Alberta First Nations health centre will join study aiming to get people tested for syphilis

Health officials are team‐ ing up to make syphilis testing more accessible to people living in central Al‐ berta as the province grap‐ ples with a worsening years-long outbreak of the serious sexually transmit‐ ted infection.

Dr. Ameeta Singh, an in‐ fectious disease specialist and clinical professor of medicine at the University of Alberta, oversaw a 19-month clinical trial of a rapid test to quickly and easily test people for both syphilis and HIV.

The test, which was 98 per cent accurate in detecting ac‐ tive syphilis and 100 per cent accurate in detecting HIV, was approved by Health Canada in March 2023.

Now, Singh has received $400,000 in federal funding to explore different ways of reaching - and testing - peo‐ ple potentially affected by syphilis and HIV. Some of the work will happen in Maskwacis, about 85 kilome‐ tres south of Edmonton, one of Alberta's largest First Na‐ tions communities.

"This test kit that we're us‐ ing provides a preliminary re‐ sult for syphilis in less than a minute," Singh told CBC's Radio Active.

"It's very exciting because it provides the opportunity to provide treatment right there and then in a single visit, in‐ stead of having to have the person come back for followup."

Rapid results, fast inter‐ vention

Syphilis, a sexually trans‐ mitted infection (STI), can lead to significant health is‐ sues if left untreated, includ‐ ing brain, heart and nerve complications. Pregnant peo‐ ple who aren't treated can transmit the infection to their fetus - called congenital syphilis - that could lead to health issues for the child, in‐ cluding stillbirth.

There have been 19 infan‐ ts born with congenital syphilis in the Maskwacis re‐ gion since 2018, including three stillborns, Singh noted in the research proposal, ap‐ proved by the Canadian Insti‐ tutes of Health Research (CI‐ HR) in April.

Singh said the rapid tests would help protect people's health.

Treatment can cure the STI and, in the case of preg‐ nancy, prevent harmful out‐ comes for the baby. Diag‐ nosis will also help stop the spread to other people.

Syphilis rates have been spiking across Canada and internationally, recently reaching levels not seen since the 1940s.

Alberta, in particular, has become a hotspot. The on‐ going outbreak was first de‐ clared in 2019; provincial da‐ ta shows infectious syphilis cases have risen each year for nearly a decade.

In 2021, Alberta recorded more than 3,200 cases - the most in Canada, according to federal government statistics. In 2022, the most recent year for which syphilis statistics are available, Alberta health officials recorded nearly 3,330 cases - second behind Ontario, which reported about 3,440 cases.

"This infection is an old in‐ fection," Singh said.

"It should have gone away, but it has come back with a vengeance."

Multiple factors are con‐ tributing to the outbreak, she said, including social deter‐ minants of health such as poverty and systemic racism in health care, dating apps that help arrange casual sex‐ ual encounters, and people having unprotected sex.

Singh's clinical trial, which ran from August 2020 to Feb‐ ruary 2022, used rapid tests from two manufacturers. The device made by Biolytical Laboratories received the green light from Health Cana‐ da.

The test checks blood droplets for antibodies of the infections with a finger stick similar to a blood-sugar test for diabetics - and results ap‐ pear within minutes, Singh said. They differ from most syphilis tests, which send blood samples to a lab and yield results within several days.

The success of the trial led to rapid test use expanding in Alberta: 18 community sites and six acute-care hos‐ pital sites use them, she said.

The grant from CIHR, a federal agency that funds health research, allows her to continue the work in the AHS Central Zone by collaborating with Maskwacis Health Cen‐ tre to figure out non-tradi‐ tional ways to offer testing.

LISTEN | Cases of syphilis continue to rise:

"Instead of having people come into a health centre or hospital for testing, it would be nice if we could go out to them - perhaps using mobile vans or events - and offer this testing as part of a range or a group of other health in‐ terventions," Singh said.

The Maskwacis Health Centre has already been doing point-of-care testing for over a year, which has al‐ lowed patients to start treat‐ ment and contact tracing sooner, said CEO Randy Lit‐ tlechild.

"They can actually start the treatment process right then and there," Littlechild said, noting that a blood sample is still sent to a lab to confirm the rapid test results.

"You could start the back‐ ward process of finding out who the [sexual] partner was… and, hopefully, in some of those cases, then you try to get those people to get tested as well and then they get treatment."

Singh and her team are al‐ so partnering with an acutecare hospital in the AHS Cen‐ tral Zone to help provide testing to pregnant women, she said.

This is in response to health ministry reporting, she said, which flagged that many of the women giving birth to babies with congeni‐ tal syphilis were examined in an acute-care centre, but weren't tested for the infec‐ tion.