Responding to a community outbreak of syphilis by targeting sex partner meeting location: an example of a risk-space intervention

BACKGROUND: Effective syphilis control and elimination require community effort and innovative case-finding techniques, especially to identify infected persons from core transmission groups. GOAL: To summarize the implementation and outcomes of a community-oriented response to a localized outbreak of syphilis directed at sex partner meeting places. STUDY DESIGN: Syphilis surveillance and rapid response data from a 7-month period were analyzed for risk behaviors, sex partner meeting locations, field investigation outcomes, and social and sexual network connections. RESULTS: Four (6%) of the sixty-nine persons tested were confirmed syphilis reactors, of whom three were new cases. A sexual and needle-sharing network of 15 persons was identified that included two of the new syphilis cases. These two had not been found through standard field investigation. CONCLUSIONS: Targeting interventions to sex partner meeting places may effectively complement traditional syphilis control tools and find previously unidentified syphilis cases in high-morbidity areas.     

An epidemiological study of syphilis incognito, an emerging public health problem in Greece

BACKGROUND: Syphilis incognito is a subtype of latent syphilis (early or late) characterized by no signs or symptoms of primary or secondary syphilis and diagnosed by positive serologic results for syphilis during routine screening. OBJECTIVE: To study the epidemiological characteristics, causes, and implications of syphilis incognito in Greece. PATIENTS AND METHODS: All new adult patients diagnosed as having syphilis in Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece, from 1989 through 1996 were studied prospectively and retrospectively (history, physical examination, serologic tests, cerebrospinal fluid examination, and imaging) to determine the stage of their disease. The epidemiological, clinical, and serologic characteristics of patients with syphilis incognito were recorded and analyzed. RESULTS: During the 8-year period, 711 new syphilis cases were detected; of these, 480 cases (67.5%) fulfilled the definition criteria of syphilis incognito. The male-female ratio was 1.8:1. Patients with syphilis incognito were most commonly heterosexual, had a median socioeconomic status, and were aged 20 to 39 years, and their conditions were diagnosed during routine screening for syphilis (prenatal care, hospital admission, or blood donation). However, the number of syphilis incognito cases appeared to decline during the period studied. CONCLUSIONS: The incidence of syphilis in Greece has decreased dramatically, following the trends in western Europe. The most common form of syphilis is syphilis incognito, affecting adults who are older and have a higher socioeconomic status than those in the past. Improved hygiene and wide use of antibiotics that minimize or abolish symptoms of early disease may have contributed to the frequency of syphilis incognito in recent years. Screening of asymptomatic persons, especially those at high risk, should continue and be reenforced to prevent the devastating consequences of unrecognized and untreated syphilis.     

A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001-2004

OBJECTIVES: To describe the epidemiology and clinical findings of neurosyphilis (NS) cases diagnosed during the current syphilis epidemic occurring predominantly among men who have sex with men. METHODS: Syphilis cases reported to the health department were reviewed for diagnosis of NS, cerebrospinal fluid venereal disease research laboratory results, and/or treatment for NS. RESULTS: During 2001-2004, 7083 cases of syphilis were diagnosed in Los Angeles. One hundred nine cases of confirmed or probable NS occurring among persons aged 19 to 65 years were identified during this period (1.5%). Symptomatic NS was present in 1.2% of reported syphilis cases (86 of 7083). NS cases were inclusive of 71 (65%) men who have sex with men. Forty-two (49%) of the symptomatic NS cases occurred during secondary (N = 28) or early latent (N = 14) syphilis. Sixty-eight percent (N = 74) of the NS cases were human immunodeficiency virus (HIV)-positive. The estimated incidence of symptomatic NS among HIV-infected persons with early syphilis was 2.1% as compared with 0.6% among HIV-negative persons. CONCLUSION: Providers should maintain a high index of suspicion for NS among patients with syphilis, particularly those with HIV infection.     

Missed opportunities for congenital syphilis prevention in an urban southeastern hospital

BACKGROUND: Despite recent declines in syphilis rates nationally, recent outbreaks suggest that prevention of congenital syphilis remains an ongoing public health problem. GOALS: To identify missed opportunities for congenital syphilis prevention during prenatal care. STUDY DESIGN: Retrospective medical record review of 157 live birth or stillbirth deliveries that involved cases of congenital syphilis from Grady Memorial Hospital (Atlanta, GA). RESULTS: The hospital congenital syphilis prevalence was 8.2 cases per 1,000 live births. Six percent of case patients were HIV positive. Opportunities for earlier maternal screening, treatment, or diagnosis were missed in 60% of case patients who received timely prenatal care. Congenital syphilis cases attributable to preventable missed opportunities were significantly more common among case patients with fewer prenatal visits (66% versus 28%, P = 0.01). CONCLUSION: Provider efforts to reduce congenital syphilis in high-risk populations receiving prenatal care should focus on (1) screening patients at the first opportunity, at both the first prenatal visit and during the third trimester (i.e., 28 weeks); (2) performing on-site testing and same-day treatment; (3) providing appropriate treatment to infected women with penicillin allergy; (4) referring sex partners for treatment to prevent reinfection; and (5) screening all pregnant women attending emergency clinics.     

Rising rates of syphilis in the era of syphilis elimination

OBJECTIVE: The objective of this study was to assess the impact of syphilis control activities in King County, Washington. STUDY DESIGN: We calculated rates of early syphilis and trends in numbers of persons tested and diagnosed through screening and partner notification from 1998 to 2005. RESULTS: Early syphilis cases increased from 38 in 1998 to 188 in 2005 with 92% occurring among men who have sex with men (MSM). Our health department conducted public awareness campaigns, increased publicly financed syphilis screening among MSM by 179%, and intensified partner notification efforts. Despite these efforts, the prevalence of syphilis among screened populations was only 1.1%, and 71% syphilis cases were diagnosed after seeking care for symptoms. The proportion of cases diagnosed through screening and partner notification did not significantly change during the evaluation period. Early syphilis incidence among MSM more than doubled between 2003 and 2005. CONCLUSIONS: New, innovative approaches to syphilis control are needed.     

The syphilis reactor grid: help or hindrance for syphilis surveillance?

BACKGROUND: Health departments use reactor grids (sex, age, and serologic test for syphilis [STS] titer criteria) to determine which persons to evaluate for untreated syphilis. GOAL: The goal of the study was to assess reactor grid performance in Chicago and reactor grid use nationally in 1999 to 2000. STUDY DESIGN: We reviewed Chicago health department records to identify characteristics of persons with a reactive STS excluded from evaluation by reactor grid criteria and syphilis cases not meeting evaluation criteria. We surveyed health departments regarding reactor grid use. RESULTS: Of persons with a reactive STS, 46% did not meet criteria for health department evaluation, including 62% of men, 29% of women, and 21% with titers > or =1:8. The reactor grid would have excluded 17% of primary syphilis cases. Overall, 82% of health departments use reactor grids. CONCLUSIONS: Reactor grids are widely used and may exclude persons with infectious syphilis from health department evaluation, especially men. The impact of reactor grid use on syphilis control and surveillance in the United States should be evaluated.     

Sexually transmitted infections among urban shelter clients

BACKGROUND: Sexually transmitted infections (STIs) remain common in the United States. One contributor to this persistent problem is pockets of infection among persons who may not have regular access to health care, a group that includes those who seek services at shelters. OBJECTIVE: The goals of the study were to: 1) determine the acceptability of STI testing among individuals seeking services at shelters in 2 midsized southeastern cities; 2) evaluate the prevalence of chlamydia, gonorrhea, syphilis, and HIV among these individuals; and 3) assess the proportion that subsequently learned their test results and received timely and appropriate treatment if warranted. STUDY DESIGN: Using a cross-sectional design, 430 individuals between the ages of 19 and 45 seen at 3 shelters in 2 cities were approached for participation. After completing a brief behavioral assessment, each participant provided a urine specimen for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) testing, blood for syphilis serologic testing, and an oral sample for HIV testing. RESULTS: The overall recruitment rate was 97% (96% in city A and 98% in city B). Seventy-eight percent were black with a mean age of 35.1 years. STI prevalence among those reporting sexual activity in the past 2 months was 12.9% in city A and 19.9% in city B (P = 0.04). The rate of CT in city B was significantly higher than city A (15.0% vs. 6.4%, P = 0.02); however, similar rates were found for GC (5.0% vs. 3.2%), primary and secondary syphilis (0.08% vs. 1.4%), and HIV (0.07% vs. 0.06%). Overall, 91.5% of the positive cases (89.0% in city A and 94.0% in city B) learned their test results and were successfully treated. CONCLUSION: We found that shelter clients were receptive to STI testing, even for HIV, with most positive cases notified and successfully treated.     

Syphilis serologic prevalence monitoring among STD clinic clients: correlation with reported syphilis incidence, San Diego, CA, 1985-2004

OBJECTIVE: To describe the serologic test for syphilis (STS) prevalence among STD clinic clients, determine the correlation between STS prevalence trends and reported community-diagnosed primary and secondary (P&S) case incidence, and evaluate the usefulness of STS prevalence monitoring as a component of syphilis surveillance. STUDY: During the period 1985-2004, 21,4336 STS were done among STD clinic clients and a variety of STS prevalence measures were evaluated. RESULTS: From 1985-1991, 10.2% of STS were positive, which declined to 5.6% during 1992-2004. Overall, STS positivity (>or=1:8) and male positivity (>or=1:8) trends were correlated with reported community-diagnosed P&S case incidence and case incidence in men (r = 0.58 and r = 0.81, respectively). Male STS positivity (>or=1:8) began increasing in 2001, 1 year before the increase in syphilis incidence in men, which began in the latter half of 2002 and occurred mostly among men who have sex with men. CONCLUSION: In a syphilis outbreak in men who have sex with men, STS prevalence (>or=1:8) among male STD clinic clients was a useful measure of syphilis case incidence trends and may provide an early warning for a subsequent increase in community-diagnosed case incidence.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

青岛市2010-2017年梅毒流行趋势及高危人群梅毒流行情况分析

目的：了解青岛市梅毒流行病学特征，为制定防控策略和措施提供依据。方法：对2010－2017年青岛市梅毒发病资料和血清学检测结果进行统计分析。结果：2010－2017年青岛市共报道梅毒16769例，年均发病率在18.32/10万～30.01/10万之间，整体呈上升趋势，年均增长3.18%。患者以青壮年为主，20~49岁占72.64%，60岁以上人群报告病例所占比例逐年上升，构成比由2010年的6.11%上升到2017年的25.78%；职业以家务及待业占比最高（26.97%），其次为农民占18.87%。暗娼、男男性行为人群及吸毒人群的梅毒平均感染率分别为9.65%，6.85%，9.25%。地区分布以市北区年均发病率最高，其次为李沧区、市南区，分别为47.58/10万、33.08/10万、32.05/10万。结论：青岛市梅毒年发病率总体呈上升趋势，老年人梅毒发病上升明显。     

Screening for syphilis in arrestees: usefulness for community-wide syphilis surveillance and control

BACKGROUND: Syphilis screening of jail arrestees has been promoted as an effective method for both disease control and surveillance. GOALS: To evaluate the yield of the East Baton Rouge Parish Jail screening program in detecting previously undiagnosed syphilis, to evaluate the program as a means for monitoring community syphilis rates, and to characterize arrestees at greatest risk for syphilis infection. STUDY DESIGN: From July 1994 to December 1998, arrestees brought to the East Baton Rouge Parish Jail were screened for syphilis. Annual early syphilis prevalence in screened arrestees was calculated and compared with the annual period prevalence of early syphilis in the general population of East Baton Rouge Parish, as reported by laboratories and health providers. A case-control study of cases detected at the jail from 1995 to 1997 and contemporary controls was conducted. RESULTS: A total of 50,941 arrestees were booked into the East Baton Rouge Parish Jail, of whom 38,573 (76%) were screened for syphilis. Of the 38,573 arrestees screened, 494 (1.3%) were diagnosed with untreated syphilis. Of these, 299 (61%) were treated for syphilis before release. The estimated prevalence of early syphilis in arrestees decreased by 68% during the study period, from 0.79% in 1994 to 0.25% in 1998. During this time, the East Baton Rouge Parish community rates decreased by 79%, from 150 cases per 100,000 to 31 cases per 100,000. In female arrestees, a booking charge of prostitution was associated with syphilis (odds ratio [OR] 7.0; 95% CI, 1.5, 39.3). In male arrestees, a booking charge of felony theft was associated with syphilis (OR 4.8; 95% CI, 1.8, 13.8). However, only 15 (12%) of the early syphilis cases would have been detected if screening had been based on the booking charges found to be associated with syphilis in this study. CONCLUSIONS: Routine syphilis screening and treatment in jail settings is feasible and identifies many persons with syphilis. Monitoring of syphilis prevalence among arrestees is a useful method for monitoring community prevalence of syphilis. Analysis of booking charges may be useful for determining factors associated with syphilis infection, but not for developing screening criteria.     

7221例梅毒流行病学分析及防治对策的初步探讨

目的:分析泉州地区梅毒流行的特征,为今后防治工作提供科学依据.方法:用全国性病计算机管理系统软件汇总分析泉州市1991年～2002年的性病疫情年度报表.结果:1991年～1994年为散发,从1995年至2002年开始出现流行态势;病期以早期(一、二期)梅毒为主,占74.58%;患者的文化程度以中学及以下为多,占94%;职业分布以无业、农民、饮服业、工人、个体为多;性别比例为男女之比为1∶1;年龄主要集中于20～39岁;已婚占47.42%;传染方式66%为非婚性接触.结论:本地区梅毒发病率已形成流行态势,同全国流行趋势一致.因此,应加强性病防治知识的宣传教育,提倡安全性行为,加强对高危人群的监测,规范梅毒的诊治等综合措施,以便能有效地控制梅毒的流行.     

Epidemics due to imported syphilis in Finland

BACKGROUND: Russia and other states of the former Soviet Union experienced a huge increase in syphilis beginning in the early 1990s. At first these epidemics were not well known in neighboring countries such as Finland. STUDY DESIGN: In 1995 the incidence of syphilis in Finland doubled to 3.3/100,000 and a local cluster of 18 cases was detected in the city of Tampere. The reasons for this epidemic were analyzed and the occurrence of syphilis was carefully monitored up to 2001. RESULTS: The main reason for the increased incidence in Finland was the import of syphilis from Russia; only a few cases were acquired from Estonia or elsewhere. The source partners of Finnish men who contracted syphilis abroad were mostly sex workers or other casual partners. Mobile prostitution to Finland was not involved in the transmission. Most syphilis cases were found sporadically in southern Finland, in areas where foreign travel is frequent. Secondary transmission in Finland was usually limited to one or two partners. The only isolated cluster was further away and developed due to unawareness of the risk of syphilis by the cases and local healthcare providers. From 1995 onward, syphilis was carefully monitored by national reporting and a special sexually transmitted disease (STD) surveillance network, and the incidence remained at a constant level even though travel to and from Russia more than tripled. Nationwide serologic surveillance in STD and maternity clinics and among blood donors showed no major changes in the prevalence of syphilis. CONCLUSION: An epidemic of syphilis imported mainly by heterosexual men from Russia caused one sporadic cluster in Finland in 1995. Thereafter, general awareness by the public and healthcare providers about the risks of contracting syphilis from abroad, in addition to effective use of national surveillance and notification systems, was needed to protect the country from further spread of syphilis to an endemic infection.     

Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study

BACKGROUND: Despite reports of unusual clinical presentations and therapeutic responses among HIV-infected patients with syphilis, syphilis has not been regarded as a serious opportunistic infection that predictably progresses among most HIV-coinfected patients. GOAL: To define and describe differences in the presentation and response to treatment of early syphilis among HIV-infected and HIV-uninfected patients, to describe any differences by gender, and to determine if clinical presentation of central nervous system involvement predicted serologic failure. DESIGN: A prospective, multicenter, randomized, controlled trial of enhanced versus standard therapy to compare the benefit of enhanced therapy, the clinical importance of central nervous system involvement, and the clinical manifestations of early syphilis infection among HIV-infected and HIV-uninfected patients. RESULTS: The median number of ulcers was significantly greater among HIV-infected and HIV-uninfected patients, as was the percent of HIV-infected patients with multiple ulcers. Among patients diagnosed with secondary syphilis, a higher percentage of HIV-infected patients presented with genital ulcers [13/53 (25%)] than did HIV-uninfected patients [27/200 (14%)]. No differences between HIV-infected and HIV-uninfected patients were detected for other secondary syphilis manifestations. Although women presented more frequently with secondary syphilis than did men, no other gender differences in clinical manifestations were noted. Neurologic complaints were reported most frequently among patients with secondary syphilis [103/248 patients (42%)] compared with patients with primary syphilis [32/136 (24%)] and early latent syphilis [48/ 142, (34%)] (P < 0.05), but no differences in neurologic complaints were apparent by HIV status or CSF abnormalities. No neurologic complaints were significantly associated with serologic treatment failures at 6 months. CONCLUSIONS: Overall, HIV infection had a small effect on the clinical manifestations of primary and secondary syphilis. Compared with HIV-uninfected patients, HIV-infected patients with primary syphilis tended to present more frequently with multiple ulcers, and HIV-infected patients with secondary syphilis presented with concomitant genitals ulcers more frequently.     

深圳市2002年～2003年423例孕产妇梅毒患者情况分析

目的：了解深圳市孕产妇梅毒患者的流行病学情况。方法：收集深圳市各级医疗单位进行产前保健及分娩的全部孕产妇梅毒患者资料，进行流行病学分析。结果：共检出孕产妇梅毒患者423例。年龄以20～30岁为主，最小17岁，最大40岁；职业以无或待业为主，其次为工人；文化程度以高中／中专为主，户籍类别以暂住人口和流动人口为主，各孕周均有孕产妇检出梅毒阳性。结论：孕产妇梅毒筛查工作意义重大，应加强妊娠早期梅毒的筛查。     

Prevalence monitoring in syphilis surveillance: results from a multicenter research program

BACKGROUND: Syphilis seroprevalence data can be used as an independent measure of syphilis trends and to augment syphilis case report data for program planning. The prevalence of reactive syphilis serology in jails, delivery rooms, and drug treatment centers was examined from 1995 to 1999. Prevalence was evaluated by age and gender at each site and compared with county primary and secondary syphilis case rates. Annual prevalence of high titer-reactive serology in jails was compared with primary and secondary syphilis case rates. GOAL: The goal was to examine trends in syphilis seroprevalence and to evaluate the relationship of trends in seroprevalence to reported cases. STUDY DESIGN: This was a cross-sectional survey. RESULTS: Prevalence of reactive serology and high titer-reactive serology was lowest among women in delivery rooms (2.9% and 0.4%, respectively) and highest among women in jails (11.1% and 4.1%, respectively), indicating substantial recently treated or active infection among women in jails. Trends in high titer-reactive serology were similar to primary and secondary syphilis case rates. CONCLUSION: The prevalence of high titer-reactive serology can provide valuable information about community syphilis morbidity for use in prevention and control programs.     

Stroke in a patient with human immunodeficiency virus and syphilis treated with penicillin and antiretroviral therapy

With the rising incidence and prevalence of syphilis, meningovascular syphilis and other forms of neurosyphilis have reappeared, particularly among persons infected with human immunodeficiency virus. We present a patient with meningovascular syphilis leading to stroke after treatment with penicillin and antiretroviral therapy.