Health unit expands access to STI testing as syphilis cases rise in Ontario

Restricting STI testing was a “frustrating consequence” of the pandemic, said Peterborough’s medical officer of health Dr. Thomas Piggott

With syphilis cases on the rise in Ontario, Peterborough Public Health’s (PPH) sexual health clinic is expanding access to STI testing for the first time since the service was restricted at the outset of the COVID-19 pandemic.

Last year syphilis cases in the province reached their highest count in at least a decade, with 2,678 reported infections, according to Public Health Ontario. The Peterborough region saw 13 new infections, up from 10 in 2019, according to data from PPH.

Beginning in March 2020, PPH’s sexual health clinic limited STI testing to only those with symptoms, due to staff being redeployed to help with the COVID-19 response.

But many STIs can be present without showing symptoms, said Dr. Thomas Piggott, Peterborough’s medical officer of health, in a statement. “As such the only way to know if you have one is by testing,” he said. 

The clinic, located in PPH’s offices at 185 King Street, has now returned to offering routine STI screening for those who do not show symptoms, Piggott said. But in-person appointments are still limited and some patients are being sent to private medical laboratories to have blood and urine samples collected. Residents can call the clinic to book an initial phone call with a sexual health nurse to determine what testing they need. Services will return to pre-pandemic levels as “staffing fully returns,” Piggott said. 

Cutting back on STI testing was a “frustrating consequence” of the pandemic, said Piggott in a phone interview. “It’s really important we get back to it.” He said he is personally doing some work in the sexual health clinic because it’s something he’s passionate about.

While testing was restricted, people in the region were directed to seek routine STI testing through their primary care provider – something that “may not have been very feasible for many” because of the region’s doctor shortage, Piggott said.

Current Canadian guidelines recommend people under age 30 who are not part of a high-risk group get screened for common STIs once a year. It’s also recommended each time someone has a new sexual partner, Piggott said.

Recorded cases of syphilis, HIV, gonorrhea and chlamydia all declined in Ontario in 2020, as the pandemic set in. But syphilis rates, which had been rising across Canada since the early 2000s, continued their upward trend last year. The highest proportion of cases are among gay, bisexual and other men who have sex with men, according to the Public Health Agency of Canada.

Some experts warn that lower rates of other STIs may be the result of a drop in testing, not lack of transmission.

In a 2020 national survey conducted by the Public Health Agency of Canada, 44 percent of service providers that test for STIs said that their ability to do so was significantly curtailed by the pandemic.

“Less detection results in more spread,” said Ontario Medical Association president Dr. Rose Zacharias during a panel discussion about health care issues facing the LGBTQ communities on June 8. “As a result [of the lack of testing], we simply cannot know the true extent of the rise in sexually transmitted diseases.”

“What we can say with certainty is that we need to reach those who may be undiagnosed to stop the spread,” she said.

Another speaker on the panel, Dr. Ed Kucharski, said that while some people may have reduced their sexual activity during the pandemic, others may have faced stigma for continuing to be sexually active.

“We were told to stay away from people, to stay home, and so when people were sexually active, I think they did face some stigma going into their healthcare provider and asking for testing,” said Kucharski, who is the chief medical officer of Toronto’s Casey House, a hospital for people living with or at risk of HIV.

“These two years have really put a damper on one’s ability to know their own [STI] status,” said Dane Record, interim executive director of PARN – Your Community AIDS Resource Network, in a phone interview. “We still have folks who want to be tested for sexually transmitted [and] blood borne infections, who are … left out and wondering where they can go.”

The Positive Care Clinic, run out of PARN’s downtown Peterborough office, continued offering STI testing throughout the pandemic. But some who needed the service stayed away for fear they would be stigmatized for walking through the doors of an HIV-service organization, Record said. “Folks don’t want … that extra layer of stigma.”

Record said that there have long been barriers to STI testing in Peterborough, which the pandemic only made worse.

For instance, some people in the region travel all the way to Oshawa to get tested, because it’s the nearest place that provides anonymous HIV testing, he said. All testing locations in Peterborough require patients to provide their name, and positive test results for certain STIs are reported to public health, he said. Those requirements can potentially deter people from getting tested because it can be considered a crime for people living with HIV not to disclose their status to sexual partners, he said.

Last year, PARN joined an Ontario-wide pilot project to mail HIV self-testing kits to people who might face barriers to getting tested. It’s available to residents of Haliburton, Northumberland, Peterborough and the City of Kawartha Lakes who are 16 years or older and identify as gay, bisexual or men who have sex with men. 

Called GetAKit, the project first launched in Ottawa. The kit includes a small needle used to prick the tip of your finger to draw a blood sample. It takes one minute to show a result, which participants can then choose to report online.

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