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Clinician alert: Provincial increase in syphilis cases

The rate of infectious syphilis in BC increased significantly from 11.9 per 100,000 in 2014, to 16.2 per 100,000 in 2015.

Like many jurisdictions, BC has observed an increase in infectious syphilis rates since 2010. However, this recent increase was much greater than previous year-to-year increases.

  • In 2015, there were 761 infectious syphilis cases – nearly 40% higher than 2014.
  • 80% of infectious syphilis cases were among gay, bisexual, and other men who have sex with men (MSM).
  • About half of infectious syphilis cases among MSM were in HIV-positive individuals.
  • Though increases were seen across all age groups, the rate of increase was greatest among young men (i.e. 20-29 years).
  • While there is a concern that this increase may lead to cases of congenital syphilis, only one congenital syphilis has been reported since 2010.

Pertinent facts about syphilis

  • Syphilis is transmitted sexually. Condoms may reduce the risk of transmission, but do not offer complete protection.
  • The classic presentation of syphilis is a painless ulcer (primary stage) or generalized maculopapular rash and lymphadenopathy (secondary stage). Left untreated, it may also progress to tertiary syphilis, where involvement of the major organs may occur (e.g. heart, aorta, bones, joints, brain).
  • Syphilis – even in its early stages – can also manifest in more complicated and serious ways, such as neurosyphilis or ocular syphilis. These more serious sequelae are more commonly seen in those who are HIV-positive.

Testing and treatment

  • Syphilis testing is done via serology, or if available, via direct examination (e.g. darkfield microscopy) or nucleic acid amplification testing (i.e. PCR) of swabs taken from a lesion.
  • Syphilis is curable with benzathine penicillin G (Bicillin) given intramuscularly.
  • Serial serology (q3 months) is typically recommended after treatment to assess response.

Populations of interest

While all sexually active individuals are at risk for syphilis, some populations are at increased risk for syphilis infection and re-infection and/or increased risk of morbidity due to syphilis. These are:

Gay, bisexual, and other men who have sex with men (MSM):

  • Increased risk for infection/re-infection.
  • Recommend screening every 3 months.

People living with HIV:

  • Increased risk for serious syphilis-related complications, and concomitant syphilis infection may contribute to onward HIV transmission.
  • Recommend screening every 3 months.

Prenatal patients and women of childbearing age:

  • Risk of vertical transmission and congenital syphilis.
  • For prenatal patients, routine screening in the first trimester is recommended.
  • If there is ongoing risk during pregnancy, repeat testing may be warranted (i.e. third trimester screening and at delivery).
  • All women should have at least one syphilis test documented prior to discharge after deliver.

Individuals with multiple sex partners:

  • Recommend screening every 3 months.

What is BCCDC doing about this?

The BCCDC, along with the regional health authorities and Perinatal Services BC, has developed an action plan to respond to this provincial increase in syphilis cases, in collaboration with clinicians, community-based organizations, laboratory personnel, and other key stakeholders.

This plan is a long-term strategy with the aim to prevent and control syphilis, especially among key populations. Included in this plan are:

  • The development of a provincial awareness campaign to be rolled out in mid- to late 2016
  • The addition of resources to our nursing, physician and administrative staff effective December 2015.
  • The development of several research projects examining the drivers of the epidemic and exploration of novel strategies to prevent syphilis infection (i.e. doxycycline pre-exposure prophylaxis). These projects have already received funding from the Vancouver Foundation and the BCCDC Foundation, and other peer-reviewed grant submissions have been completed.

Questions?

If there are any questions about the testing or treatment of syphilis, or other clinically-related questions, please call the BCCDC STI Physician at 604-707-5610.

If you have questions about, or require assistance with partner notification or management, need information on a patient’s previous syphilis results or treatments, or would like to order syphilis treatment, call the BCCDC Syphilis Nursing Team at 604-707-5607.

 

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