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Appropriate antimicrobial therapy is one of the essential strategies in the global control of gonorrhea. We sought to determine the provider compliance with provincial treatment guidelines for gonococcal infections in Alberta, Canada, and to identify characteristics associated with provider noncompliance. A retrospective population-based analysis of gonorrhea treatment from January 1, 2000, to December 31, 2019, using data extracted from a communicable disease database was performed. Prevalence ratios were calculated for provider compliance to treatment guidelines of patient, infection, and treating provider characteristics. We identified a total of 42,875 cases of gonorrhea, 58.3% were men, 40.3% were White, 28.2% were First Nations, and 16% were “unknown ethnicity.” Most cases were treated by family physicians (43.4%), sexually transmitted infection (STI) clinics (31.9%) and urgent care centers/hospitals (10%). Overall, there was 80.3% provider compliance with treatment guidelines. Provider compliance to treatment guidelines had the highest rates of compliance when treatment was provided by STI nurses in correctional facilities, STI clinics, and treatment of men having sex with men (94.7%, 91.7%, and 87.5%, respectively). Provider compliance to treatment guidelines was lowest when treating women (75.5%), pregnancy status (68.4), individuals of “unknown race/ethnicity” (74.8%), and those treated in urgent care centers and emergency department (66.7%). Delivery of STI care by nurse-led models had the highest level of compliance with treatment guidelines. Our study informs areas for targeted interventions to improve the uptake of treatment guidelines, including the provision of treatment in urgent care centers and among women.

An infectious syphilis outbreak in Alberta has resulted in increased congenital syphilis (CS) cases. To shed light on potential risk factors, we used administrative data sets to examine care milestones for the prevention of CS among pregnant women diagnosed with syphilis, as well as correlates of women giving birth to infants with CS.Provincial administrative databases were used to identify and describe pregnant women diagnosed with any stage of infectious or noninfectious syphilis who gave birth in Alberta between January 1, 2017, and December 31, 2019. Data on prenatal care, syphilis screening, and syphilis medication dispensation were used to evaluate the care milestones. Clinical care and maternal demographics were assessed using logistic and linear regression analyses to determine correlates for missed care milestones or a newborn outcome of CS.Of 182 syphilis-infected pregnant women, 63 (34.6%) delivered a newborn with CS. Overall, in the first trimester, 136 (75.1%) women had a health care visit, 72 (39.6%) had a prenatal care visit, 71 (39.0%) were screened for syphilis, and 44 (24.2%) were treated. Gestational time to treatment initiation (adjusted odds ratio, 1.04; 95% confidence interval, 1.02-1.06) and older maternal age at diagnosis (adjusted odds ratio: 1.28, 95% confidence interval, 1.08-1.50) were independently associated with CS outcomes. No variables were found to be independently associated with a health care visit, prenatal screening, or initiation of treatment.Although nearly two-thirds of CS cases were prevented, there remained missed opportunities in the prevention of CS. Early treatment, which relies on timely access to prenatal care and screening, was the most important for the prevention of CS.

Background: Congenital syphilis (CS) is a significant public health challenge, requiring early diagnosis and treatment to improve infant outcomes. The aim of this study is to describe public health outcomes of infectious syphilis cases among pregnant patients and factors associated with a CS diagnosis for their infant. Methods: We conducted a retrospective review of demographic and clinical characteristics of infectious syphilis cases diagnosed during pregnancy and resulting infant outcomes in Alberta from 2017 to 2020 from the provincial communicable disease database. Adequate maternal treatment was defined as receiving at least one dose of Benzathine penicillin G-LA 2.4 million units IM at least 28 days before delivery. Univariate and multivariate analysis was performed to determine factors associated with CS diagnosis using SPSS version 25. Results: A total of 374 cases of infectious syphilis were diagnosed in pregnancy, with two patients being diagnosed twice in a single pregnancy. The majority (79.1%; n=296) of women had a live birth, followed by therapeutic abortion (9.4%; n=35), stillbirth (7.5%; n=28) and spontaneous abortion (4.0%; n=15). Infant records (n=265) were available for review (n=117 CS cases and 148 non-cases). Correlates associated with CS were screening time in third trimester (adjusted odds ratio [AOR] 8.4, 95% confidence interval [CI], 2.9–24.6) and fewer than 28 days before delivery (AOR 8.1, 1.4–47.8 [vs. first and second trimester] and inadequate treatment (AOR 86.1, CI, 15.9–466.5). Among the CS cases, 23.1% (n=27) were stillborn compared with one (0.7%) stillbirth in the non-CS infants (p

Background: A multi-country outbreak of monkeypox virus (MPXV) infections was identified by the World Health Organization in May 2022. The western Canadian province of Alberta identified its first case of MPXV in a returning traveller on June 2, 2022. We undertook a retrospective testing exercise to evaluate whether MPXV may have been circulating in the province earlier. Methods: Skin (genital and non-genital) and mucosal lesion swabs submitted for herpes simplex virus (HSV)/varicella zoster virus (VZV)/syphilis testing from male patients attending sexually-transmitted infection clinics across the province of Alberta from January 28 to May 30, 2022 were retrieved from storage. The population tested was selected based on the epidemiology of the current 2022 multi-country MPXV outbreak. Samples underwent viral nucleic acid extraction and testing for the presence of Orthopoxvirus DNA using a commercial real-time polymerase chain reaction (PCR) kit. Results: A total of 392 samples (representing 341 unique individuals of median age 31 years) were retrieved. Of them, 349 (89.0%) samples were submitted for HSV/VZV/syphilis testing, 13 (3.3%) for HSV/VZV only, and 30 (7.7%) for syphilis PCR only. None of the 392 samples tested were found to be positive for Orthopoxvirus DNA. Conclusions: The results of this study indicate that circulation of MPXV in a higher-risk population in Alberta, prior to the first case, was less likely. We recommend that other provinces/territories review their local epidemiology, context and resources prior to conducting similar studies.

The increased procurement of organs from donors with risk factors for blood-borne diseases and the expanding syphilis epidemic have resulted in a growing number of organs transplanted from donors with reactive syphilis serology in our center. Based on guidelines, recipients typically receive therapy shortly after the transplant, but data on outcomes are limited. The primary objective of this study was to determine syphilis seroconversion rates at three months post-transplant in recipients of solid organs procured from donors with reactive syphilis serology. Organ donors and recipients were tested for syphilis antibody; positive results were confirmed with Treponema pallidum Particle Agglutination (TPPA). Eleven donors with reactive syphilis antibody donated organs to 25 syphilis negative recipients. Three recipients seroconverted at post-transplant month 3. All of them had received therapy shortly after transplant. TPPA was negative in all 3. Despite post-transplant treatment, 3 of 25 (12%) syphilis negative recipients of organs from syphilis positive donors seroconverted at 3 months. All remained TPPA negative possibly reflecting passive antibody transfer or differing test sensitivity to low level treponemal antibodies. Further studies are needed to assess optimal syphilis transmission prevention strategies and follow up recipient testing in organ transplantation.

Incarcerated populations experience higher rates of sexually transmitted infections (STIs) than the general population, alongside inconsistent testing strategies. In response, universal opt-out STIs (chlamydia, gonorrhea, syphilis, and HIV) screening was implemented at admission in a short-term correctional facility in Alberta, Canada, for individuals ≤35 years. A cross-sectional, retrospective evaluation of testing outcomes between March 2018 and February 2020 was completed. Descriptive statistics were used to stratify STIs by gender, age group, and date for univariate analysis. Despite low uptake (31.2%), opt-out screening resulted in high positivity rates (14.9%, 10.8%, 29.5%, and 0.3%, respectively) and treatment completion (93.7%) while capturing a high proportion (52.6%) of asymptomatic cases. Opt-out screening at admission is feasible and can improve STI testing in high-risk individuals experiencing incarceration in Canada.

BACKGROUND: We undertook an audit of a province-wide HIV pre-exposure prophylaxis (PrEP) program in Alberta (Canada). METHODS: A retrospective record review of individuals accessing PrEP in Alberta included demographics, PrEP indication(s), and reported non-prescription drug and alcohol use from March 2016 to June 2019. Hepatitis A, B, C, HIV and syphilis serology, serum creatinine, and nucleic acid amplification tests testing for chlamydia and gonorrhea were collected. Descriptive statistics, incidence, and prevalence were calculated. RESULTS: A total of 511 participants were seen at STI, sexual, and reproductive health clinics and private family practitioner (FP) offices; 98.4% (503) were men, median age was 34 years (IQR 28–43 years), and 89.8% (459) were gay or bisexual men who have sex with men. Non-prescription drug use was reported by 39.3% (201) and alcohol use by 55.4% (283). 94.3% (482) reported condomless anal sex in the past 6 months. Testing rates were high (>95%) for all tests except for chlamydia and gonorrhea at the first follow-up visit 89.6%; (3–4 months). There was one HIV seroconversion. The incidence of new bacterial STIs was high: chlamydia 17 cases per 100 person-years (95% CI 13.5% to 21.4%), gonorrhea 11.14 cases per 100 person-years (95% CI 8.3% to 15.0%), and syphilis 1.94 cases per 100 person-years (95% CI 0.73% to 5.12%). CONCLUSIONS: Following implementation of a provincial program for PrEP in Alberta, PrEP initiation and continuation was feasible in a range of settings and by both specialists and FPs.

Of 39 pregnant women at ≥20 weeks' gestation treated with benzathine penicillin G for infectious syphilis, we identified only 2 mild Jarisch-Herxheimer reactions. There were no immediate fetal sequelae. Data from our study do not support the recommendation for routine admission for the treatment of infectious syphilis in late pregnancy.

PurposeIncarceration provides an opportunity for screening and treatment of sexually transmitted and blood-borne infections (STBBIs) in high-risk groups. The purpose of this paper is to determine positivity rates of STBBI screening within correctional facilities using opt-in strategies and estimate the proportion of admissions tested.Design/methodology/approachA cross-sectional, retrospective review of testing data from January 2012 to August 2015 from three provincial correctional facilities located in Alberta, Canada was completed. Analysis variables included STBBI, gender, facility, collection year and age. STBBI-stratified analysis was performed to identify correlates for positivity using univariate and logistic regressions.FindingsOverall prevalence of chlamydia was 11.2 percent and gonorrhea was 3.5 percent; correlates for both were younger age and facility type. The syphilis prevalence rate was 3.2 percent; correlates included being female, older age, adult facilities, with later years being protective. In total, 14 (0.3 percent) newly diagnosed HIV cases were found, prevalence increased with age. HBV prevalence was 1.7 percent with no significant correlations. Nearly one-tenth (n=422) of those screened for HCV antibody were positive; all variables were significantly correlated. Overall estimates of the proportion of admissions tested by STBBI were low and ranged from 4.8 to 16.1 percent.Originality/valueThis study found high rates of STBBI in correctional facilities and showed that only a small proportion of the population was tested using an opt-in strategy. Shifting to an “opt-out” strategy may be warranted.

Background In Alberta (Canada), infectious syphilis rose from 4:100,000 in 2014 to 52:100,000 in 2019 with a parallel rise in congenital syphilis. Treatment of pregnant women is highly efficacious but can precipitate the Jarisch-Herxheimer (JH) reaction. Symptoms of JH reaction are often transient but may include fever, uterine contractions, fetal heart rate abnormalities, and preterm labor. Because of these observations, many guidelines recommend hospitalization for fetal monitoring be considered. We sought to determine the incidence, and severity of JH reactions and the maternal and fetal outcomes following treatment. Methods Retrospective cohort study of pregnant women at >20 weeks gestation admitted to urban referral centers for treatment of infectious syphilis between 2015 and 2020. Data was extracted from a provincial database and supplemented by a review of medical records. Data collection was completed in March 2021. Results 39 women received benzathine penicillin G for the treatment of infectious syphilis in pregnancy. One mild JH reaction was identified in a patient with early latent syphilis. There were no serious maternal or fetal outcomes attributable to treatment. Average gestational age at treatment and delivery was 26 and 37 weeks respectively. Ten cases were staged as primary, 4 as secondary, and 25 as early latent syphilis. Five cases of confirmed congenital syphilis were identified. Further analysis of results is underway. Conclusions Data from our study challenges the recommendation for routine admission for the treatment of infectious syphilis in late pregnancy as no moderate or severe JH reactions were identified in our cohort. Further research is required to determine if a subgroup of women not identified in our cohort are at risk for moderate or severe JH reaction. These findings are timely given the global resurgence of infectious syphilis as inpatient resources continue to be strained by the ongoing COVID-19 pandemic.

Background:: HIV transmission during pregnancy and breastfeeding among serodiscordant heterosexual couples represents an ongoing barrier to the elimination of vertical transmission of HIV-1 infection in Canada. Objective:: To report a case of vertical HIV transmission during breastfeeding and examine the prevalence of risk factors for HIV transmission in the pregnancy and postpartum periods among serodiscordant couples where the male partner is HIV positive and female partner HIV negative. Methods:: Case report and retrospective chart review of HIV-serodiscordant pregnant couples over an eight-year period in Edmonton, Canada. Results:: We report a case of maternal primary HIV infection during the postpartum period and vertical transmission to a nursing infant that went undetected until the infant presented with AIDS. We also report a series of 41 serodiscordant pregnant couples identified by our public health nurse between 2008 and 2016. Among HIV-infected male partners, 20 (49%) had a detectable viral load (VL) during their partner’s pregnancy and during breastfeeding, with median peak VL 4,700 copies/mL (range 49-120,000) and 5,100 copies/mL (range 40-120,000) during pregnancy and breastfeeding, respectively. None of the female partners seroconverted during pregnancy, but three seroconverted at 1.8, 2.4, and 6.9 years after delivery. No vertical transmission occurred. Conclusion:: Despite concerted attempts to minimize HIV transmission during pregnancy and breastfeeding in our well-resourced setting, residual transmission risk remains due to non-suppressed viral load within many HIV-serodiscordant pregnant couples.

Background There is a need for acceptable and feasible HIV testing options to ensure people living with HIV know their status so they can access care. Pharmacist-provided HIV point-of-care testing (POCT) may overcome testing barriers, including privacy concerns, testing wait times, and improve accessibility. In the APPROACH study, we aimed to develop and assess an HIV POCT program in community pharmacies for future scale up and evaluation. This paper describes the program uptake, participant and pharmacist experiences, and implementation factors. Methods A pharmacist-provided HIV POCT program was offered in 4 pharmacies in two Canadian provinces. A mixed methods design incorporated self-report questionnaire data, participant telephone interviews, pharmacist focus groups, workload analysis, and situational analysis to assess the uptake, acceptability and feasibility of the HIV POCT program. Results Over the 6-month pilot, 123 HIV tests were performed. One new case of HIV was identified; this participant was linked with confirmatory testing and HIV care. Participants were predominantly male (76%), with a mean age of 35 years. This was the first HIV test for 27% participants, and 75% were at moderate to very high risk of undiagnosed HIV infection, by Denver HIV Risk Score. Questionnaires and telephone interviews showed participants were very satisfied with the program; 99% agreed HIV POCT should be routinely offered in pharmacies and 78% were willing to pay for the service. Participants felt the pharmacy was convenient, discreet, and that the pharmacist was supportive and provided education about how to reduce their future risk. Pharmacists felt prepared, confident, and expressed professional satisfaction with offering HIV POCT. Community and public health supports, clear linkage to care plans to refer participants with positive HIV POCT results, and provision of counselling tools were important enabling factors for the program. Pharmacist remuneration, integration with existing healthcare systems, and support for ongoing promotion of HIV POCT availability in pharmacies were identified as needs for future scale-up and sustainability. Conclusions A successful model of pharmacy-based POCT, including linkage to care, was developed. Further research is needed to determine the effectiveness and cost-effectiveness of this approach in finding new diagnoses and linking them with care. Trial registration Retrospectively registered with clinicaltrials.gov (NCT03210701) on July 6, 2017.

A case of gonococcal conjunctivitis (GC) prompted us to review the reported cases and treatment regimens of GC in Alberta, Canada.Gonococcal cases reported from 2000 to 2016 were extracted from the provincial sexually transmitted infection reporting database. The diagnosis of GC was based on a positive culture and/or nucleic acid amplification test from the eye.A total of 45 cases of GC were reported in adults. Three quarters (75.6%; n = 34) of the cases were diagnosed using culture, 57.8% (n = 26) of cases were among men, and 55.5% (n = 25) were diagnosed since 2014. Very few (13.3%; n = 6) of the cases were treated according to current Canadian Guidelines on Sexually Transmitted Infections, using 2 g of ceftriaxone in combination with azithromycin or doxycycline. Results of test of cures were available for 15.6% (n = 7) of the cases and occurred within 10 to 79 days (median = 26 days) after treatment; all were negative.Gonococcal conjunctivitis was relatively uncommon in our region, but given its potential for severe manifestations and sequelae coupled with the rising rates of gonorrhea; it remains important to consider this diagnosis in sexually active individuals presenting with purulent conjunctivitis. Additional studies are needed to inform treatment recommendations and to evaluate outcomes of infection.

One hundred thirteen patients with gonococcal and chlamydial pelvic inflammatory disease were reviewed at 2 Canadian sexually transmitted infection clinics. Most patients (81%) with pelvic inflammatory disease were diagnosed as having chlamydia alone. Three treatment failures were seen in patients treated with ofloxacin.

Background Rates of anal cancer from HPV infections are significantly higher in HIV-positive men-who-have-sex-with-men (MSM) compared to the general population. Recent estimates in the US and Europe report the incidence of anal cancer amongst HIV-positive individuals to be 75–137 cases/100 000 person-years, a rate 30–100 times higher than the general population. Despite the restoration of immune function with modern antiretroviral therapy, the incidence of anal cancers is increasing amongst HIV-positive MSM. We report the results of an anal cancer screening program in HIV-positive MSM in Calgary, AB, Canada from October 2014 to December 2018. Methods HIV-positive MSM attending the Southern Alberta Clinic and STI Clinic were offered an anal pap smear. Patients with abnormal cytology were examined with digital anorectal exam and High Resolution Anoscopy (HRA) to detect anal intraepithelial neoplasia (AIN). Dysplastic areas were biopsied and sent for histopathology. High-grade AIN II-III were treated using infrared coagulation. Results A total of 214 patients were examined with HRA. 87 patients (40.7%) had biopsy-proven AIN I, II, or III. Asymptomatic internal anal warts (AIN I) were detected in 60 patients (28%). Twenty-five patients had AIN II-III (11.7%) and 2 patients had invasive squamous cell cancer. High-risk oncogenic HPV was identified in 100% of the biopsy specimens. Conclusion High rates of anal HPV infections causing AIN I, II, and III were identified in HIV-positive MSM, supporting ongoing use of HRA for anal cancer screening programs in this population. High rates of asymptomatic internal anal warts were incidentally found. These rates of anal HPV infections support consideration of offering HPV vaccination to HIV-positive MSM on clinic intake as a preventative tool. Disclosure No significant relationships.

Background In April of 2016, a provincial sexually transmitted infections (STI) outbreak was declared in Alberta. In response to sharply rising rates, Alberta formed the Alberta Sexually Transmitted and Blood Borne Infection (STBBI) Network (ASN) and developed the 2016–2020 STBBI Operational Strategy and Action Plan (OSAP). The aim of the STBBI OSAP is to transform STBBI care in Alberta by leveraging engagement and commitment from within the ASN to achieve collective impact and develop wrap around shared care models through formalized interagency collaboration. Methods ASN has grown to include over 500 stakeholders representing approximately 200 community-based, provincial and federal organizations including communities most affected by STBBI (Indigenous, LGBTQ2+, immigrants, and street involved clients). The OSAP comprises 74 recommendations that focus on five pillars of client-centred STBBI care: (1) prevention, (2) testing/screening, (3) treatment, (4) linkage to care, and (5) stigma. Seven working groups designed 15 project concepts with endorsement from the Steering Committee to optimize achievement of prioritized recommendations. Results Implementation of STBBI OSAP priority recommendations is still underway in 2019. Some prioritized action items include: PrEP guidelines and training program for designated prescribers; a validation study of self-collected gonorrhea/chlamydia NAAT specimens to improve access to low barrier testing opportunities; expedited partner therapy; expanded Hepatitis C treatment access in Indigenous communities; education for primary care providers to increase access and linkage to STBBI care; and formalizing interagency collaboration through the development of STBBI wrap around shared care model demonstration projects. Conclusion The STBBI OSAP is an innovative, comprehensive, and collaborative intersectoral approach to address the high burden of STBBI in Alberta and to strengthen the provincial outbreak response. The strength of this provincial initiative is the engagement and collaboration amongst ASN stakeholders to achieve long lasting impact and sustainability of both systemic and operational interventions. Disclosure No significant relationships.

Background Since 2014, Edmonton, Alberta, Canada has seen an alarming rise in infectious syphilis and gonorrhea infections. Individuals from vulnerable communities with substance use, involvement with corrections, transactional sex, and inadequately housed are overrepresented among cases. The aim of this project was to increase access to sexually transmitted and blood borne infections (STBBI) testing and treatment among hard to reach populations in Edmonton. Methods Outreach teams from the Edmonton STI clinic consisting of a registered nurse and community health representative or licensed practical nurse offered STBBI testing at subsidized housing locations, community based organizations, and through street outreach. Clients were offered testing and treatment for chlamydia (CT), gonorrhea (NG), syphilis, HIV, Hepatitis C. Clients received a $10 gift card for testing and a $10 gift card when returning for results and/or treatment. Results From October 2018 to February 2019, 393 testing visits were completed among 342 individuals. Nearly two-thirds (61%; n=207) of individuals were men with a median age of 32 years. Women were younger with a median age of 20.4 years. Nearly 60% (57.9%; n=198) of individuals reported substance use with 19.0% (n=65) reporting injection drug use. Six percent (n=20) of individuals were involved in transactional sex. The positivity rate for CT was 9.5% (n=26) and 4.0% (n=11) for NG (273 tested). The positivity rate for HCV was 5.4% (n=15; 278 tested). The syphilis seropositivity rate was 10.8% (n=34; 315 tested). No new HIV cases were found. Eight-percent (n=31) of visits involved treatment for an ST Conclusion Offering STBBI incentivized testing was effective in improving access to testing and treatment for hard to reach clients resulting in high positivity rates for STBBI. By offering testing and treatment to individuals linked to high transmission activities, we aim to reduce the burden of STBBI among vulnerable groups Disclosure No significant relationships.

Background Gonorrhea (GC) is the most commonly reported drug resistant sexually transmitted infection (STI) in Canada with 23,708 cases reported in 2016, double the 11,874 cases reported in 2007, corresponding to an 81% increase in rates. Only about 19% of these were cultured, meaning that direct AMR data was only available for one-fifth of GC cases. The Public Health Agency of Canada (PHAC) launched the Enhanced Surveillance of Antimicrobial-Resistance Gonorrhea (ESAG) program in 2013 in three jurisdictions (Alberta, Manitoba, and Nova Scotia) in order to improve the understanding of current trends of AMR-GC. This enhanced laboratory-epidemiological linked surveillance program collects data not available via its existing routine and laboratory surveillance. Methods All cultures and data from participating jurisdictions are included in the surveillance program. The National Microbiology Laboratory performs antimicrobial susceptibility testing for a panel of antimicrobials and sequence typing. Enhanced epidemiological data collected includes treatment information and risk factors. Results From 2014–2017, ESAG captured 2767 cultures from 2566 cases. The majority of the cases were male (81%) and less than 40 years old (83%). There was a 25% decrease from 2014 to 2017 in the number of cases from men who have sex with men. The proportion of isolates demonstrating resistance to at least one antibiotic agent steadily increased from 2014 (54%) to 2016 (66%), dropping to 58% in 2017. Large declines in decreased susceptibility to both cefixime (91%) and ceftriaxone (88%) and increasing rates of resistance to azithromycin were observed. Conclusion ESAG data for 2014–2017 demonstrated decreased susceptibility to the preferred therapy antimicrobials, suggesting that resistance to these key antimicrobials could complicate GC treatment considerably in the future. The expansion of ESAG remains a priority with negotiations currently underway with the remaining jurisdictions with the goal national representation. Disclosure No significant relationships.

Background Incarceration provides an opportunity for screening and treatment of STBBI in high-risk groups. The purpose of this study was to evaluate the uptake and outcomes of opt-out screening at time of admission. Methods Between March and September 2018, all individuals ≤ 30 years admitted to a short-term correctional facility in Alberta, Canada were offered urine nucleic acid amplification test (Aptima Combo 2®, Hologic Inc., Marlborough, MA) for Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG), upon admission. Admission line-lists recorded offering of opt-out testing and reasons for testing non-completion. Laboratory data extracts provided test results by matching collection date with unique patient identifiers. Simple descriptive statistics analysis were completed. Results A total of 1,735 (1,295 males) admissions were recorded, with a median age of 23 years (IQR: 21–25). Most (92.7%; n=1,608) of individuals were offered opt-out testing; reasons for not offering testing included inability to consent (35.1%; n=39), operational limitations (28.8%; n=32), guardianship issues (10.8%; n=12), other concerns (9.0%; n=10), and missing (16.2%; n=18). Of those offered testing, 32.3% (n=520) consented. Reasons for not consenting included: no perceived risk (35.3%; n= 384), recently tested (16.6%; n=181), deferred testing (13.3%; n=145), declined (11.0; n=120), not sexually active (4.7%; n=51), other (5.9%; n=65), and missing (13.1%; n=142). The positivity rate for CT was 18.0% (n=83) and NG was (12.6%; n=58). Women were more likely to test positive for CT (26.1% vs 15.2%, P=0.008) and NG (21.8% vs 9.3%, P Conclusion Opt-out testing at admission proved to be feasible, although uptake was relatively low, CT and NG positivity rates were high. With the majority of incarcerated individuals in Canada being held in short-term correctional facilities, intensification of screening strategies to an opt-out model is effective for a large number of high-risk individuals. Disclosure No significant relationships.

Background Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis (CT) biovars L1-3, which has been increasingly reported among men who have sex with men (MSM). Our study aimed to establish a surveillance system among MSM attending STI clinics in Alberta, Canada to determine prevalence and characteristics of cases. Methods CT NAAT (Genprobe Aptima COMBO 2® Assay) positive specimens from all anatomical sites among MSM attending three STI clinics between May to November 2018 had real-time PCR and DNA sequencing for LGV. Demographic, clinical, and sexual behaviours of cases were extracted from the provincial reporting database. Clinic-stratified analysis was performed to identify differences in sample characteristics using Chi-square or Fisher’s exact test. Results A total of 340 specimens from 299 CT cases were tested for LGV. CT cases were reported from Calgary (52.8%; n=158), Edmonton (46.2%; n=138), and Fort McMurray (1.0%; n=3). There were no significant differences in ethnicity, sexual partner type, anonymous partners, sex outside Alberta, or symptoms; however, cases from Calgary were significantly older than cases from Edmonton (median age: 34 years, IQR: 28–42 vs 29 years, IQR: 25–36, p=0.001) and more cases were co-infected with HIV (20.5% vs 10.0%; p=0.008). Anatomical site was similarly distributed between clinics with specimens from the rectum (61.2%; n=208), urine (26.2%; n=96) and pharynx (10.6%; n=36). LGV sequencing was feasible on 336 specimens. The LGV positivity rate was 1.2% (n=4; 95% CI 0.2–2.4); three rectal LGV cases (1 asymptomatic) and one asymptomatic pharyngeal LGV case were detected, of which two were HIV-positive. Conclusion LGV was rare in our MSM population; however, one pharyngeal and one asymptomatic case were found. If untreated, these cases could serve as a reservoir and play an important role in transmission. Disclosure No significant relationships.

ObjectivesTo review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era.MethodsA retrospective review of all neurosyphilis and tertiary syphilis cases reported in Alberta from 1973 to March 2017 was undertaken and cases classified into early neurosyphilis, late neurosyphilis and cardiovascular (CV) syphilis. Variables collected included demographics, sexual partners, HIV status, clinical parameters, symptoms and treatment and distributions were compared between early versus late neurosyphilis and asymptomatic versus symptomatic cases (stratified by early versus late stage). Data were analysed using IBM SPSS Statistics V.19.0.Results254 cases were identified; 251 were neurosyphilis and 3 were CV. No cases of gummatous syphilis were reported. Early neurosyphilis accounted for 52.4% (n=133) and 46.1% (n=117) were late neurosyphilis cases; one (0.4%) case with unknown duration. Three outbreaks of infectious syphilis were identified during the study period and a concurrent rise in both early and late neurosyphilis was observed during the outbreak periods. The most common manifestation of symptomatic neurosyphilis was ocular involvement which was more likely in early neurosyphilis. Relative to late neurosyphilis cases, early neurosyphilis cases were more likely to be younger, Caucasian, born in Canada, HIV positive and reporting same sex partners.ConclusionsOur review of tertiary and neurosyphilis cases found that early and late neurosyphilis cases continue to occur in the context of cycling syphilis outbreaks. CV syphilis cases were extremely rare. Ongoing identification of new cases of syphilis and clinical evaluation of cases for complications continues to be important in the context of global resurgence of syphilis.

Trichomonas vaginalis prevalence (2.8%) in female sexually transmitted infection clinic attendees was within the prevalence of chlamydia (5.8%) and gonorrhea (1.8%), while being very low for male attendees (0.2%). Correlates among women were indigenous ethnicity, other ethnicity, and being symptomatic.

Fifty-seven cases of gonococcal and chlamydial infections complicated by acute epididymitis seen at 2 Alberta STI clinics from 2004 to 2014 were reviewed. The majority responded to treatment recommended by national guidelines. Three of 6 treatment failures were not treated according to guidelines.

Alberta established a surveillance system in 2001 to monitor resistance to antibiotics used for the treatment of gonorrhea. A retrospective review of gonorrhea cases during the last five years was conducted. All cases of gonorrhea were reportable to public health by testing laboratories and clinicians. Specimens were primarily submitted for nucleic acid amplification testing (NAAT), three sentinel sites obtained specimens for culture and NAAT. The Provincial Laboratory for Public Health conducted E-tests on isolates for multiple antibiotics. A proportion of isolates and NAAT specimens were submitted to the National Microbiology Laboratory for sequence typing (ST). Data were combined and analyzed using SAS version 9.4. Between 2012 and 2016, 13,132 gonorrhea cases were reported, 22.0% (n = 2891) had isolates available for susceptibility testing. All culture positive isolates were susceptible to ceftriaxone. Decreased susceptibility (0.5 ug/mL) to cefixime was reported in four cases in 2014. Resistance to azithromycin (&ge, 2 ug/mL) ranged between 0.4% and 1.8%. Many (n = 509) unique STs were identified, the most prevalent sequence groups (SG) were SG-7638 (n = 367), SG-5985 (n = 145), and SG-11299 (n = 127). The Alberta model for maintaining surveillance for antimicrobial resistance in gonorrhea employs culture and NAAT specimens, providing information crucial to informing provincial treatment guidelines.

The implementation of express testing in an sexually transmitted infection (STI) clinic reduced the length of visit time compared with other visit types and increased the proportion of STIs diagnosed at clinic visits. Express testing did not impact the time to treatment for asymptomatic patients diagnosed as having an STI.

Objectives To determine the prevalence and correlates of Mycoplasma genitalium (MG) infection among men and women, determine the prevalence of gene mutations conferring resistance and compare test performance of female specimen types. Methods A cross-sectional study was conducted on specimens collected for gonorrhoea (NG, Neisseria gonorrhoeae) and chlamydia (CT, Chlamydia trachomatis) among male and female Alberta STI clinic attendees using the M. genitalium transcription-mediated amplification-research use only test. Positive specimens were sequenced for 23SrRNA, parC and gyrA genes. Gender-stratified analysis compared test results using χ2 or Fisher’s exact test, Mann-Whitney U test and logistic regression. Female endocervical and urine specimens were compared. Results A total of 2254 individuals were tested; 53.8% (n=1212) were male. Male prevalence of MG was 5.3%; CT was 5.9% and NG was 1.8%. Correlates of male infection were a non-gonococcal urethritis diagnosis and NG coinfection. MG prevalence for women was 7.2%; CT was 5.8% and NG was 1.8%. Correlates of female infection were younger age, Indigenous/Other ethnicity and CT/NG coinfection. Nearly two-thirds of eligible specimens had mutations associated with macrolide resistance and 12.2% of specimens had a parC mutation signifying possible moxifloxacin resistance. There was high concordance (98.1%) of results between urine and endocervical swabs. Conclusions The high prevalence of MG relative to CT and NG supports the incorporation of MG testing into routine sexually transmissible infection screening. The high rate of resistance to macrolides and moxifloxacin raises concerns about treatment options. The good concordance of results between urine and endocervical swabs supports the use of female urine specimens for testing.

Adding universal rectal screening to urogenital screening should positively impact rectal Chlamydia trachomatis (CT) incidence in affected populations. A dynamic Markov model was used to evaluate costs and outcomes of three rectal CT screening strategies among women attending sexually transmitted infection clinics in Alberta, Canada: universal urogenital-only screening (UG-only), additional selected (exposure-based) rectal screening (UG+SR), and additional universal rectal screening (UG+UR). The model included two mutually exclusive health states: infected and susceptible. Additionally, the model included two rounds of transmission: male sex partners of women infected with rectal-only CT and female sex partners of those men. CT complications impacting patients’ quality of life (QALY) were considered. Alberta and Canadian data were used to estimate model inputs. We used a health care perspective, a time period of 10 years, and a discount rate of 3% for analyses. Compared to UG-only screening, the incremental cost effectiveness ratios (ICERs) were CA$34,000 and CA$49,000 per QALY gained for UG+SR and UG+UR screening strategies, respectively. Compared to UG+SR, the ICER was CA$62,000 per QALY gained for the UG+UR strategy. Both adjunct selected and universal rectal screening strategies are cost effective compared to UG-only screening, and UG+UR screening is cost effective when compared to UG+SR screening.

Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. Significant barriers to establishing anal cancer screening programmes include the small number of healthcare professionals performing high resolution anoscopy and the lack of data showing that anal cancer screening can reduce morbidity and mortality related to anal carcinoma. Despite several controversies surrounding anal cancer screening, the rising incidence of this disease in some groups supports routine screening programmes in high-risk populations, especially in HIV-positive men who have sex with men. This review outlines the epidemiology of anal intraepithelial neoplasia and anal cancer and summarizes issues related to the introduction of anal cancer screening programmes.

We examined the prevalence of rectal chlamydia treatment failures in men who have sex with men and women attending Alberta sexually transmitted infection clinics. Among those completing a test of cure, there was no significant difference among patients treated initially with azithromycin (treatment failure, 39/460 [8.5%]; 95% confidence interval, 5.9%-11.0%) compared with patients treated with doxycycline (0/16; 95% confidence interval, 0%-0.2%; P = 0.63).

Objectives To determine the prevalence and correlates of M ycoplasma genitalium (MG) infection among men and women, determine the prevalence of gene mutations conferring resistance and compare test performance of female specimen types. Methods A cross-sectional study was conducted on specimens collected for gonorrhoea (NG, Neisseria gonorrhoeae ) and chlamydia (CT, Chlamydia trachomatis ) among male and female Alberta STI clinic attendees using the M. genitalium transcription-mediated amplification-research use only test. Positive specimens were sequenced for 23SrRNA, parC and gyrA genes. Gender-stratified analysis compared test results using χ 2 or Fisher’s exact test, Mann-Whitney U test and logistic regression. Female endocervical and urine specimens were compared. Results A total of 2254 individuals were tested; 53.8% (n=1212) were male. Male prevalence of MG was 5.3%; CT was 5.9% and NG was 1.8%. Correlates of male infection were a non-gonococcal urethritis diagnosis and NG coinfection. MG prevalence for women was 7.2%; CT was 5.8% and NG was 1.8%. Correlates of female infection were younger age, Indigenous/Other ethnicity and CT/NG coinfection. Nearly two-thirds of eligible specimens had mutations associated with macrolide resistance and 12.2% of specimens had a parC mutation signifying possible moxifloxacin resistance. There was high concordance (98.1%) of results between urine and endocervical swabs. Conclusions The high prevalence of MG relative to CT and NG supports the incorporation of MG testing into routine sexually transmissible infection screening. The high rate of resistance to macrolides and moxifloxacin raises concerns about treatment options. The good concordance of results between urine and endocervical swabs supports the use of female urine specimens for testing.

Pharyngeal Neisseria Gonorrhea Cases in Adults in Alberta, Canada Jennifer Gratrix, MSc1, Joshua Bergman, MPH1, Natalie Anderson, MSc3, Ron Read, MD3, Ameeta Singh, BMBS, MSc2 and Petra Smyczek, MD1, (1)Alberta Health Services-Centralized STI Services, Edmonton, AB, Canada, (2)Alberta Health Services-Edmonton STI Clinic, Edmonton, AB, Canada, (3)Alberta Health Services-Calgary STI Clinic, Calgary, AB, Canada