CANADA: Treponema pallidum infection in NUNAVUT:territory popn 32,000 ( Iqualuit- 7,000 )

SYPHILIS - CANADA (04): (NUNAVUT) INCREASED CASES, REQUEST FOR INFORMATION ************************************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Thu 5 Dec 2013 Source: CBC News [edited] A syphilis outbreak in Nunavut [territory] that began last year [2012] continues to concern health officials. Nunavut health officials say there have been 74 confirmed cases of the sexually transmitted infection in Nunavut since May 2012 with new cases every week. Most are in Iqaluit [the capital city of Nunavut]. Dr. Maureen Baikie, Nunavut's chief medical officer of health, is urging people to get tested for syphilis even if they don't have symptoms, as the infection can have serious health consequences. "The important things about syphilis are, 1st of all, people can have it and not know they have it, which is why it's so important to go and get tested," said Dr. Maureen Baikie, Nunavut's chief medical officer of health. "The other thing is it can be a lifelong infection, and the longer you have it without treatment, the more serious the consequences can be." The infection is easily cured with antibiotics, but if left untreated it can cause severe damage to the heart, blood vessels and brain, and even death. Health officials are encouraging people to get tested and practice safer sex, by decreasing the number of sexual partners and using a condom during sex. -- Communicated by: ProMED-mail from HealthMap Alerts [Nunavut, the largest federal territory of Canada, is the size of Western Europe; it comprises a major portion of Northern Canada, and has an estimated population in 2010 of about 33 000, mostly Inuit (). The territorial capital Iqaluit, which had a population in 2011 of 6699, is located on the south coast of Baffin Island (). Iqaluit was founded in 1942 as an American airbase to provide a stopover and refueling site to support the war effort in Europe (). Iqaluit is only accessible by aircraft and, subject to ice conditions, by boat. Nunavut did not officially become a territory until 1999; prior to 1999, data for Nunavut was combined with Northwest Territories. In 2008, no cases of infectious syphilis (primary, secondary and early latent stages) were reported in Nunavut (); in 2012, 13 cases of infectious syphilis, all of them in Iqaluit, were reported in a prior ProMED-mail post (Syphilis - Canada (03): (NU) RFI 20120912.1291334), where we were told that "the pattern of transmission in Iqaluit has been largely the same as in other parts of Canada and other countries." The rates of infectious syphilis in Canada, as in the United States, have been increasing since about 2000. In Canada, the male-to-female rate ratio increased from 1.5:1.0 in 1999 to 6.4:1.0 in 2008, reflecting that more males than females were reported with infectious syphilis, and this disparity increased over time (). In 2008, men accounted for 86.1 percent of reported cases. Between 1999 and 2008, the rate in men increased from 0.7 to 7.3 per 100 000 and in women increased from 0.5 to 1.1 per 100 000. In men, the highest reported rate of infectious syphilis was shared between 25-29 year olds and 30-39 year olds (13.3 per 100 000) (). Together, these age groups accounted for almost 40 percent of reported cases in men in 2008. In women, the highest reported rate was in 20-24 year olds (3.6 per 100 000). In males, the greatest increase in reported rates of infectious syphilis between 1999 and 2008 was in 25-29 year olds. Most of the Canadian syphilis outbreaks have been in men who have sex with men (MSM), and other outbreaks were related to the sex trade, but some have been locally acquired infections in heterosexual persons (). In Calgary, Alberta, as in the United States, a syphilis outbreak has been associated with the acquisition of anonymous sex partners through the internet. In a ProMED-mail post in February 2013 (Syphilis - Canada: (NU) RFI 20130214.1542486), we were told that there were more than 30 cases in Iqaluit since the outbreak began in May 2012, and the outbreak was spreading to other "regions." According to the news report above, that number of cases has risen to 74 with new cases every week, again mostly occurring in Iqaluit. Some of this increase could be due to an increase in screening for syphilis, but details of the outbreak such as gender, sexual behavior, ethnicity, use of illicit drugs, or prostitution were again not given then, nor are they given in the news report above. Such information would be greatly appreciated from knowledgeable persons. Inuit comprise about 58 percent of Iqaluit's population (), and they may constitute a large portion of the syphilis cases in Iqaluit, as in the Canadian province of Alberta, where infection rates of infectious syphilis are reported to be 18.6 times higher among young Aboriginal women and 2.8 times higher in Aboriginal men compared to their Caucasian counterparts (). These young Aboriginal women are reported to be largely linked to the "street based" sex trade, are often involved with problematic substance use, and are poor. (Aboriginal peoples in Canada comprise the 1st Nations, Inuit, and Metis; Metis are people with mixed 1st Nations and European ancestry).