Syphilis and HIV co-infection

Syphilis is a complex disease, which is sexually transmitted. The incidence of syphilis is rising all over the world, partly due to the increased transmission in HIV patients and other high risk groups such as men who have sex with men. Interestingly syphilis itself facilitates HIV infection in several ways. Great importance exists in recognition of both diseases and their complex interactions. This article will review the manifestations of syphilis in the context of HIV infected patients, and the challenging diagnosis and management of these patients.     

Syphilis and HIV: a dangerous combination

HIV and syphilis affect similar patient groups and co-infection is common. All patients presenting with syphilis should be offered HIV testing and all HIV-positive patients should be regularly screened for syphilis. Syphilis agent may enhance the transmission of the other, probably through increased incidence of genital ulcers. Detection and treatment of syphilis can, therefore, help to reduce HIV transmission. Syphilis may present with non-typical features in the HIV-positive patient: there is a higher rate of symptomless primary syphilis and proportionately more HIV-positive patients present with secondary disease. Secondary infection may be more aggressive and there is an increased rate of early neurological and ophthalmic involvement. Diagnosis is generally made with serology but the clinician should be aware of the potential for false-negative serology in both primary and, less commonly, in secondary syphilis. All HIV-positive patients should be treated with a penicillin-based regimen that is adequate for the treatment of neurosyphilis. Relapse of infection is more likely in the HIV-positive patient and careful follow-up is required.     

HIV/梅毒共感染国内外研究进展

梅毒是一种复杂的性传播疾病,在世界范围内其发病率正在上升。同时,作为一个公共健康问题,艾滋病病毒(HIV)感染也为世界各国所重视。梅毒和HIV的感染人群和传播途径相似,其共同感染也日渐增多。二者相互影响,梅毒能显著提高HIV感染的风险,而HIV可以改变梅毒的自然病程。文章综述了国内外近年来关于这两种疾病共同感染的研究进展,包括流行病学特征、共感染的表现、相互作用,以及针对HIV/梅毒共感染病人的诊断和治疗等。     

2005-2011年深圳市MSM献血者梅毒/HIV感染调查

目的了解2005-2011年深圳市男男性行为人群（MSM）献血者梅毒/艾滋病病毒（HIV）感染情况,为制订有效阻断输血传播梅毒/HIV策略提供参考依据。方法对深圳市MSM献血者梅毒/HIV监测资料进行统计分析;趋势分析采用Cochran-Armitage趋势检验法。结果近2年内曾经献血的1 320名MSM中,感染梅毒282例,感染率为21.36%;确认感染HIV 80例,感染率为6.06%。梅毒感染率从2005年起快速上升,2009年达到峰值后,维持波动在20%左右;HIV确认阳性率从2006年起迅速上升,2009年达到峰值后,稳定在7%左右;HIV初筛阳性率呈直线上升趋势。结论深圳市MSM献血者梅毒感染率居高不下,HIV感染率逐年增加,应引起有关政府部门足够重视,确保血液安全。     

深圳市2943例MSM梅毒感染影响因素分析

目的了解深圳市男男性行为人群（MSM）的梅毒感染状况及影响因素。方法整理深圳市MSM的梅毒监测资料,并进行单因素和多因素Logistic回归分析。结果共2943名MSM接受自愿咨询检测,梅毒感染率为20．76％,梅毒合并HIV感染率为4．3;％。多因素Logistic回归分析结果显示,MSM感染梅毒与职业、性角色、半年内女性性伴数、半年内肛交性伴数、合并感染HIV有关。职业为无业／待业与工人者,感染梅毒的风险分别是职员的1．675倍和1．766倍。性角色以主动被动两者兼有者,感染梅毒的风险是主动者的1．450倍。半年内女性性伴数为1个和≥2个者,感染梅毒的风险分别是无女性性伴者的0．873倍和0．589倍;半年内肛交性伴数为2～4个和≥5个者,感染梅毒的风险分别是≤1个者的1．353倍和1．839倍;HIV感染者合并梅毒感染的风险是HIV阴性者的4．991倍。结论深圳市MSM梅毒影响因素复杂,应有针对性地开展预防控制工作。     

Changing epidemiology of syphilis and its persistent relationship with HIV

Syphilis rates are increasing, particularly among men who have sex with men, many of whom are HIV coinfected. Screening based on risk behaviors, in addition to early recognition of primary and secondary syphilis and prompt reporting of cases to local and state health departments to assist in partner notification and treatment services, may curtail further spread of both infections.     

汕头市性病门诊2004-2011年梅毒及HIV感染状况调查

目的了解汕头地区性病门诊患者梅毒及艾滋病感染情况。方法对皮肤性病防治院2004年1月至2011年12月性病门诊患者进行梅毒、艾滋病血清学检测,并对检测结果及临床资料进行统计分析。结果 14 491例性病门诊患者中,共确认梅毒阳性666例,阳性率4.60%。其中男性患者感染率为3.76%(384/10 214),女性患者感染率为6.59%(282/4 277),两者差异有统计学意义(P<0.01)。确认HIV阳性者20例,阳性率0.14%。其中男性患者HIV阳性率0.14%(14/10 214),女性患者阳性率0.14%(6/4 277),两者差异无统计学意义(P>0.05)。有6例HIV阳性者合并感染梅毒。结论汕头地区性病门诊就诊患者梅毒及HIV感染率近年虽未见明显增长,但还应继续做好性病高危人群HIV及梅毒的防治工作,争取早发现、早治疗,防范HIV及梅毒向一般人群的传播。     

Managing syphilis in the HIV-infected patient

Syphilis has re-emerged in the United States and elsewhere, and clinicians caring for HIV-infected patients are challenged with syphilis diagnosis and management decisions. HIV alters the natural history of syphilis to an extent that is poorly understood, and initial presentation may be more varied in coinfected patients. Although commonly available diagnostic assays for syphilis should be interpreted as usual, such tests rely on antibody measurement and may be an imperfect indicator of active infection. Assessment of all available clinical and risk behavior data remains critically important in the diagnosis of syphilis in coinfected patients. Treatment of syphilis in such patients requires stage-appropriate therapy, with careful serologic monitoring to assess response. Clinicians must have heightened appreciation of the role of frequent risk assessment, serologic screening, symptom recognition, and follow-up of treated patients, as well as an understanding of public health functions such as sex partner treatment and communicable disease reporting.     

Risk factors of syphilis co-infection among HIV-infected men who have sex with men in Tel-Aviv,Israel

Syphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR?=?1.8 [1.2–2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR?=?2.2 [1.5–8.2]), especially with HIV-infected partner (OR?=?3.2 [1.1–7.9]).

In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.     

Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections

BACKGROUND: Syphilitic ulcers are known to facilitate the transmission of HIV infection, but the effect of syphilis infection on HIV viral loads and CD4 cell counts is poorly understood. METHODS: We abstracted medical records for HIV-infected male syphilis patients seen at three clinics in San Francisco and Los Angeles from January 2001 to April 2003. We compared plasma HIV-RNA levels and CD4 cell counts during syphilis infection with those before syphilis infection and after syphilis treatment, using the Wilcoxon signed rank test. RESULTS: Fifty-two HIV-infected men with primary or secondary syphilis had HIV viral load and CD4 cell count data available for analysis; 30 (58%) were receiving antiretroviral therapy. Viral loads were higher during syphilis compared with pre-syphilis levels by a mean of 0.22 RNA log10 copies/ml (P = 0.02) and were lower by a mean of -0.10 RNA log10 copies/ml (P = 0.52) after syphilis treatment. CD4 cell counts were lower during syphilis infection than before by a mean of -62 cells/mm3 (P = 0.04), and were higher by a mean of 33 cells/mm3 (P = 0.23) after syphilis treatment. Increases in the HIV viral load and reductions in the CD4 cell count were most substantial in men with secondary syphilis and those not receiving antiretroviral therapy. CONCLUSION: Syphilis infection was associated with significant increases in the HIV viral load and significant decreases in the CD4 cell count. The findings underscore the importance of preventing and promptly treating syphilis in HIV-infected individuals.     

秦皇岛市MSM的HIV、TP、HCV感染状况及影响因素

目的了解秦皇岛市男男性行为人群（MSM）的艾滋病病毒（HIV）、梅毒螺旋体（TP）、丙型肝炎病毒（HCV）感染状况和相关影响因素,提出有针对性的防控性病艾滋病的干预建议。方法 2009-2012年连续4年采用自愿招募和滚雪球的方法,通过自愿咨询检测（VCT）门诊和开展外展干预活动,对第一次接受艾滋病咨询检测的MSM进行问卷调查和血清学检测。结果 4年共招募MSM 1043人。70.76%（738/1043）的人通过网络寻找性伴,4年间,艾滋病知识知晓率、接受艾滋病干预服务和接受HIV检测人数均逐年上升（P〈0.01）。近6个月,898人（86.10%）有过同性肛交行为,其中坚持使用安全套率为42.76%;34.63%（311/898）有过异性性行为,安全套坚持使用率为36.98%;9.02%（81/898）有过商业性性行为,安全套坚持使用率为53.09%。HIV、TP、HCV平均感染率分别为5.75%（60/1043）、7.19%（75/1043）、0.19%（2/1043）,HIV、TP感染率呈逐年上升趋势（P〈0.05）。多因素分析结果显示：文化程度相对低、在当地居住时间短、曾感染过性病是HIV、TP感染率的危险因素;年龄较大的MSM,TP感染的风险更大。结论秦皇岛市MSM HIV、TP感染率较高,应重点加强对年轻MSM的宣传干预力度,切实提高安全意识和安全行为,同时推广网络宣传干预;而在年龄大、已婚的MSM,则应加强TP筛查并提供方便、可及的诊疗服务。在开展性病艾滋病防治宣传的同时不应忽视丙型肝炎防治知识的宣传。     

HIV and Syphilis Prevalence and Associated Factors Among Young Men Who Have Sex with Men in 4 Cities in China

To know the status of HIV and syphilis infection, and the correlates for HIV and syphilis prevalence among YMSM in China. 150 YMSM were recruited in Beijing, Harbin, Zhengzhou and Chengdu respectively and investigated with questionnaire, HIV and syphilis testing. The prevalence of HIV infection, syphilis infection and concurrent infection of HIV and syphilis was 6.7, 8.3, 1.5% respectively. HIV infection was associated with numerous factors including education level of high school, not being student, etc. Syphilis infection was associated with not being student and having had vaginal intercourse. The prevalence of HIV and Syphilis are high among YMSM in cities in China. Preventive interventions should be developed for controlling HIV spreading among YMSM urgently.     

海南省吸毒暗娼行为学及梅毒感染调查

目的 了解海南省吸毒及暗娼行为学特征及梅毒、艾滋病感染情况。方法 对海南省妇教所的317名暗娼及海口、三亚、万宁、澄迈强制戒毒所的276名女性吸毒人员进行匿名问卷调查并进行梅毒、艾滋病血清学检测。结果（1）593名调查对象平均年龄25.36岁,317名暗娼中经常使用安全套者为154名（48.57％）,276名吸毒女性中有28名（10.14％）共用注射器吸毒,吸毒妇女中98.2 ％的人伴有卖淫,而暗娼中伴有吸毒者为14.83％;（2）吸毒及暗娼中梅毒感染率分别为31.88％及17.67％;两者均明显高于普通人群,吸毒女性中梅毒感染率则明显高于暗娼。结论 吸毒及暗娼均有明显的高危行为,梅毒感染率高,应该采取有效措施对该类人群进行相关危险行为的干预。     

The association of syphilis with risk of human immunodeficiency virus infection in patients attending sexually transmitted disease clinics

A serologic survey of 4863 patients attending two inner-city sexually transmitted disease clinics was conducted in 1988 1 year after an initial survey to reassess the prevalence and associated risk factors for human immunodeficiency virus (HIV) infection. The HIV seroprevalence rates had not changed significantly (5.2% in 1987, 4.9% in 1988), and remained higher among men (5.6%) than among women (3.6%). The HIV seroprevalence increased steadily with age, to 34 years in women and to 39 years in men. Of patients with a reactive syphilis serologic test result, 24.3% were HIV infected compared with 3.5% of patients with a nonreactive test for syphilis. In multivariate analysis, a reactive serologic test for syphilis was significantly associated with HIV infection in all major risk behavior categories. Among heterosexuals who denied parenteral drug abuse, HIV infection rates were 6.8 and 8.7 times greater for women and men, respectively, who had a reactive serologic test for syphilis. Evidence of heterosexual transmission of HIV was further suggested by a change in HIV seroprevalence in women from 3.0% in 1987 to 3.6% in 1988, a male to female HIV infection ratio of 1.6, and 3.0% prevalence of infection among patients who denied established risk factors. This was most evident among those younger than 25 years, in whom 72% of infected women and 46.2% of infected men denied high-risk behaviors. These data demonstrate the strong association between syphilis and HIV infection and the importance of heterosexual HIV transmission in patients attending sexually transmitted disease clinics. This study underscores the need for a more comprehensive control program for sexually transmitted diseases, including syphilis and HIV infection.     

Study challenges beliefs about spread of syphilis

The Centers for Disease Control and Prevention (CDC) recently released results of a study of sexual behavior in high-risk populations in New Orleans, LA. The results show that syphilis is spread by large numbers of people engaging in moderately risky behavior, rather than by a few people with high numbers of sex partners. Only five percent of syphilis transmitters had five or more sex partners. The study, Innovations in Syphilis Prevention, indicates that cocaine use and the number of sex partners are the highest risk factors for acquiring syphilis, and there are widespread misconceptions about this disease. Many people did not know that syphilis is curable, did not know the symptoms, and did not recognize that the infection put them at a higher risk for HIV. Syphilis prevalence was highest among males attending STD clinics and among females in drug treatment centers and jails.     

HIV and syphilis in young Chinese adults: implications for spread

Our objective was to explore the epidemiology of HIV and syphilis at population level in young Chinese adults. The study was carried out in six areas of three Chinese provinces: Zhejiang, Yunnan and Shaanxi. All couples attending the compulsory premarital examination were recruited. Routinely taken blood was collected onto filter paper. Tests for HIV and syphilis used modified particle agglutination techniques. In all, 17,226 individuals were tested. There were no HIV infections in Zhejiang or Shaanxi. In Yunnan, there were 28 positives: 0.75% (95% confidence interval: 0.5, 1.1), with 22 (78%) in men and 16 (57%) in known high-risk individuals. Syphilis prevalence ranged from 0.33% to 0.71% across study sites, with 58% in men. Although syphilis levels suggest that unsafe sexual activity is occurring in all areas, HIV is not yet affecting the general population of Zhejiang or Shaanxi. The epidemic in Yunnan is being driven by injecting drug users, but there may now be transmission in the general population.     

沈阳市男男性行为人群HIV感染率及其影响因素分析

目的了解沈阳市男男性行为人群（MSM）艾滋病病毒（HIV）感染率及其影响因素,进一步做好MSM的艾滋病防治工作。方法采用同伴推动法（RDS）招募900名MSM,由经过专业培训的调查员进行面对面的问卷调查,主要内容包括社会人口学特征、艾滋病知识知晓水平、性行为状况、接受干预服务情况和HIV/梅毒感染状况,并抽取静脉血检测HIV及梅毒,对影响HIV感染的相关因素进行χ2检验。结果调查了900名MSM,艾滋病知识知晓率达到91.3%。86.9%的调查对象最近6个月有同性肛交性行为,最近6个月与男性发生肛交性行为时每次都使用安全套的比例为57.5%。HIV感染率为9.3%,梅毒感染率为11.0%。分析显示,年龄较大、文化程度在初中及以下、最近6个月与男性发生肛交性行为时未坚持使用安全套、梅毒感染是感染HIV的危险因素。结论 MSM人群高危性行为发生率、HIV和梅毒感染率均高,可能成为当前HIV流行的重要人群和重要因素,应采取积极有效的宣传教育和行为干预活动。     

Sexually transmitted infections prevalence rates in slum communities of Dhaka, Bangladesh

The study objective was to estimate the prevalence of selected sexually transmitted infections (STIs) and associated factors among Dhaka slum dwellers. Blood and urine specimens were collected from 1534 men and women. Participants in this cross-sectional study responded to a questionnaire, providing socioeconomic data, symptomatology and treatment-seeking behaviour. Specimens were tested for syphilis, hepatitis B (HBsAg), Neisseria gonorrhoeae, Chlamydia trachomatis, and HIV. Serologic evidence of syphilis infection was found in 6.0% of respondents, HBsAg in 3.8%. Prevalence rates of gonorrhoea and chlamydia were 1.7% and <1%, respectively. No HIV infections were found. Men were more than twice as likely as women to be infected with syphilis or HBsAg carriers. Behaviours facilitating STI transmission were common among men. Syphilis infection is prevalent enough to warrant the initiation of screening programmes in this population. The prevalence rate of hepatitis B carriage suggests that this population would benefit from universal vaccination against hepatitis B.     

MSM中HIV感染者无保护肛交行为及其影响因素分析

目的了解男男性行为人群（MSM）中艾滋病病毒（HIV）感染者的无保护肛交性行为的状况,分析其影响因素,为开展针对性干预活动防止＂二代传播＂提供信息。方法对＂全国男男性行为人群艾滋病综合防治试点＂工作数据库中,HIV感染者的信息进行分析,描述研究对象的社会人口学和高危性行为特点,并分析无保护肛交性行为的影响因素。结果共获得MSM中HIV感染者的有效样本754人,梅毒检出率为28.9%。最近6个月内无保护肛交发生率为67.4%。与无保护肛交发生有关的危险因素是在当地居住时间超过6个月,经常到浴池、公园等场所寻找性伴,以及最近1年内未接受过艾滋病相关服务。结论 MSM中HIV感染者的无保护肛交行为发生率、梅毒感染率高,构成艾滋病进一步传播流行的风险,亟待在该人群中开展针对性行为干预。     

Syphilis elimination seen as good HIV prevention

The syphilis epidemic, that fueled the HIV epidemic in the late 1980s, has subsided. Syphilis is now at the lowest levels ever recorded. This reduction has led to optimism that the disease may be eliminated in the next ten years. Elimination is defined as one case per million people. The United States has the highest syphilis rates in the industrialized world. The syphilis cases are concentrated in fewer than 40 counties, mostly in the South, offering a unique opportunity to eliminate syphilis from the United States. Federal and private organizations are funding programs that seek to reduce the risk of HIV transmission while eliminating syphilis. The syphilis elimination strategies include developing a national task force, involving the community, funding demonstration projects, enhancing surveillance systems, deploying technical assistance, and targeting prevention and research programs.