Hastings Prince Edward Public Health
Online Bulletin for Health Care Providers

July 7, 2021

From:
Dr. Piotr Oglaza
Medical Officer of Health
Hastings Prince Edward Public Health

Increase in Local Syphilis Cases – Testing and Treatment Guidance

HPEPH is monitoring a significant increase in local cases of syphilis. While syphilis rates have been gradually increasing across the province and in HPEC, a sudden and unprecedented increase is taking place in the region. 10 cases were reported in each of 2019 and 2020, compared to a previous average of 2-3 cases a year. In comparison, 16 cases have already been reported in 2021, 7 of these in the month of June.

Of unique and increasing concern regarding the spread of syphilis, is impacted populations now include heterosexual males and females. This is in addition to the previously predominant population of men who have sex with men (MSM).

We truly appreciate the assistance of our emergency and community health care providers who continue to provide sexual and reproductive health services for patients and would like to remind our partners of the following:

Enhanced Syphilis Testing Recommendations

Individuals from a variety of age groups, relationship statuses, and sexual orientation are testing positive in HPE – meaning that anyone who is having condomless/unprotected sex could be at risk.

Syphilis can present with a variety of different symptoms that can imitate many other conditions and range from very mild to severe. The infection also progresses in multiple stages. Early symptoms often include:

  • chancres or non-painful ulcers in the genitals, mouth, and/or rectal area,

  • lymphadenopathy (swollen lymph nodes),

  • body rashes (may be very mild),

  • fever,

  • malaise,

  • sore throat,

  • headaches,

  • alopecia (hair loss),

  • uveitis and/or retinitis (eye inflammation)

Individuals are also encouraged to consider getting tested, even if they only have one partner. If one individual is engaging in sexual activities outside of a relationship, they could pass STIs on. STIs can be spread through unprotected oral, vaginal and anal sex with a partner who is already infected. Sharing sex toys can also spread infection.

Treatment and Management of Syphilis

Syphilis must be treated according to the diagnosed stage of infection:

  • Infectious syphilis (primary, secondary and early latent stages): Long-acting Benzathine Penicillin G 2.4 million units intramuscular as a single dose.
  • Longer duration syphilis (late latent and tertiary syphilis): Three (3) weekly doses of Benzathine penicillin G-LA 2.4 million units IM.
  • Neurosyphilis requires more aggressive treatment with intravenous antibiotics, and should be managed by, or in consultation with, an infectious disease specialist.
  • Follow-up: Post treatment serologic testing is used to assess treatment response. It should be done at recommended intervals, which vary depending on stage of infection.

(Canadian Guidelines on Sexually Transmitted Infections, 2020)

Accessing Treatment

Health Care Providers can order publicly funded (no cost) STI medications from HPEPH by using the HPEPH Vaccine/STI form available online a hpePublicHealth.ca. Benzathine penicillin G (Pen G) may be ordered directly from the HPEPH Sexual Health Program (x 418) for patients once a completed Syphilis Surveillance Report Form is returned. In special circumstances, treatment with Pen G may be administered through Public Health with a script from the patient’s own Health Care Provider and a completed syphilis surveillance report form.

For more information on diagnosing syphilis stages, interpreting testing results, treatment, and follow-up monitoring schedules, please see HPEPH’s Syphilis Infection and Laboratory Results Interpretation Guide.

COVID-19 Vaccine News & Updates

Acceleration of Second COVID-19 Vaccine Doses for Youth (12-17)

Ontario is accelerating second dose eligibility to all children and youth aged 12 to 17 to provide them with a strong level of protection against COVID-19, including the Delta variant, and support a safe return to school in September. Starting on Monday, July 5, 2021 at 8:00 a.m., youth aged 12 to 17 across the province became eligible to book an accelerated second dose appointment to receive the Pfizer vaccine through the provincial booking system.

From time to time, local clinics are also available for booking at https://www.canadaehs.com/hpepublichealth/vaccine. Youth can also book an appointment at many local pharmacies.

Additional vaccine eligibility and booking information, including resources to support discussion with youth/caregivers experiencing hesitancy, can be found on HPEPH’s COVID-19 Vaccine Booking and Eligibility web page.

Updated NACI Statement Regarding Adverse Events Following COVID-19 Immunization

The National Advisory Committee on Immunization (NACI) has released updated information and guidance on the use of mRNA COVID-19 vaccines in response to rare adverse events following COVID-19 vaccination. Practice recommendations include:

  • Providing informed consent for people receiving an mRNA vaccine, including a discussion about the very rare risk of myocarditis and/or pericarditis following immunization.

  • As a precaution, NACI recommends that individuals who experienced myocarditis and/or pericarditis after a first dose of an mRNA vaccine should wait to get their second dose until more information is available.

NACI continues to strongly recommend that a complete series with an mRNA vaccine should be offered to all eligible individuals without contraindications, including those 12 years of age and older. The Pfizer-BioNTech vaccine is approved for use in people 12 years and over and the Moderna vaccine is approved for use in people 18 years of age and over.

(NACI, 2021)

In addition, Health Canada has updated the following COVID-19 vaccine product monographs:

  • AstraZeneca and COVISHIELD product monograph updates highlight that capillary leak syndrome has been observed very rarely following vaccination with the AstraZeneca COVID-19 Vaccine, and provide further guidance for healthcare professionals and vaccine recipients. In addition, information about thrombosis and thrombocytopenia (rare adverse reactions to the vaccine) has been updated on the label, recommending to healthcare professionals that individuals with thrombocytopenia following vaccination with the AstraZeneca COVID-19 vaccine should be investigated for signs of thrombosis, and similarly individuals who present with thrombosis should be investigated for thrombocytopenia.
  • Pfizer-BioNTech and Moderna Product Monograph updates describe very rare reports of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the tissue surrounding the heart) following vaccination. These reports are very rare and investigations into the association between myocarditis/pericarditis and mRNA vaccines continue.

(Ministry of Health, 2021)


HPEPH is offering services by appointment only. We remain dedicated to protecting our community by providing local HCPs and community members with new information as it becomes available. Current information on COVID-19 specifically for health care providers can be found at hpePublicHealth.ca, Ontario Ministry of Health and at publichealthontario.ca.

Contact Information: 

To give us your comments: hart.sara@hpeph.ca

To report communicable diseases:613-966-5500 x349

To report AEFI or DOPHS: Online / Fax: 613-966-1813 or CDCFAX1@hpeph.ca

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