From coast to coast, Canada is battling what experts are describing as “the return of the syphilis plague.”

The sexually transmitted disease, common in the Elizabethan era and close to being eradicated in Canada just 13 years ago, is on the rise again. There was an almost 10-fold increase in cases between 1993 and 2009 and the resurgence is particularly affecting men.

In the 1990s, the Public Health Agency of Canada considered it possible that the elimination of syphilis was on the horizon. But since then the number of cases has skyrocketed. In 2009, there were 1,683 confirmed cases, 1,501 of which affected men.

“Sexually transmitted infections, including syphilis, continue to be a public health concern in Canada,” PHAC spokesperson Jana Lerner said in an email Thursday.

Outbreaks are being fuelled, in part, by inconsistent or improper use of condoms and other safer sex methods, she said.

Jurisdictions across the country are turning to creative, if not controversial, advertising campaigns to combat the problem.

The province of Alberta created the mock website, plentyofsyph.com, which mimics the online dating service, plentyoffish.com. The website describes itself as: “Your one-stop syphilis shop. Start laughing, flirting and getting infected in seconds with sexy singles simmering with syphilis.” It posts photos of prospective dates like “OralLaura” who is in the latent stages of syphilis. She has a sore on her face and writes that, “I have syph but none of the symptoms.”

The site has attracted a lot of attention, including on Twitter where one commenter writes that it “uses stigma, shame and fear” and another describes it as “pretty frickin’ funny.”

The PHAC is disseminating more educational information about the risks of contracting syphilis and recently posted audio-visual material of a syphilis symposium online, under the heading “Return of the Syphilis Plague.”

The Aids Committee of Toronto, in conjunction with Toronto Public Health and the provincial health ministry, has created what looks like a 1950s B-movie poster for “Attack of the Cursed Syphilis.” It shows a green monster attacking a man and warns “poz guys look out …. If you’ve got HIV, syphilis can hit you harder and faster.”

Bruce Clarke, of Toronto Public Health, said about 90 per cent of the 508 cases of syphilis in Toronto last year affected men, 50 to 70 per cent of whom were HIV-positive.

Explaining the high rates in this population, Clarke said it’s believed that some HIV-positive men have adopted the concept of “sero-sorting.” That’s where they choose to have sex with other HIV-positive men as a way to reduce spread of the virus. They think there is no need to use condoms since they’re both infected with HIV, but could be unknowingly spreading syphilis.

Clarke said Toronto Public Health, the provincial government, Toronto’s Hassle Free Clinic and Ottawa Public Health will be launching in the fall a new advertising campaign to urge men to get tested for both HIV and syphilis.

Dr. Todd Hatchette, an infectious disease specialist in Halifax, said the numbers are up in eastern Canada also.

“It’s hard to know (why). Probably it is linked to increased unsafe practices, multiple partners (and) anonymous sex,” he said.

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Syphilis is passed from person to person through direct contact with a syphilis sore, which mainly occur on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth.

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications, such as damage to internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Damage may be serious enough to cause death.