HMN 2026: How New cases of syphilis in Alberta drop after introduction of rapid testing with immediate treatment

University of Alberta-led research reports that new cases of syphilis dropped in Alberta following the introduction of rapid point-of-care testing and same-day treatment. The research team compared new syphilis positivity rates before the tests were introduced, when testing was made available in the Edmonton zone after 2020, and then once provincewide testing had started in 2022.

Rates dropped by an average of 15% during the Edmonton phase and then by 25% during the provincial phase, the team reports in an article published in Clinical Infectious Diseases.

“This is very strong supportive evidence that point-of-care testing and treatment in affected populations has had an impact in terms of bringing those numbers down,” says principal investigator Ameeta Singh, clinical professor of infectious diseases in the Faculty of Medicine & Dentistry. “But even though we’re on a downward trend, our rates are still very high.”

Alberta declared a syphilis outbreak after reported cases increased 14-fold between 2014 and 2019. A sexually transmitted infection, syphilis often has only low-grade symptoms but can eventually lead to damage to the nervous system, heart or vision if left untreated.

Of particular concern is congenital syphilis, which passes from mother to fetus and can cause stillbirth or severe health issues for the baby. Between 2015 and March 2024, there were 350 cases of congenital syphilis in Alberta, resulting in 61 stillbirths.

Key affected populations include heterosexual people with multiple partners and those experiencing homelessness, incarceration or drug use. In a separate study between 2017 and 2019, two-thirds of women with syphilis in Alberta self-identified as Indigenous and half lived in the lowest-income neighborhoods.

The team used a method called interrupted time series analysis to look back at transmission rates, controlling for factors such as testing volume and variations in population. Because the study was retrospective rather than prospective, it can only identify association rather than causation, but the researchers are confident that the testing and immediate treatment made the difference.

“In the Edmonton phase, we found that rates declined in the Edmonton zone only. Then, when we scaled it up provincially, we started seeing the provincial rates come down as well,” points out first author Alexa Thompson, who won the Governor General’s Gold Medal award along with her Ph.D. in laboratory medicine and pathology last spring. She is now a senior policy adviser for the Alberta Primary and Preventative Health Services Indigenous Health Division.

Both point-of-care syphilis/HIV tests evaluated in Singh’s earlier clinical trial in Alberta have now been approved for use across Canada. The tests require a single finger-prick and yield results within five minutes. They can be offered in community clinical settings and don’t require repeat laboratory visits.

Ninety percent of people who test positive for syphilis accept immediate treatment—a single dose of injectable penicillin, which kills the bacteria and stops the disease from spreading to others within a week. People who test positive are also offered laboratory testing to determine whether further treatment might be necessary.

Singh notes that targeting testing and treatment to geographical locations and age groups where syphilis rates are highest will be key to stopping the outbreak. Partnerships with inner-city agencies, as well as rural and remote communities, allow clinicians to adapt delivery for each setting.

“The Indigenous population in Alberta is disproportionately affected by syphilis and other STIs, and there is a significant overlap with many social determinants of health such as houselessness, poverty, mental health and addictions, as well as the impacts of racism and colonialism,” Singh says. “In Canada today, we should expect to see no babies being born with congenital syphilis, so we still have a long way to go.”

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