What we’re doing: We are conducting a clinic-based intervention to enhance syphilis testing among men living with HIV. View a video of Dr. Ann Burchell describing the study here.

Why we’re doing it: Syphilis is on the rise among HIV-positive men who have sex with men (MSM) in Ontario. Untreated syphilis may lead to serious outcomes such as neurosyphilis, can be spread to sexual partners, and can increase the likelihood of spreading HIV from one person to another. On the other hand, if syphilis is detected early, treatment is simple, effective and inexpensive.

How we’re doing it: We are working with four Ontario clinics to see syphilis testing incorporated whenever men in HIV care undergo HIV viral load testing, which typically occurs every three to six months. The syphilis test is ‘opt-out’ – after patients are told about the test and study, the test is done unless a patient requests otherwise. This intervention means that:

– Greater numbers of HIV-positive men may be screened for syphilis.

– They may be screened more often.

– Early treatment may be initiated in a greater number of cases.

Over 30 months, enhanced screening will be applied to roughly 3131 patients. As the trial goes on, we will measure the success and cost-effectiveness of the intervention.

Our partners:

  • The four participating clinics: Medical Outpatient Clinic at Sunnybrook Health Sciences Centre, Immunodeficiency Clinic at The Ottawa Hospital, Positive Care Clinic at St. Michael’s Hospital, and Immunodeficiency Clinic at Toronto General Hospital
  • Public Health Ontario Laboratories
  • Ontario HIV Treatment Network

Our contribution: Our program science approach involving researchers and knowledge users will guide policy and practice decisions regarding scale-up in these and other HIV clinics in Ontario. Results will contribute to evidence-based recommendations on policies, practices, and strategies to control the spread of syphilis among MSM and prevent serious syphilis-related disease. Knowledge gained may also be applicable to other sexually transmitted and blood-borne infections that pose risk for HIV-positive men.

For more information: Click here for access to the published protocol.

You can also contact the Principal Investigator Dr. Ann Burchell at burchella@smh.ca.


Burchell AN, Allen VG, Grewal R, MacPherson PA, Rachlis A, Walmsley S, Mishra S, Gardner SL, Raboud J, Cooper C, Gough K, Rourke SB, Rousseau R, Salit I, Tan DHS. Enhanced Syphilis Screening among HIV-positive Men Who have Sex with Men (ESSAHM): Protocol for a cluster-randomized trial. Implementation Science 2016; 11(1):8. Full text available here.

Burchell AN, Allen VG, Gardner S, Moravan V, Tan DHS, Grewal R, Raboud J, Bayoumi AM, Kaul R,  Mazzulli T, McGee F, Rourke SB. High incidence of diagnosis with syphilis co-infection among HIV-positive men who have sex with men in Ontario, Canada. BMC Inf Dis 2015; 15:356. Full text available here.

Tuite A, Burchell AN, Fisman D. Cost-effectiveness of enhanced syphilis screening among HIV-positive men who have sex with men. PLoS ONE 2014; Jul 1; 9(7):e101240. Full text available here.

Burchell AN, Allen V, Moravan V, Gardner S, Raboud J, Tan DHS, Bayoumi AM, Kaul R, Mazzulli T, McGee F, Millson P, Remis RS, Rourke SB. Patterns of syphilis testing in a large cohort of HIV patients in Ontario, Canada, 2000-2009. BMC Infect Dis 2013; 13:246. DOI: 10.1186/1471-2334-13-246. PMID: 23710699. Full text available here.