January 11, 2004
Sexual diseases bounding back
Health officials puzzled as cases of STIs swell globally
By THANE BURNETT -- Toronto Sun

At 46 years old, divorced, with teenagers of his own, he never thought he would be part of a burgeoning social trend.

Especially a sexual evolution -- even re-evolution.

But here he is, on the cutting edge of an alarming increase in sexually transmitted diseases (STDs) among Canadians.

"The clap (gonorrhea) is something you got stopping over in navy ports in the 40s ... my father's generation," the unlucky divorcee says over the telephone line.

"I got a flu shot this year. I wasn't worrying about a sexually transmitted disease."

It's not just your Dad's "dose" anymore. From 1997 to 2001 -- the numbers are anticipated to be even higher recently -- Canada has seen gonorrhea cases rise 45%. For men aged 30 to 39, the rate was closer to 70%.

While we've learned to fear new strains of infections and afflictions -- the scars of SARS can still be felt in Toronto -- health-care officials are fighting a serious resurgence of old foes.

Like tuberculosis, health risks we thought were almost scrubbed from the charts are gaining ground fast.

STDs -- now often classified as STIs or sexually transmitted infections -- are rising dramatically, not just here, but in cities around the world.

Vancouver now has the dishonour of having the world's largest per capita outbreak of syphilis.

Sex education in New Brunswick is under attack because of a high rate of chlamydia and an increase in mortality rates for cervical cancer.

While an STD epidemic charted in Britain has reached a crisis point -- syphilis rates have increased by 500% in the past six years while cases of gonorrhea have doubled -- most local Ontario officials are unwilling to use that kind of dire language. But if not a crisis, almost all agree what this province faces -- a sure and puzzling spike in most types of sexually transmitted diseases -- is alarming.

And unlike getting a handle on the number of flu cases, or West Nile numbers, knowing how many Canadians are suffering from gonorrhea, chlamydia or syphilis is almost guesswork. Not only do many cases go undetected, but few people want to talk about the risks, even to the person they're most intimate with.

"Next to talking about money (how much we earn), people don't like to talk to one another about this subject," notes Joann Ackerly, who manages an STD program for the city of Toronto.

The 46-year-old Toronto man I started this column with -- he first noticed a swelling in his testicles more than a week after sleeping with a woman from work -- has yet to tell his new partner about his diagnosis. He was so nervous about being featured in this column that -- after responding to a request by local clinics for an STD patient to tell their story -- he would not give his name, occupation or even his new partner's age.

"This is something you don't live down," he explains.

But it's something many people are apparently living with.

"We're so busy, we can't keep up," says Jane Greer, spokesman for downtown Toronto's Hassle Free Clinic, one of the country's busiest STD clinics.

In 1998, they had 18,000 visits. Last year, that number was an estimated 24,000.

Long-term damage

"We are insanely busy, and have had to turn people away," she says.

"The volumes just get bigger."

Experts worry many Canadians who can't quickly get into a clinic or find a family doctor are going without treatment. In many cases, the treatment is rather simple -- gonorrhea can often be taken care of with just one dose of antibiotics -- but the long-term effects, if nothing is done, can be painful and serious.

Sexually transmitted diseases can cause genital lesions, stillbirths and make people more susceptible to contracting AIDS.

Toronto, like other Canadian cities including Vancouver and Montreal, is recording a dramatic spike in the number of syphilis cases.

Toronto clinics are also seeing a rise in HIV cases among women, as well as a noticeable increase in treatments for human papillomavirus -- genital warts.

"If someone tells you they know the reason for all this, they don't," says Greer from the Hassle Free Clinic.

Officials can only guess, she notes.

Catherine Saunders, a spokesman for Health Canada, says theories for the new rash of sexually transmitted infections include a possible burnout of the safe-sex message, faith in the new AIDS drug cocktails, a new generation which didn't have to live through the '80s AIDS/HIV crisis, and even the internet, which is allowing couples to court online and meet to have sex without really knowing one another's history.

The numbers can be dramatic, and frightening. While Toronto battles high rates of new syphilis cases, in Peel Region, where in 1996 there were 877 reported cases of chlamydia, in 2001 there were 1,429. In 1997, there were 194 cases of gonorrhea -- in 2001, there were almost 300.

And while they are now compiling more statistics from recent years, evidence points to new increases, rather than any victory over the swell.

It was only a few years ago some public health officials were predicting the end of syphilis -- a disease which killed millions in the Middle Ages.

"Are people truly aware of STDs?" asks Ackerly from Toronto Public Health.

The answer, if teens are any indication, may be a painful "no."

A recent Health Canada survey found half of Grade 9 students polled didn't know there was no cure for HIV/AIDS, and 50% of Grade 11 students didn't know a person could have an STI but show no signs of being ill.

The man I started this with spent decades living with the same woman. The person he believes he contracted gonorrhea from is one of the only people he's slept with since leaving the marriage.

"I was thinking the worst that could happen would be that she wouldn't like my kids," he says.

"I guess that wasn't the worst."