth in a clinical setting. When you meet people like that, what surprises you, or what surprises them, I guess. I assume you're meeting a lot of people who are pretty surprised that they have syphilis right? Or like that this is a thing?
Dr. Bullard: I would say kind of- our first case here in Manitoba where I practiced was in 2015, and subsequently over the next five years we saw more. Then in 2020 is when we started to see significantly more. And again, the context that I can provide there is that we in Manitoba see somewhere between 200 to 250 syphilis exposed infants every year.
Megan: Wow.
Dr. Bullard: And so not all of them end up requiring treatment and investigation, maybe a third of those do.
Megan: Okay.
Dr. Bullard: So initially what we would find is that when we met the women and birthing parents, they were surprised. It was just like, "Oh wow. Where did I get this? I didn't know syphilis was a thing." But I would say over the past couple of years there's a lot more awareness of syphilis, at least in Manitoba and the Prairie Provinces. And so, it's not unusual for a lot of the patients that I see to say, "Yeah I'm not surprised, I thought I might have had syphilis again." or "I know that I had a partner who had syphilis".
Megan: Okay, so the information has reached them already and there's possibly been treatment.
Dr. Bullard: Absolutely.
Megan: So, I'd like to just contextualize syphilis in other STBBI. So, like, in my mind when I think about chlamydia or gonorrhea they're sort of on one plane. Syphilis is on sort of another plane, like it's much more serious, it's rare, it's different. I wonder if you can speak to that. Is that a misunderstanding on my part?
Dr. Bullard: No, you're correct. I think there was a really orchestrated effort amongst Public Health to get rid of syphilis in the 1940s and 50s. And as a result, we really didn't see very much syphilis until probably closer to the 1990s. And so, you're right, it's not in the public consciousness. Whereas you have other ones, like you said chlamydia and gonorrhea, those are way more common still.
Megan: They are still, yeah?
Dr. Bullard: Yeah, you're gonna see more chlamydia and gonorrhea.
Megan: And are they on the rise as well though?
Dr. Bullard: So that's the unfortunate fact of the sexually transmitted infections is they love to run together
Megan: Okay.
Dr. Bullard: Right? So, if you are seeing a person who you think has an STI, if you think they just have gonorrhea, it is very worthwhile to ensure that you test for the other ones too. Because that's something that we have seen as well. We see people who have gonorrhea or chlamydia, and they only have the urine test which looks for that and they don't do the blood test where you can look for syphilis, HIV and hepatitis...
Megan: Right.
Dr. Bullard: ...and then you find out after they actually had syphilis too, or even more concerning is when they have HIV and the other STI's on top of it.
Megan: Wow.
Dr. Bullard: But absolutely. But you're right, like I think that from an awareness perspective, I grew up in the 90s, I think that we talked about STI all the time and condom use and it was all related to HIV, but syphilis wasn't even a consideration, right?
Megan: Yes exactly! It wasn't in the mix! I also grew up in the 90s, that's what I'm saying, like this wasn't on my radar, so I think people are hearing this probably right now and this is like a bit new.
Dr. Bullard: Absolutely, absolutely. And I think that's part of it too that the sexual practices as we go through the generations. Like the people who grew up in the 90s I think were hit very hard about safer sexual practices, condom use consistently, to avoid HIV. And then what we've seen is that HIV has become a very different disease with really great treatments and so those safe sex practices in more Millennials and Gen Z are less common, so you start to see a little bit more transmission.
And then ironically you also see it in our elder population, right? So, the Baby Boomers didn't really think about it. They had their sexual revolution in the 60s, and now they are getting out of marriages, they are having their spouses die, and they don't even think about it. And they're getting STI's too. So, it's really neat to see our, I'd say Gen X core, is kind of all traumatized and a little bit more careful, whereas these generations on either side are a little bit less careful.
Megan: Right, okay, so what I'm hearing from you on that is this is for everyone to care about truly, right?
Dr. Bullard: Absolutely, this is extremely relevant.
Megan: And even though syphilis is different, we can sort of lump these things all together when we're talking about prevention, right? So, you just mentioned safe sex, let's talk about that,
Dr. Bullard: Absolutely.
Megan: Let's talk about safe sex and what prevention looks like for all STBBI.
Dr. Bullard: Right, and I see a number of adolescent and teen patients and that's something that's really important to me. We talk about sex before they start having sex. And I think that that might be an awkward conversation depending on how you approach it...
Megan: Right.
Dr. Bullard: ...and what I find more often than not is the more comfortable you are asking questions, the more comfortable they are, right? And part of it is also establishing that relationship over time, because if you're meeting a teenager for the first time and you start talking about oral, anal, vaginal sex, and sexual partners and sexual practices, they're going to clam up and look at you surprised.
Megan: Yeah, you probably see some people shut down I'm guessing, in your practice.
Dr. Bullard: They can but again it depends on how comfortable you are. But that's part of it, is starting the conversation early. But in that activity, you're talking about condom use, and you're talking about negotiating for safe sex practices, and you're also talking about normalizing STBBI testing and all of it, right?
Megan: Right.
Dr. Bullard: And making sure that you're getting the urine and the blood test for all the different agents and bugs that are out there. And that when you are engaging in a new sexual relationship, or you are going to be fairly frequently engaging in new sexual relationships, that it becomes part of your normal routine. You're going to get it done on a regular basis, because you know, if you're having sex, you're at risk for STI's and that's just the reality.
Megan: Right.
Dr. Bullard: And that's probably essential to start early, and make sure that people have that in their heads as they proceed, and making sure it's normal. Because there's a lot of stigma still about STI's, and I think syphilis is not unusual in that.
Megan: For sure. Let's talk about stigma a little bit because we know that it can be a difficult conversation to have with a health professional, whether you know them or whether you don't know them. It's also a difficult conversation to have with a partner as well, so wondering if you have any practical tips to reducing that stigma?
Dr. Bullard: Again, most of my experiences is around teenagers and adolescents. And so part of normalizing the testing is that when I see them for routine things that have nothing to do necessarily with a concern about STI's, is saying "By the way I'm also going to check you for STI's, it's just what I do, and if we happen to find any results that are concerning we'll make sure that we will talk about them and what the next steps are".
And we also know from a fair amount of research that there's a number of missed opportunities as well, in that people who come to the health care setting may in fact have sexual concerns. In particular if we know they have those other risk factors, that probably it's prudent just to offer it on spec, like if we're talking about the emergency departments. But it's also important when you're more in a primary clinic just to have that conversation. Because I think that depending on where you live in the country, often those clinics in cities are a lot better in general about talking about sexual health. Whereas I'd say rural, not quite the same. But there's other challenges in rural settings too and I know that so.
Megan: What are those challenges in rural settings?
Dr. Bullard: So, the main concern that we have seen as we try to conduct research in more rural settings is that STI's do have that stigma attached. And often in small communities, everybody knows everybody else's business. And I think that people don't necessarily want that business to be known. And so even when you're offering all of this testing in a rural community, people might be hesitant to do it because they don't want people to know that one, they're getting tested because it might right put an arrow toward their behavior even if it is just normal activity and you should get these STI tests. But moreover, they definitely don't want people to know if there is a positive result, right?
Megan: Right.
Dr. Bullard: So, what you often see is people going to other communities or coming to larger urban centers to get their testing as well. And so that normalization is probably really important, and that's similar to our Northern Communities too. I would say that it's difficult to go and see a nurse practitioner or a physician when they might be your relative or a close family friend, right?
Megan: Right, for sure.
Dr. Bullard: And say "Yeah, I think I might have syphilis" or "I might have chlamydia".
Megan: Right.
Dr. Bullard: But again, part of the conversation is just making sure it's as normal as possible.
Megan: Okay, so imagine someone, let's say they have some sign of symptoms or they had a sexual interaction that felt risky, they're worried, and they're feeling nervous about coming to talk to a health professional. They need to make that leap. What would you tell someone to reassure them as someone who might be the person they're talking to?
Dr. Bullard: No and it's a common conversation. I'd say usually by the time they come to see me I'm fully aware of they already have something but...
Megan: Okay, a little bit different.
Dr. Bullard: Yeah, that being said, I think that one of the things you do is that you just kind of make people feel comfortable in having that conversation. And it is a challenge to do on that initial contact, and I fully appreciate that. But it's important for all of us and that's regardless of the area of medicine that you're in, or what type of practice. If you're a nurse practitioner or physician assistant. Just to make sure that you're able to and willing to have that conversation.
And if you're not and you just don't want to talk about all the different sexual practices just saying, "I'd like to offer you an STI test, have you had one recently?" and then you can kind of explore that a little bit and just say "Yeah I think it's worthwhile if you haven't had one to get that done", right?
Megan: Yeah.
Dr. Bullard: And that's probably the easiest thing to do, because it opens the door for patients and people coming to see you to have that conversation and think about doing it, even if they're not necessarily considering. Because it's exceptionally rare where I've had a person where I offer STI testing and they refuse. I can count on one hand sort of thing, most are like "Yeah that'd be a good idea".
Megan: Wow okay. So normalizing, that's what we want to do. And I'm going to just be bold and say I think probably we all have a role to play in normalizing it, right? Like let's normalize a conversation in a clinical setting but we could all be talking more about sexual health and getting tested, right, openly. It doesn't need to be a very secret and private thing, right?
Dr. Bullard: It does not, and I would say that like, again, when I think about who's good at it I think women are a lot better in general about...
Megan: Say it again Jared.
Dr. Bullard: ... talking about their sexual health and talking about what's important in the relationships and in terms of getting testing and concern, whereas men are not. But I will say the one caveat there is that our gay, bisexual and men who have sex with men are much better in I think being able to talk about sexual health and sexual activity and normalization of STI. It's more I'd say the heterosexual men in general that are not as comfortable for a variety of reasons. But yes, I think it is everybody's responsibility to talk about sexual health and making it normal and it's only so far the health care providers can go, right?
Megan: Exactly!
Dr. Bullard: And I think we're getting there. I think when I look kind of at my adolescent patients and my own children they are so much more comfortable than you would expect- and admittedly my own children that's an anomaly. They've grown up in a house with two physicians so that's weird in and of itself.
Megan: For sure. Okay I want to talk about treatment, and let's focus on treatment for syphilis specifically. So if you catch syphilis early on in, let's say, routine screening, what does what does treatment look like?
Dr. Bullard: Absolutely. So it depends on the stage of the disease, and so we'll talk first about our adult adolescent patients and then we can talk about pregnant patients.
Megan: Yes.
Dr. Bullard: And we can talk about the congenital syphilis and the infants who are exposed. So when we're talking about the adults in general stage is going to be most important. So, we have to make sure that there's not neurological involvement, it's not super common. And if everything looks okay and it's pretty straightforward primary or secondary syphilis we can get away with a single dose of penicillin that you basically inject.
There are other options too though. There are oral antibiotics that people can take. The challenge is often that they have to take them consistently over the course of like a week or two to be effective, and so that's why the injection of penicillin makes a lot more sense. Sometimes when we're thinking they have a latent infection, meaning that it's not obvious and it's been established for a while, we often have to give three separate doses over 3 weeks to be an effective treatment.
When we're talking about pregnancy it follows that same rule but often it's hard to know if they have a latent infection versus more primary, and so we tend to give them two or three doses of IM penicillin overall. And it has to be IM penicillin, so the oral antibiotics out there won't be as effective at preventing the transmission to the infant. When we're talking about infants that's a bit more complicated. That's one of my areas of research where we've been trying to figure out where the guidelines came from that have said that we need to give 10 days of IV penicillin to these infants, because there's a lot of effort that has to go into that.
We have to bring them to the hospital. We have to make sure that they have intravenous access, which in a little baby is not easy, so often we have to get a specialist to come and insert a line. And then making sure that they get that for 10 days where they're away from home and not able to be with family necessarily, which is a little bit disruptive, right? In the first ten days of life. And we also do sometimes have the option of giving that same injection to babies, which most parents who see it they don't like it. But it's close to as effective. So that's kind of the approach. The main stay for sure is the intramuscular penicillin, so the injection of.
Megan: Okay. I'm curious about what is the Public Health Agency doing?
Dr. Bullard: From personal experience what has been done is that certain jurisdictions where we have a lot of syphilis out in the community have changed their practices and willingness to do the testing. When it comes to pregnancy specifically it used to be kind of a more risk-based.
In other words, do we think you're at risk for having syphilis? And we said that's probably not sufficient so we started in Manitoba in 2016 doing it at three different time points during the pregnancies. And so that has allowed us to pick up a number of women and birthing parents who didn't know that they had syphilis, so it's kind of that enhanced screening.
Megan: Okay.
Dr. Bullard: Other things that we've been up to is a lot of education in communities and talking about syphilis. And I think that's led to, like we talked about earlier, people have this awareness and they know and they're not as surprised as they once were. And it's even resulted in some people actively seeking out testing. Now keep in mind that testing is widely available and I think the vast majority of Canadians are able to access testing, but then we do have some groups that are not going to seek out medical care of any kind. And so it's important to try to get to them and offer testing in those communities.
And so the NML has been working very hard to do some of those activities. And so, we've established new ways of doing it: using dried blood spots, we have certain technologies called point of care testing where you can go do a blood test and tell someone their result within five to ten minutes, and that's helpful too. Especially if they have no idea that they actually have syphilis or HIV as well, so a point of care test.
There's also been a fair amount of work talking to healthcare providers about syphilis. Because even though we have and have had syphilis in the Prairie Provinces it's not unusual to hear one of my colleagues who's in a different specialty like anesthesia or surgeons talk about, "We have syphilis?", it's like "Yeah, we do". And so that's part of it. And then also education to the public in general. I've done a lot of different media talking about syphilis and all the different aspects and what we should be doing, and really focusing kind of on that normalization of sexual health.
I think that we also- I forgot to mention up front that it's not unique to Canada. These are numbers that we are now seeing in other countries as well. So, our neighbors to the south in the States, particularly in Texas you're seeing like a horde of syphilis. Like their congenital syphilis numbers are not quite as high as the Prairie Provinces but they're getting there, if not about to surpass them. And you're seeing a very similar pattern in terms of who it's affecting.
Megan: I think that is super interesting. The federal government is a complicated thing for people to understand when they don't work there, and the Health Care System also on top of that, complicated, right? So I love how you just explained that. It gives a real-life example of how do we deal with an issue at a national level, at a provincial level, even at a local level and we're working with our international partners as well, right, on it.
Dr. Bullard: Absolutely, and I think that that goes a long way and that's something that I've been working on for a while. So, from a local perspective I've already talked about I see patients I was involved very much in the testing and making sure that we get out to the communities. From an academic research perspective, I was one of the co-investigators, lead investigators of the Canadian Pediatric Society surveillance program for congenital syphilis. We're looking at collaborating with some of our colleagues in the US to better define exactly what is appropriate for congenital syphilis.
Megan: Right.
Dr. Bullard: Because the data's old and then we use that information to inform as many people as we can, whether it's practitioners, or Canadians in general, or politicians, we're happy to talk to them about all sorts of different initiatives that we think can make a difference.
Megan: That's so cool and I just want to thank you for even spending time with us to talk about it because I think you have a unique perspective that also makes it very interesting for people. Before we close, I want to end on actionable advice, and you already gave some of that but. For those who have heard this, the awareness has been raised, what are the basics? What do we want people to do who want to learn more, who want to make sure they're maintaining good sexual health, what are we going to tell people?
Dr. Bullard: Right, so I think there is a number of really good resources for people to reach out to, and whether that's the Public Health Agency of Canada or individual provincial health authorities, they have good information both for practitioners and then also for Canadians in general, so you can learn all about syphilis. I would say that it's not a bad idea to talk to your health care provider as well and say you know like, "I want to know more", and they will be able to, if they don't know, refer you to someone who does know.
And I think there's increasing expertise across the country of people who know about syphilis and can talk quite knowledgeably about syphilis. In terms of other actions, we've already mentioned normalizing sexual health is going to be important, that's everybody's job. Making sure that we're doing fairly regular testing, that's important. Making sure that we reach out to populations who are less likely to get testing, whether that's a novel technology or just trying to make it so that the healthcare system is just more accessible and friendly to them is great. Men need to get that testing.
Megan: Extra push for men, you heard it here from Jared.
Dr. Bullard: Yeah, exactly. And then just making sure that we're capturing that information as we go forward too. Because as I said it's helpful from an educational perspective and then it's also helpful to know if all the various public health activities that are taking place... And we have a lot of dedicated public health officials, and physicians, and practitioners who are doing all sorts of great work. Are we making a difference? Are we actually impacting this?
Megan: Right.
Dr. Bullard: So, I think that we're on the right track and I think that those provinces with more experience can absolutely assist those who are at the beginning of their epidemic to ideally get in front of it earlier.
Megan: I love when we end on a note of optimism, so thank you for that.
Dr. Bullard: Oh, you're very welcome.
Megan: I'll use this also as an opportunity to plug canada.ca because you mentioned those resources, that's a good place for people to find them. If you have a healthcare provider, start that conversation there. If you don't have a health care provider, because we know you mentioned accessibility, not everybody does. If you don't, check in with your local public health unit, see what services are available for STBBI, is that a good place for people to start if they don't have a doctor?
Dr. Bullard: Absolutely, I think all of those things. And then part of it for practitioners I would say too is that yeah, canada.ca has good information, but there's a number of different groups including the Canadian Pediatric Society, The Society of Obstetricians and Gynecologists of Canada, and we put a lot of thought and effort into making resources available. There's the Canadian Pediatric Aids HIV research group. There's Katie. There's a lot of different people who have all sorts of great ideas and so you can absolutely find all of those resources online as well.
Megan: And we'll list them on the podcast show notes, so you don't have to name them all. But that is a great plug for those resources as well. This has been a great conversation. Thank you so much Jared for joining us.
Dr. Bullard: Yeah, absolutely my pleasure, thank you.
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Megan: Thanks for tuning in to Healthy Canadians. If you're watching on YouTube, don't forget to click the like button below and subscribe to stay up to date on future episodes. Find us wherever you get your podcasts and leave us a review if you like what you heard. For more information on the health topics that matter to you visit canada.ca/health.
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