Doctors are optimistic that a rapid syphilis test could help limit the spread of a continuing outbreak of sexually transmitted infections in the prairies, due to a promising clinical trial in Alberta.
Infectious Diseases Specialist Dr. Amita Singh led a 19-month clinical trial that tested 1,500 participants in two downtown emergency departments, a correctional facility in Edmonton and the community of first nations in northern Alberta.
Two double rapid tests for HIV and syphilis were tested in the study. Both options offer results in less than 15 minutes – and have been found to have more than 90 percent accuracy, according to Singh.
Rapid HIV tests are not new, but rapid tests for syphilis are in Canada.
Preliminary findings from the clinical trial show that approximately 500 people tested positive for syphilis, 240 of whom were new infections. These results were later confirmed by laboratory tests.
“We expected that maybe 10 percent of our participants would give a positive test. So it was really amazing and it really tells us that we’re offering tests in places where we’re very likely to take people at risk for syphilis, “Singh said.
“I think it’s going to be an amazing change in the game for Canada.”
Two different rapid tests for HIV / syphilis were used in a clinical trial in Edmonton and Northern Alberta. (Julia Wong / CBC)
Rapid tests still need Health Canada approval before they can be more widely used, but the regulator has approved a second clinical trial using rapid tests in Saskatchewan.
The companies that will manufacture the products – one from Medmira, another from Biolytical Laboratories – have not yet received Health Canada approval.
Syphilis can affect the organ systems
Those infected with syphilis can develop serious brain, heart and nerve 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 the provincial government – and 39 have died.
“If women are not tested during pregnancy and early pregnancy, then we cannot interfere with our treatments,” Singh said.
Infectious syphilis has been on the rise in Canada over the past decade. The latest data from the Alberta health services show that in 2020, 2,500 new infections were reported. For comparison, in 2014, 160 cases were reported.
Singh said the reasons why the cases have jumped in recent years range from increasing drug use on the prairies to the growing popularity of dating apps, which facilitates casual sex with multiple partners.
Canada’s syphilis rate has been rising since mid-2010.
The global impetus for rapid testing for syphilis dates back more than two decades, said Dr. Rosana Peeling, president of the London School of Hygiene and Tropical Medicine and one of the leading advocates of research on the availability of double rapid tests for HIV and syphilis.
Peeling, who did not participate in the clinical trial but did similar research for 20 years, said the results of the study were in line with the rising rate of syphilis.
“I was not surprised by the results because I knew there was a lot of syphilis in Canada,” she said.
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Doctors and outreach workers hope that the wider use of a new rapid syphilis test could help slow the spread of the dangerous sexually transmitted infection.
Peeling carried out a meta-analysis of research on the use of rapid syphilis tests between 2012 and 2016, which were published in the British Medical Journal in 2017, which found that offering double screening tests “prevents less favorable results” for mothers who did not know, that they have the infection.
That’s why she said Canada needs to take swift action to make these tests more accessible, noting that babies born with congenital syphilis are often the most visible sign that STIs are spreading.
“Why are we doing another study in Saskatchewan?” She said of the second clinical trial. “Shouldn’t this simply be spread in Canada as a means of preventing further deaths?” If this study in Saskatchewan takes another 19 months, how many babies will die?
Barriers to testing
One hope is that accelerated testing will reduce some of the barriers for vulnerable populations.
Dr Noel Ives, co-ordinator of the study, said there could 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 make appointments, as well as navigating competitive health issues such as addiction.
“Patients often have barriers to receiving care and booking appointments and seeing the main providers,” Ives said.
In addition, traditional laboratory tests can sometimes take a week or more.
“When people don’t find out about their status right away, it simply means that syphilis is more likely to spread to either their current partners or new sexual partners in the community,” he said.
In the clinical trial, participants with a positive sample were offered on-site treatment – and 84% accepted the offer.
Ives said many of the participants were “shocked” when they received their results.
“Most of the participants were happy to have an answer to their health problems,” Ives said.
The secondary stage of syphilis ulcers are shown here on the palms of the hands. (Shutterstock)
What it can mean for patients
At Turning Point, a harm reduction agency in Red Deer, Alta, officials stepped up awareness campaigns for syphilis and talked to STI clients.
“People are worried about the long-term consequences if they don’t get treatment,” said registered nurse Reid Charbono.
“They are aware that this is something that could happen in the third stage [of syphilis] which can affect their organs or even cause death. “
Many clients find it difficult to make appointments or come for follow-up, Charbono said, so an immediate syphilis test result would be a significant help to the population they work with.
“Sometimes people get tested positive and it’s hard to track 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 stepping up their reports of syphilis as the disease continues to spread. (Julia Wong / CBC)
Expansion to Saskatchewan
Saskatchewan also deals with high levels of syphilis.
Dr Stuart Skinner, executive director of the Wellness Wheel Medical Outreach Clinic in Regina, said the 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 are crucial here,” he said.
Skinner said the trial would begin at clinics and pharmacies in Regina, hoping to extend to the communities of the first nations. He said the goal is to test about 1,600 patients.
“I would expect to see a large number [of infections]especially in the way we look at testing or testing the patients who are most vulnerable, “he said.” So I expect to see high levels. “
Singh’s research team will present data from its clinical trial in Alberta at the International AIDS Conference in late July.
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