- A pilot program screened pregnant people for hepatitis C virus (HCV) and other microbes
- Researchers found that 87 cases had HCV infection and 20% of these also had syphilis
- Continued screening for sexually transmitted and blood-borne infections in pregnancy is needed
During pregnancy, healthcare providers routinely request patients to give blood samples to labs for many tests. These tests can uncover conditions that may require monitoring and treatment. The province of Alberta has a prenatal screening program that tests people for the following transmissible infections:
- hepatitis B virus (HBV)
- HIV
- rubella (also called German measles)
- syphilis
- varicella (causes chickenpox in children and shingles in adults)
As part of a pilot program that began in 2020 and lasted for 21 months, researchers in Alberta added routine HCV testing to the package of tests offered in prenatal testing.
Blood samples were first tested for the presence of HCV antibodies, which indicates exposure to the virus. Samples that tested positive were then tested for the genetic material (RNA) of HCV—a positive test indicates active HCV infection.
During the pilot program, Alberta, like many other parts of Canada, had an outbreak of syphilis (this outbreak is still ongoing). Researchers were interested to find if there were cases where people had both HCV and syphilis. Over the course of the pilot program, 87 pregnant people tested positive for HCV infection; of these, 20% also had syphilis.
The researchers encouraged other regions to also conduct screening for HCV and syphilis co-infection. Studies are needed to test interventions that will improve the health and well-being of people before they become pregnant. Such interventions would include screening and treatment of HCV and syphilis as well as ways to reduce the risk of these infections.
Other findings and issues
The researchers also made the following findings:
- There were no cases of HIV or HBV infection among people with HCV and syphilis.
- A majority of people with HCV-syphilis co-infection were aged 26 to 30 years and lived in or around Edmonton.
- Many co-infected people lived in neighbourhoods where people generally had a low income.
Based on their findings, the researchers stated that a subpopulation of people who underwent prenatal screening were at high risk for acquiring both HCV and syphilis. The pilot program was not designed to interview people who tested positive for HCV and syphilis. However, based on a study that had taken place in Alberta earlier, the researchers stated that people who had HCV and syphilis likely had one or more of the following risk factors:
- sharing equipment for injecting drugs
- involvement in sex work
- a history of incarceration
For the future
As issues such as drug use and sex work are stigmatized, these risk factors may not be disclosed at clinic visits by pregnant people. The researchers therefore encouraged healthcare providers to consider HCV testing in pregnant people who test positive for syphilis.
As HCV and syphilis can affect the health of the fetus, the researchers called for studies to help find ways to “engage at-risk populations [with] testing and treatment for both syphilis and HCV prior to conception to prevent [poor] congenital outcomes.”
The researchers underscored this point by noting that, as a result of searching confidential health information databases, they found that “the majority of HCV and syphilis infections were identified in patients who had tested positive prior to prenatal screening.” They added: “Patients were still testing positive for these infections during pregnancy, suggesting a lack of treatment before conceiving or incidence of reinfection. Until outcomes can be improved before pregnancy through holistic care in women of child-bearing age, screening for sexually transmitted and blood-borne infections should continue to remain a priority during the prenatal period.”
—Sean R. Hosein
Resources
Syphilis Resources – CATIE
Hepatitis C testing and diagnosis – CATIE
Researchers explore issues related to sexual health among women who are sex workers – CATIE News
Rapid combined syphilis-HIV testing found accurate and useful in an Alberta study – CATIE News
Alberta study underscores the importance of syphilis testing in people who use stimulants – CATIE News
Alberta study finds high rates of sexually transmitted infections among people in prison – CATIE News
REFERENCES:
- Thompson LA, Plitt SS, Gratrix J, et al. Prevalence of syphilis coinfection in hepatitis C virus positive prenatal patients from Alberta during a pilot routine screening program. Canadian Liver Journal. 2023 Feb 28;6(1):70-75.
- Raval M, Gratrix J, Plitt S, et al. Retrospective cohort study examining the correlates of reported lifetime stimulant use in persons diagnosed with infectious syphilis in Alberta, Canada, 2018 to 2019. Sexually Transmitted Diseases. 2022 Aug 1;49(8):551-559.