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:
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chancres or non-painful ulcers in the genitals, mouth, and/or rectal area,
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lymphadenopathy (swollen lymph nodes),
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body rashes (may be very mild),
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fever,
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malaise,
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sore throat,
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headaches,
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alopecia (hair loss),
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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.
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