Doctors are optimistic that a rapid syphilis test can help reduce the spread of sexually transmitted infections in the prairie, due to a promising clinical trial in Alberta.
Infectious disease specialist Dr. Amita Singh supervised the 19-month clinical trial, which tested 1,500 participants in two emergency departments within the city, a correctional facility in Edmonton and in the First Nations community in northern Alberta.
Two dual 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 over 90 percent accuracy, according to Singh.
Rapid HIV tests are not new, but in Canada, rapid syphilis tests are considered.
Preliminary results of the clinical trial show nearly 500 people tested positive for syphilis, 240 of whom were new infections. These results were later confirmed by laboratory tests.
“We expected 10 per cent of the participants to test positive. So that was really incredible and really tells us that we are offering the test in locations where we were very likely to catch people at high risk of syphilis,” Singh said.
“I think this is going to be an incredibly game-changer for Canada.”
The rapid tests still need approval from Health Canada before they can be used on a larger scale, but the regulator has approved a second clinical trial to use the rapid tests in Saskatchewan.
The companies that will manufacture the products — one test by Medmira and one test by Biolytical Laboratories — have not yet received approval from Health Canada.
Syphilis can affect organ systems
People with syphilis can develop serious complications in the brain, heart, and nerves, and pregnant women who do not receive treatment can pass the infection on to their unborn child.
In Alberta, 183 babies have been born with congenital syphilis since 2016, according to figures from the provincial government — and 39 have died.
“If women are not tested during pregnancy, and early in pregnancy, we cannot interfere with our treatments,” Singh said.
There has been a re-emergence of contagious syphilis in Canada in the past decade. The latest figures from Alberta Health Services show that 2,500 new infections were reported in 2020. By comparison, 160 cases were reported in 2014.
Singh said the reasons for the jump in cases in recent years range from increased drug use in the prairie to the rise in popularity of dating apps, which have made it easier to have casual sex with multiple partners.
Rates of syphilis in Canada have been on the rise since the mid-2010s.
Dr Rosanna Billing, Head of the London School of Hygiene and Tropical Medicine and one of the leading advocates of research into access to dual rapid HIV and syphilis tests, said the global push for rapid syphilis testing goes back more than two decades.
Billing, who was not involved in the clinical trial but has conducted similar research for 20 years, said the trial results are consistent with the higher rates of syphilis.
“I wasn’t surprised by the results because I knew there was a lot of syphilis in Canada,” she said.
Attention: Rapid syphilis tests mean that patients can get faster treatment:
Peeling performed A A meta-analysis of studies regarding the use of a rapid syphilis test between 2012 and 2016 published in the British Medical Journal in 2017, which found that offering dual screening tests “prevented further negative results” to mothers who did not know they had the infection.
That’s why she said Canada must move quickly to make these tests more available, noting that babies born with congenital syphilis are often the most visible sign of an STI outbreak.
“Why are we doing another study in Saskatchewan?” She said, regarding the second clinical trial. “Shouldn’t this be rolled out across Canada as a way to prevent more deaths? If it takes another 19 months to study Saskatchewan, how many children will die?”
One hope is that the regression test will lower some of the barriers for at-risk populations.
Dr. Noel Ives, study coordinator, said there are often obstacles for those trying to get tested for syphilis. This can range from not being able to get to transportation or reach for the phone in order to make appointments, as well as navigating competing health issues, such as addiction.
“Patients often face barriers in obtaining care, booking appointments, and seeing primary providers,” Ives said.
Furthermore, traditional lab tests can sometimes take a week or more.
“When people don’t find out about their situation right away, 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 immediate treatment — and 84 percent accepted the offer.
Ives said a good number of participants were “shocked” when they got their results.
“Most of the participants were happy to get a response to their health concerns,” Ives said.
What can it mean for patients
At Turning Point, a damage reduction agency in Red Deer, Alta, employees have ramped up syphilis awareness campaigns and are talking with clients about STDs.
“People worry about the long-term effects if they don’t get treatment,” registered nurse Reed Charbonneau said.
“They realize that this is something that can happen in the third stage [of syphilis] It can affect their organs or even cause death.”
Charbonneau said many clients have difficulty keeping appointments or coming in for a follow-up, so getting an immediate syphilis test result would be a huge help for the residents they work with.
“Sometimes people get a positive test and it’s hard to track down letting them know they need treatment, and that would make a big difference,” they said.
Expansion into Saskatchewan
Saskatchewan also deals with high rates of syphilis.
The rates in 2020 were 78.4 per 100,000 people, nearly nine times higher than they were in 2016, said Dr. Stuart Skinner, executive director of the Wellness Well Clinic in Regina.
“Getting a quick diagnosis and easy access to tests is critical here,” he said.
Skinner said the trial will begin in clinics and pharmacies in Regina with the hope of expanding to include First Nations communities. The goal is to test about 1,600 patients, he said.
“I expect to see a large number [of infections], particularly in the way we look at testing or testing the most at-risk patients. “So I would expect us to see high rates.”
Singh’s research team will present its clinical study data in Alberta at the International AIDS Conference at the end of July.