SuppliedFaced with a syphilis outbreak beginning in 2019, Alberta researchers tried something new to reach the affected and underserved — rapid/point of care testing (RPOCT). A new study from University of Alberta researchers has associated RPOCT with decreasing rates of syphilis province-wide.
Syphilis — a sexually transmitted infection (STI) — is easily identified with a blood test and quickly cured with antibiotics. RPOCT allows patients to be diagnosed and treated for syphilis within the same day and in nontraditional settings.
“People who were affected by syphilis were not coming into clinics and saying ‘hey, I want to get tested,’” Dr. Singh says
In the midst of the outbreak, identifying and treating those with the infection presented a challenge, prompting the introduction of RPOCT, Dr. Ameeta Singh explained.
A clinical professor in the U of A’s faculty of medicine and dentistry, Dr. Singh has spent much of her career treating and researching STIs. While Dr. Singh has seen outbreaks of syphilis before, in 2019 she explained “we were seeing rates not seen since the 1940s and so that was really shocking to see.”
She explained many of the cases were initially seen within Edmonton’s inner city and populations affected by other social determinants such as homelessness, poverty, addiction, and mental health issues. According to Dr. Singh, “people who were affected by syphilis were not coming into clinics and saying ‘hey, I want to get tested.’”
From August 2020 to February 2022, Dr. Singh’s team conducted a clinical trial in Edmonton evaluating the first rapid test for syphilis. The trial targeted an STI clinic, an inner city emergency department, an urgent care centre, a correctional facility, and one First Nation’s community all in the Edmonton health zone.
Study finds syphilis positivity rates decreased by 15 per cent in Edmonton and 25 per cent provincially
In March 2022, the RPOCT program was expanded province-wide. In 2023, Health Canada approved the rapid test after Singh’s team found it 98 per cent accurate at identifying active syphilis.
“Testing and treatment on the same day means that people don’t have to come back for test results seven to 10 days later,” Dr. Singh said.
After implementing RPOCT in Edmonton, syphilis positivity rates decreased by an average of 15 per cent. Provincially, rates decreased by 25 per cent. While Dr. Singh is awaiting the final numbers for 2025, “preliminary data suggests that the numbers are continuing to come down.”
“Most importantly, we strongly believe that if we discontinue these activities at this point in time, that what will happen is we’ll see a rebound,” Dr. Singh said.
Dr. Singh emphasized the importance of continuing to monitor positivity rates, target testing, and offering same day treatment.
Dr. Singh speaks on the health risks of untreated syphilis and remaining challenges
Untreated syphilis can present a number of issues. There is a risk of neurologic complications, such as loss of vision or hearing and problems with walking. Up to 40 per cent of untreated syphilis cases can progress into tertiary syphilis, which can impact the spinal cord and nervous system, or cause psychosis or dementia.
Additionally, the affected individual can spread syphilis through any intimate, sexual contact. If someone is pregnant and becomes infected, the syphilis can also spread to the individual’s fetus. Congenital syphilis was of special concern, Dr. Singh explained. Congenital syphilis can cause stillbirth as well as a number of health issues in newborns.
While pregnant women are routinely tested for syphilis during pregnancy, “many pregnant women were not accessing prenatal care because of fear that their babies would be taken away from them.”
“Many of the women delivering babies with congenital syphilis have been women who are underserved in one or more ways,” Dr. Singh said.
Dr. Singh identified a few challenges remaining in reaching those affected by syphilis. Namely, transportation barriers and mistrust in the health-care system.
“People are still experiencing racism and discrimination in our health-care system. There are a number of measures that are ongoing to try and address that, but I think we still have a long way to go.”
Additionally, one drawback to the test is that it can not distinguish between an active and previous infection, Dr. Singh said. Currently, a new rapid test is being trialed in several provinces, including Alberta, that could address this issue.
