Sexually Transmitted Infections in Canada: A Sticky Situation

The West African spider folktales describe triumphs of Anansi – a ‘spider-man’ who overcomes numerous challenges through his cunningness. One of Anansi’s tasks is to capture an evasive character named Mmoatia; he catches Mmoatia using a doll covered in sticky gum (1). Mmoatia gets into a tussle with the doll; because of the sticky gum, the harder he struggles, the more he gets stuck. Echoes of this story appear in folklore from other countries including the Brer Rabbit tales recorded by Joel Chandler Harris in the American south (2). What does this have to do with infectious diseases? The analogy is not a perfect one, but with reference to sexually transmitted bacterial infections, we find ourselves at a somewhat similar juncture this year in Canada. We struggle and struggle, and the more we struggle, the more we get stuck. For chlamydia and syphilis, accurate laboratory tests and highly effective antimicrobials theoretically make these threats controllable; indeed, we are only 10 years removed from an ambitious effort in the United States (US) to actually eliminate syphilis (3). Not only are these threats not controlled, but the incidence of both infections has risen sharply across Canada in recent years (4). Chlamydia rates in several countries have increased sharply with screening efforts, raising questions as to whether screening itself might somehow enhance chlamydia transmission or whether (as we believe) more intensive case finding efforts are simply uncovering an increasing fraction of the chlamydia ‘iceberg’. The situation with gonorrhea is less startling with respect to change in disease burden (4), but in some ways, it is even more concerning, with multidrug resistance now an established fact that complicates the management of this still common infection (5). In the present article, we describe emerging clinical and epidemiological facets of these important challenges in Canada and elsewhere.