Addressing the STBBI Outbreak
Manitoba continues to experience very high rates of all reportable sexually transmitted and blood-borne infections (STBBIs), they are among the highest rates in Canada. The number of cases reported last year from Jan 1-June 30 (Q1-Q2 2022) compared to Q1-Q2 2021 were:
- 52% higher for HIV
- 27% higher for congenital syphilis
- 18% higher for gonorrhea
- 13% higher for hepatitis C
- 7% higher for chlamydia
Achieving a reduction in the number of STBBIs in Manitoba requires a coordinated effort between public health and health care providers. There are several things that physicians can do to help address the STBBI outbreak:
Encourage patients to get tested for STBBIs
a. Know your STBBI status – encourage anyone who is sexually active (regardless of risk factors) to get tested for STBBIs, and to share that information with their partner(s).
b. Test for one, test for all – co-infection with more than one STBBI is common. Recommend the full panel of STBBI tests for your patients.
c. STBBI testing during pregnancy is critical to prevent vertical transmission to the baby. Test ALL pregnant people for STBBIs three times during pregnancy at the first prenatal visit, in the third trimester, and at delivery.
i. Monthly syphilis testing during pregnancy is recommended if the pregnant person is newly diagnosed, newly re-infected, or receiving treatment during the pregnancy.
ii. Additional repeat testing for STBBIs should be considered when there are ongoing risk factors during pregnancy.
iii. Pregnant people who were not tested during pregnancy should be tested for all STBBIs at delivery, including syphilis, HIV and Hepatitis B, which will inform whether prophylactic treatment is required for the infant. Consider doing a HIV point-of-care test if available.
Provide treatment whenever possible/indicated
a. If you test, consider treating – If a client is symptomatic and/or is unlikely to return for follow-up of test results, initiate treatment while the client is engaged in care. Treat for syphilis based on symptoms, or if identified as a contact or having high-risk exposures. Initiating STI treatment is particularly important in settings such as ER’s or walk-in-clinics, for clients who may not otherwise routinely access health care. Contacts of confirmed cases should also be treated without waiting for test results, even if they are asymptomatic.
b. Manitoba Health provides coverage for HIV antiretroviral therapy – for post-exposure and pre-exposure prophylaxis of at-risk individuals, and to treat people living with HIV. You can review eligibility criteria and clinical guidance for HIV treatment here.
c. Providers are encouraged to maintain point-of-care supply of free STI medications for timely treatment. You can order medications with this form.
d. This document describes how to administer Bicillin® L-A for syphilis.
Report treatments, cases, and contacts
a. Manitoba’s Public Health Act requires health care providers to report all individuals who have been diagnosed with, or are being treated for a STBBI, as well as the identity of all individuals (contacts) who a confirmed case may have transmitted the infection to.
b. The new Provider Report Form for Sexually Transmitted and Blood-Borne Infections (STBBI) and/or STI Treatment (MHSU 6781) is a more concise, health care provider-focused form that replaces the need to complete the three provincial public health STBBI surveillance forms and the STI Medication Administration Form. Providers may bill the following tariffs for completion of the form:
·78010 – Completion of pages 1 and 2 – $20
·78011 – Completion of contact information (page 3) – $30
c. A project is underway for STBBI treatment information that is submitted on the form to Public Health to be transferred from the Public Health Information System (PHIMS) into eChart Manitoba. This project is expected to be completed in the spring of 2023 and will facilitate provider access to treatment records.
Thank you for your cooperation in completing these forms for ALL STBBI cases and contacts.
4. Recommend STBBI Immunizations
Offer vaccination for HAV, HBV and HPV to people at risk of these infections. Eligibility criteria for publicly funded vaccines in Manitoba are available here.
5. Ensure your practice is informed by current STBBI trends, and be prepared to test AND treat individuals who present for care.
a. Public Health is leading a series of educational STBBI webinars, including:
Addressing the STBBI Epidemic in Manitoba - Register to watch the recording on-demand here.
b. The provincial syphilis and HIV protocols were recently updated. Providers are encouraged to review the protocols at:
Syphilis protocols (updated September 2022)
HIV protocols (updated December 2022)
c. Additional resources and clinical tools are provided on the Manitoba Public Health STBBI website
Contact your local public health office/Medical Officer of Health with questions about case and contact management, or email STBBI@gov.mb.ca for general questions about provincial STBBI initiatives.