HEPATITIS C (HCV) PREVALENCE AMONG RECENT SYPHILIS CASES AT AN INNER-CITY COMMUNITY HEALTH CENTRE IN VICTORIA, BRITISH COLUMBIA, CANADA

Author: Selfridge M, Barnett T, Besko K, Guarasci K, Lundgren K, Moher M, Fraser C

Theme: Clinical Research Year: 2025
Background:
Syphilis rates have risen dramatically in the past decade in Canada and British Columbia (BC), particularly among gay, bisexual, and other men who have sex with men (gbMSM), including those who are living with HIV (lwHIV). The surge in female cases, primarily among child-bearing ages, is alarming, with a fifteen-fold increase from 2017 to 2022 and raises concerns for congenital syphilis.  Comprehensive testing for syphilis, HCV and HIV, rather than isolated HCV screening offers a vital opportunity to detect syphilis as an emerging co-infection that might otherwise be missed.

Cool Aid Community Health Centre in Victoria, BC serves 7,000 clients experiencing homelessness and mental health and substance use challenges. Sexually transmitted blood-born infection (STBBI) testing, including HCV, is offered during regular client encounters and as part of the weekly nurse-led drop-in clinic, Prism Wellness, staffed by STI certified practice nurses offering STBBI education, screening, treatment, pre-exposure prophylaxis (PrEP) and doxycycline post-exposure prophylaxis (doxyPEP).

Methods: 
A retrospective chart review was conducted to identify and include all clients tested for syphilis between January 1, 2021, to December 31, 2024. Client demographic variables included age, sex, gbMSM, lwHIV, HCV testing and PrEP.

Results:
7828 syphilis tests were completed with 2994 unique individuals in the last 3 years (2725 non-reactive, 269 reactive). Of the 269 reactive tests (mean age=46), 111 (41%) were determined to have a current infection (149 previously treated, 9 false positive). For those with current infection, 106 (95%) were fully treated. While females account for 25% of all reactive syphilis tests, they represent 41% of current infections. One fifth (n=56, 21%) of syphilis reactive individuals had positive HCV antibodies, and 95% of these had undetectable RNA from spontaneous clearance or cure.

Conclusion:
High prevalence of HCV antibodies rates in syphilis positive individuals reinforces the need for integrated STBBI screening programs. 
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