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Syphilis is on the rise, but there is new evidence for ETS. Getty Images Photo by jarun011 / Getty Images / iStockphoto
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As we hear more about smallpox, another disease that was once simply called “smallpox” is resurfacing in Canada. Syphilis rates have been rising since 2001, and most provinces and territories have reported outbreaks. Alberta Health Services reports that “the rate of syphilis has increased more than 10 times since 2014.” In recent years, the province has seen its highest level of syphilis since the 1940s. This was in the pre-antibiotic era before penicillin became the usual treatment for this disease.
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According to the Canadian AIDS Information Exchange (CATIE), Alberta had 46 cases per 100,000 people in 2019, the highest provincial rate except Manitoba, which is again half as high. The Northwest Territories reported double the Alberta rate. Then there is Nunavut, where the rate was 260 per 100,000 inhabitants.
The CATIE website also notes that in 2018, syphilis was four times more common in men than in women. They say this was “driven primarily by cases between gays, bisexuals and other men who have sex with men,” although heterosexual men and women are also affected. CATIE also notes that “The increase in syphilis cases coincides with the introduction of highly effective HIV treatment in the late 1990s, which may have contributed to a decrease in condom use.” They also attribute some of the blame to the increase in dating applications that facilitate relationships with multiple sexual partners.
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Syphilis has always carried considerable stigma. Predictably, sex workers have high rates of infection due to their occupation, which adds to the negative picture of the disease. Even countries have tried to use syphilis to insult their neighbors. For many years it was called “the French disease” in England and the “Neapolitan disease” in France. The Russians called it “Polish disease” and the Poles called it “German disease”.
Syphilis tests are usually done by blood tests, which leads to my own encounter of grazing with the disease. Years ago, while I was a student at Columbia University, I was somehow convinced that I might have a sexually transmitted disease. Upside down, I took the subway to a public health clinic in Harlem, where a boy in a white robe asked me, “Have you had your blood drawn?” Wow, I didn’t know I had to do it myself! Of course, it meant that if I had crossed the line to take blood. I learned that my test was negative when I received the results by mail on a postcard, yes, a postcard! It took me a while to recover my arm and my pride.
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Syphilis testing in Canada is about to change as a result of the rapid combined tests for HIV and syphilis that were recently evaluated in a clinical trial supervised by Dr. Ameeta Singh, a clinical professor at the University of Alberta. Two finger prick tests were evaluated and yielded results in about 15 minutes.
The clinical trial involved 1,500 participants in the city’s emergency departments, as well as a First Nations community and a correctional facility in Edmonton. Surprisingly, 500 of those tested were positive. While they were certainly at risk populations, the results surprised even the researchers, who expected a positivity rate of around 10%.
Rapid syphilis tests have been available for 20 years. In an email interview, Singh says, “they are widely used in low- and middle-income countries.” However, they are new to Canada and have not yet received Health Canada approval.
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Another recent study evaluated the Reveal ™ Rapid TP Antibody test and the DPP® Syphilis Screen and Confirm test and found that they had an accuracy ranging from 83% to 95% in 100 blood samples. with known syphilis. The researchers, led by Raymond Tsang of the Public Health Agency of Canada, concluded that these tests show “promising results in detecting syphilis.”
Singh believes that having the quick test will be a “game changer” because it will allow testing in different places in traditional healthcare settings. He adds that “treatment can be provided based on the preliminary positive result, thus preventing continued transmission (to sexual partners and a pregnant woman to the fetus), preventing progression to a more serious disease and preventing loss of follow-up.” .
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He also advises that “anyone who has sex outside of a mutually monogamous relationship should be monitored for STIs (sexually transmitted infections and blood infections) regardless of whether they have symptoms or not.”
Since we started with monkeypox, which is a growing concern, it is worth noting that it is currently being diagnosed in Canada by PCR tests that look for the presence of monkeypox DNA. However, at least one company, the Chinese manufacturer Joysbio, is announcing a quick test kit for monkeypox, and there are probably more things on the way. We hope you don’t have to pick one up at our local pharmacy soon.
Dr. Tom Keenan is an award-winning journalist, public speaker, professor at the University of Calgary School of Architecture, Planning, and Landscape, and author of the best-selling book, Technocreep: The Surrender of Privacy and the Capitalization of Intimacy.
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