{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:42:10Z","timestamp":1772163730574,"version":"3.50.1"},"reference-count":22,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,4]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Canadian guidelines recommend HIV testing for individuals being evaluated for syphilis. Our objective was to examine three aspects of HIV testing (ie, if an HIV test occurred, the timing of the HIV test in relation to the syphilis test and the proportion with a positive HIV test result) among syphilis tests between 2017 and 2022 from individuals with no evidence of a previous HIV diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>This study is a retrospective analysis of comprehensive laboratory testing data from Ontario\u2019s provincial public health laboratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Direct fluorescent antibody (DFA) and serological non-prenatal syphilis tests were conducted from 1 January 2017 to 31 December 2022, from individuals aged \u226515 years with no evidence of a previous HIV diagnosis (n=3\u2009001\u2009058 total tests). Positive syphilis tests were categorised using the rapid plasma reagin (RPR) titre as \u2018current\u2019 (DFA+\/RPR\u22651:8) or \u2018historical\u2019 (RPR&lt;1:8). Exposure categories were assigned using individually linked HIV exposure category data retrieved from the laboratory\u2019s HIV DataMart.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The number and proportion of syphilis tests with a corresponding HIV test on the same day or within 7, 28, 90 or 180\u2009days, and, among those with an HIV test within 28 days, the number and proportion with an HIV-positive test result.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2017 to 2022, 1\u2009516\u2009726 and 1\u2009484\u2009332 syphilis tests among males and females, respectively, were included in the analysis. Individuals with a positive syphilis result were less likely to be tested for HIV within 28 days of their syphilis test compared with those with a negative syphilis test result (74.7% vs 91.1% in males, 97.5%\u2009CI (\u22120.17 to \u22120.16); 65.2% vs 92.4% in females, 97.5%\u2009CI (\u22120.28 to \u22120.26)). Males with \u2018current\u2019 positive syphilis test results were less likely than males with \u2018historical\u2019 positive syphilis results to be tested for HIV within 28 days (69.1% vs 76.6%, 97.5%\u2009CI (\u22120.084 to \u22120.066)); this was not true in females (67.1% vs 64.4%, 97.5%\u2009CI (0.0062 to 0.049)). Males overall and males with \u2018current\u2019 syphilis were more likely to be diagnosed as HIV-positive (p&lt;0.025).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most individuals who tested for syphilis at Public Health Ontario were also tested for HIV; however, those who tested positive for syphilis were less likely to be tested, representing an opportunity for enhanced HIV testing. Ensuring that individuals with syphilis are tested for HIV may help identify previously undiagnosed individuals living with HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-097142","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:10:35Z","timestamp":1757481035000},"page":"e097142","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["How often did syphilis tests have corresponding HIV tests in Ontario, Canada? A retrospective analysis of comprehensive laboratory data"],"prefix":"10.1136","volume":"15","author":[{"given":"Sean","family":"Colyer","sequence":"first","affiliation":[{"name":"Public Health Agency of Canada, Ottawa, Ontario, Canada"},{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen G","family":"Avery","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail E","family":"Kroch","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Liu","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin","family":"Zygmunt","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8804-4264","authenticated-orcid":false,"given":"Maya A","family":"Kesler","sequence":"additional","affiliation":[{"name":"Clinical Public Health Division, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada"},{"name":"Ontario HIV Treatment Network, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashleigh","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4584-2565","authenticated-orcid":false,"given":"Vanessa","family":"Tran","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"2025090922102763000_15.9.e097142.1","unstructured":"Ontario HIV Epidemiology & Surveillance Initiative . Trends in HIV testing, diagnoses and the care cascade in Ontario in 2022. 2023. Available: https:\/\/www.ohesi.ca\/trends-in-hiv-testing-diagnoses-and-the-care-cascade-in-ontario-in-2022\/"},{"key":"2025090922102763000_15.9.e097142.2","unstructured":"Ontario Agency for Health Protection and Promotion (Public Health Ontario) . Infectious syphilis and early congenital syphilis in Ontario: focus on 2022. Toronto, 2024."},{"key":"2025090922102763000_15.9.e097142.3","unstructured":"Public Health Agency of Canada. Government of Canada . Sexually transmitted and blood-borne infections: guides for health professionals. 2024. Available: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines.html"},{"key":"2025090922102763000_15.9.e097142.4","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054706"},{"key":"2025090922102763000_15.9.e097142.5","unstructured":"Public Health Agency of Canada. 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Available: https:\/\/www.canada.ca\/en\/public-health\/services\/hiv-aids\/hiv-screening-testing-guide.html"},{"key":"2025090922102763000_15.9.e097142.8","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7005a1"},{"key":"2025090922102763000_15.9.e097142.9","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ289"},{"key":"2025090922102763000_15.9.e097142.10","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2012-050580"},{"key":"2025090922102763000_15.9.e097142.11","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/OLQ.0000000000000964","article-title":"Human Immunodeficiency Virus Diagnosis After a Syphilis, Gonorrhea, or Repeat Diagnosis Among Males Including non-Men Who Have Sex With Men: What Is the Incidence?","volume":"46","author":"Tilchin","year":"2019","journal-title":"Sex Transm Dis"},{"key":"2025090922102763000_15.9.e097142.12","unstructured":"Public Health Agency of Canada. Government of Canada . HIV in Canada: 2022 surveillance highlights. 2023. Available: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/diseases-conditions\/hiv-2022-surveillance-highlights.html"},{"key":"2025090922102763000_15.9.e097142.13","unstructured":"Public Health Agency of Canada. Government of Canada . Estimates of HIV incidence, prevalence and Canada\u2019s progress on meeting the 90-90-90 HIV targets, 2020. 2022. 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Technical notes: HIV exposure categories. 2020. Available: https:\/\/www.ohesi.ca\/technical-notes\/hiv-exposure-categories\/"},{"key":"2025090922102763000_15.9.e097142.17","unstructured":"Ontario HIV Epidemiology and Surveillance Initiative . HIV tests in Ontario, 2021. Toronto, 2024. Available: https:\/\/www.ohesi.ca\/wp-content\/uploads\/2023\/10\/HIV-tests-in-Ontario-2021-2023Oct12_final.pdf"},{"key":"2025090922102763000_15.9.e097142.18","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/08964289.2021.2020207","article-title":"Provider Perspectives on Barriers to Routine HIV Testing of Adolescent and Young Adult Patients in Emergency Department Settings","volume":"49","author":"Ibitoye","year":"2023","journal-title":"Behav Med"},{"key":"2025090922102763000_15.9.e097142.19","doi-asserted-by":"crossref","DOI":"10.1177\/2325958220936014","article-title":"Clinician Barriers and Facilitators to Routine HIV Testing: A Systematic Review of the Literature","volume":"19","author":"Bagchi","year":"2020","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"2025090922102763000_15.9.e097142.20","unstructured":"Ontario HIV Epidemiology and Surveillance Initiative. Trends in hiv testing, diagnoses and the care cascade in ontario in 2022. 2023. 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