|
BACKGROUND
Syphilis notifications have increased among women and heterosexual men in Canada and people who inject drugs (PWID) are an emerging group at risk. However, there is a limited understanding of syphilis specifically among PWID. We examined syphilis prevalence and how this varied by intersecting population groups and environmental-structural factors.
METHODS
Data were from HEPCO, a cohort study of PWID in Montreal. Syphilis testing via venipuncture was added in November 2022 with treponemal testing reflexed to non-treponemal testing if positive. We included the result at each person’s first test and Fisher’s exact test was used to examine differences in the prevalence of any syphilis exposure, inclusive of current or past infection.
RESULTS
As of March 2024, 386 people (16.1% women, 2.6% non-binary/transgender/two-spirit) had a syphilis test. Two people (0.52% [95%CI 0.1-2.1]), one man and one woman had current syphilis and 33 (8.6% [95%CI 6.1-11.8] had any syphilis exposure. Men and women both had a prevalence of 8.1%. Among men, prevalence was higher among those identifying as gay, bisexual and other MSM (gbMSM), those with HIV, and those who reported recent sex work (all p <0.001). All women with syphilis identified as heterosexual and none were living with HIV. Prevalence was higher among women reporting recent sex work and recent unstable housing; however, this was not statistically significant.
CONCLUSION
Current syphilis infection was uncommon among this cohort of PWID; however, any syphilis exposure was higher than anticipated. Among men, there is an intersection and overlap among those who identify as gbMSM and are living with HIV. Among women, there was a possible link to sex work and unstable housing however caution is needed due to the small sample size. Periodic syphilis testing among PWID may be justified alongside testing for other sexually transmissible and blood borne infections.
|