Doctors are optimistic that a quick syphilis test could help curb the spread of an ongoing outbreak of sexually transmitted infection in the Prades, due to a promising clinical trial in Alberta.
Infectious Disease Specialist Dr. Ameeta Singh oversaw the 19-month clinical trial, which tested 1,500 participants in two downtown emergency departments, a prison in Edmonton and a community of the First Nations north of Alberta.
Two rapid tests for HIV and syphilis were tested in the study. Both options delivered results in less than 15 minutes and were found to have more than 90% accuracy, according to Singh.
Rapid HIV testing is not new, but in Canada, rapid syphilis testing is.
Preliminary findings from the clinical trial show that approximately 500 people tested positive for syphilis, 240 of whom were new infections. These results were subsequently confirmed by laboratory tests.
“We had predicted that maybe 10 percent of our participants would test positive. So that was really amazing and it really tells us that we were offering tests in places where people at risk of syphilis are very likely to be picked up,” Singh said.
“I think this is going to be an incredible change of game for Canada.”
Two different rapid HIV / syphilis rapid tests were used in a clinical trial in Edmonton and northern Alberta. (Julia Wong / CBC)
Rapid testing still needs Health Canada approval before it can be used more widely, but the regulator has approved a second clinical trial to use rapid testing in Saskatchewan.
The companies that would manufacture the products, one test from Medmira and another from Biolytical Laboratories, have not yet received approval from Health Canada.
Syphilis can affect organ systems
People infected with syphilis can develop severe brain, heart, and nervous complications, and untreated pregnant women can pass the infection on to their unborn child.
In Alberta, 183 babies have been born with congenital syphilis since 2016, according to provincial government data, and 39 of them have died.
“If women are not tested during pregnancy and early pregnancy, we cannot intervene with our treatments,” Singh said.
There has been a resurgence of infectious syphilis in Canada over the past decade. The latest figures from Alberta Health Services show that 2,500 new infections were reported in 2020. In comparison, 160 cases were reported in 2014.
Singh said the reasons why cases have increased in recent years range from an increase in drug use in the Prades to the growing popularity of dating applications, which has made it easier to have casual sex with multiple pairs.
Syphilis rates in Canada have risen since the mid-2010s.
The global momentum for rapid syphilis testing dates back more than two decades, said Dr. Rosanna Peeling, president of the London School of Hygiene and Tropical Medicine and one of the leading proponents of research on the accessibility of syphilis. rapid dual tests for HIV and syphilis.
Peeling, who did not participate in the clinical trial but has done similar research for 20 years, said the findings of the trial are aligned with rising rates of syphilis.
“I wasn’t surprised by the results because I knew there was a lot of syphilis in Canada,” he said.
LOOK: Rapid syphilis tests mean that patients can get treatment faster:
The new rapid test for syphilis could slow the spread of the disease, doctors say
Doctors and outreach workers hope that a wider use of a new rapid test for syphilis can help curb the spread of the dangerous sexually transmitted infection.
Peeling performed in meta-analysis of studies on the use of rapid tests for syphilis between 2012 and 2016 published in the British Medical Journal in 2017, which found that offering dual screening tests “prevented more adverse results” for mothers who did not know who had the infection.
That’s why he said Canada should move quickly to make these tests more available, noting that babies born with congenital syphilis are often the most visible sign that STIs are rampant.
“Why are we doing another study in Saskatchewan?” he said, regarding the second clinical trial. “Shouldn’t it be deployed across Canada as a means to prevent more deaths? If this Saskatchewan study takes 19 more months, how many babies would die?”
Barriers to testing
One hope is that rapid testing will reduce some of the barriers for vulnerable populations.
Dr. Noel Ives, study coordinator, said there can often be obstacles for those trying to get tested for syphilis. This can range from not having access to transportation or access to a phone to making appointments, as well as navigating competitive health issues such as addiction.
“Patients often have barriers to receiving care and booking appointments and seeing major providers,” Ives said.
In addition, traditional lab tests can sometimes take a week or more.
“When people don’t find out about their condition immediately, it just means that syphilis is more likely to spread to their current partners or new sexual partners in the community,” he said.
In the clinical trial, participants who tested positive were offered treatment at the time, and 84% accepted the offer.
Ives said a good number of participants were “surprised” when they got their results.
“Most participants were happy to have an answer to their health problems,” Ives said.
Secondary syphilis sores are shown here in the palms of the hand. (Shutterstock)
What it could mean for patients
At Turning Point, a damage reduction agency in Red Deer, Alta., Staff has increased syphilis awareness campaigns and are talking to clients about STIs.
“People are worried about the long-term impacts if they don’t get treatment,” registered nurse Reed Charbonneau said.
“They are aware that this can happen in the third stage [of syphilis] which can affect their organs or even cause death. “
Many clients have difficulty meeting appointments or following up, Charbonneau said, so having an immediate result on a syphilis test would be an important help to the population they work with.
“Sometimes people get a positive test and it’s hard to keep track of them to let them know they need treatment, so that would make a big difference,” they said.
Turning Point in Red Deer, Alta., Works with vulnerable people. They are increasing their messages about syphilis as the disease continues to spread. (Julia Wong / CBC)
Expansion in Saskatchewan
Saskatchewan has also been dealing with high rates of syphilis.
Dr Stuart Skinner, executive director of the Wellness Wheel Medical Outreach Clinic in Regina, said rates in 2020 were 78.4 per 100,000 people, almost nine times higher than in 2016.
“Getting a quick diagnosis and easy access to testing is very important here,” he said.
Skinner said the trial will begin in Regina clinics and pharmacies in hopes of spreading to First Nations communities. He said the goal is to test about 1,600 patients.
“I hope we see a lot of them [of infections]”Especially in the way we’re analyzing the trials or trials of patients who are most vulnerable,” he said. “So I hope we see high rates.”
Singh’s research team will present data from the Alberta clinical trial at the International AIDS Conference in late July.