Syphilis Outbreak Declared in HPEC, New Cases of HIV Reported
HPEPH has declared an outbreak of syphilis in the region. The current rate of infectious syphilis in HPEC is almost 3 times higher than the 5-year average. HPEC also continues to be in a state of gonorrhea outbreak, with 48 cases reported so far this year. In addition, new cases of HIV have recently been reported in the region. The support of health care providers is requested to evaluate potential risk of exposure of patients, and encourage testing for STIs, and HIV if determined to be appropriate.
HPEPH recommends using an abundance of caution and recommending testing for STIs if/when patients have engaged in any condomless/unprotected sexual intercourse with new or multiple partners, even if symptoms are not present.Populations impacted by syphilis now include heterosexual males and females, in addition to the previously predominant population of men who have sex with men (MSM).
Enhanced Syphilis Testing Recommendations
Individuals from a variety of age groups, relationship statuses, and sexual orientations are testing positive in HPE – meaning that anyone who is having condomless/unprotected sex could be at risk. 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. Please consult with your patients about potential risk of spread through unprotected oral, vaginal and anal sex or sharing of sex toys.
Syphilis can present with mild or nonexistent symptoms, and when symptoms are present they can imitate many other conditions and range from very mild to severe.
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 at 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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