CIHR Operating Grant : Addressing Infectious and Congenital Syphilis in Canada – Registration

Well-being, Health and Biomedical Discovery

Deadlines

Academic Unit: inquire with unit

Memorial Deadline: RIS review not required for registration

External Deadline: Thursday 12th, October 2023

Description

In 2018, Canada endorsed the WHO global health sector strategies to address HIV, viral hepatitis and sexually transmitted infections (STI), and established a Pan-Canadian Framework for Action for which success would be measured against the global targets to eliminate Sexually Transmitted and Blood-Borne Infections (STBBI) as a health concern by 2030. Accordingly, in 2018, CIHR expanded the scope of the HIV/AIDS Research Initiative (RI) to integrate other STBBI, including syphilis.

Syphilis is a sexually transmitted bacterial infection that can be effectively cured with early antibiotic treatment — often with only a single dose. When left untreated, persistent syphilis can cause severe neurological damage, multi-organ disease and death in adults. It can also be passed from the pregnant mother to fetus in utero and at birth, resulting in congenital syphilis, a debilitating disease that can also lead to stillbirth and neonatal death.

For more than two decades, the rate of reported cases of infectious syphilis in Canada steadily increased from a low of less than 0.5 per 100,000 population in the late 1990s to 10.7 per 100,000 in 2016¹. This increase has been linked to drug use, amongst other causes, with specific outbreaks in Canada connected to methamphetamines². Tragically, since 2017, there has been a dramatic increase in rates of infectious syphilis, with rates reaching 30 per 100,000 by 2021³. During this period, there has also been a major shift in the demographics of the populations affected. Between 2017 and 2021, rates of infectious syphilis have increased 729% among women compared to 96% among men over the same time period, with 87% of cases among women in 2020 occurring in women aged 15-39 years¹.

As a result of these changing demographics, a concurrent re-emergence of congenital syphilis has occurred with cases increasing from 7 in 2017 to 96 in 2021 – a 1271% increase³. In 2020, the provinces with the highest proportions of cases of infectious syphilis among women were Saskatchewan (51%), Manitoba (49%) and Alberta (43%)¹. Accordingly, 86% of confirmed early congenital syphilis cases were from these provinces². In these regions and in the North, Indigenous populations are disproportionately affected by both infectious and congenital syphilis². In Ontario, Quebec and British Columbia, as of 2021, a majority of infectious syphilis cases remain among gay, bisexual and other men who have sex with men; however, preliminary reports from BC, where the greatest number of cases are reported, suggest more than 90% of new case reports in 2022 were among females aged 15-49 years, raising concern for increased rates of congenital syphilis in BC^1,4,5.

Early diagnosis of infectious syphilis, followed by appropriate treatment, is critical to reducing transmission for both infectious and congenital syphilis. In Canada, universal syphilis testing is considered part of standard prenatal care. Unfortunately, because of stigma, racism, sexism and other forms of systemic and structural discrimination, access to STBBI testing and prenatal care is particularly limited for people from Indigenous and rural, remote and isolated communities, as well as for people who use drugs or experience homelessness. There is an urgent need to improve access to syphilis testing and prenatal care for these communities.

See ResearchNet for further information.

Funding Sources

Canadian Institute of Health Research (CIHR)