青岛地区MSM中HIV/梅毒及尖锐湿疣的感染情况

目的了解青岛地区男男性行为人群（MSM）艾滋病病毒（HIV）/梅毒及尖锐湿疣的感染情况。方法利用中盖项目支持平台,对前来接受干预检测的MSM进行相关查体及实验室检查。结果 687名MSM共检出尖锐湿疣41例,检出率为5.97%;梅毒89例,检出率为12.95%;HIV 8例,检出率1.16%。8例HIV阳性患者中,3例合并CA,4例合并梅毒;2例CA患者同时伴有HIV、梅毒阳性;89例梅毒阳性患者中,19例合并CA。结论 MSM中HIV、梅毒及尖锐湿疣感染情况严重,提示临床医生在对MSM的梅毒、尖锐湿疣患者诊治的同时,应注重HIV的检测。     

Characteristics of patients with syphilis attending Baltimore STD clinics. Multiple high-risk subgroups and interactions with human immunodeficiency virus infection

Medical records of 341 patients with syphilis seen at a health department sexually transmitted disease clinic were reviewed to assess membership in high-risk subgroups and interactions with human immunodeficiency virus (HIV) infection. When compared with the entire clinic population, patients with syphilis tended to be older and were more likely to acknowledge intravenous drug use, more often had a history of syphilis, and, among men, were more often homosexually active. Half of the men with syphilis and one third of the women fell into one or more of these high-risk subgroups. Patients with syphilis were also more likely to test positive for HIV infection than other patients attending the clinic. Patients admitting to intravenous drug use, prior syphilis, or being homosexually active were significantly more likely to be HIV seropositive than patients without these characteristics, even though patients with these characteristics were significantly more likely to refuse HIV serologic testing. Although clinical stage of syphilis at presentation did not differ when patients with and without concurrent HIV infection were compared, geometric mean rapid plasma reagin titers were significantly higher in HIV-infected patients with secondary syphilis.     

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.     

The resurgence of syphilis among men who have sex with men

PURPOSE OF REVIEW: To identify recent progress and emerging problems in addressing syphilis among men who have sex with men. RECENT FINDINGS: A resurgence of syphilis has occurred among men who have sex with men in many developed countries. Infection has been associated with HIV coinfection, multiple partners, and recreational drug use. Unlike HIV, oral sex appears to be a common route of syphilis transmission. Many prevention approaches have shown, at best, modest success. Variable clinical presentation and potentially inconclusive lab tests make diagnosis confusing. SUMMARY: As the infection remains relatively rare, clinicians treating men who have sex with men should maintain a high index of suspicion for syphilis lesions, and should screen their sexually active patients for latent disease. Debates about syphilis control and treatment continue. The clinical manifestations, serologic responses, efficacy of treatment, and complications of syphilis have always been complicated. HIV coinfection adds to the confusion.     

Syphilis in Denmark-Outbreak among MSM in Copenhagen, 2003-2004

Denmark is currently experiencing an outbreak of syphilis that began in 2003 and has continued in 2004. Data from the national surveillance system show that most cases are in men who have sex with men (MSM), and that a large proportion of these patients are also HIV positive. The proportion of known HIV positive cases in MSM notified with syphilis during the outbreak has, however, not been significantly different from previous years. The majority of cases were reported from Copenhagen municipality, and 70% of the cases were acquired domestically. The outbreak does not seem to be affecting the age group under 20 years. We speculate that most of the MSM found with both syphilis and HIV were already HIV positive when they acquired syphilis infection.     

Syphilis and HIV co-infection: when is lumbar puncture indicated?

The rate of syphilis/HIV co-infection amongst men who have sex with men (MSM) in large urban regions ranges from 20 to 70%. Concurrent HIV infection can alter the clinical presentation of syphilis, the response to treatment, and complicate the diagnosis and clinical course of neurosyphilis. Therefore whether to perform a lumbar puncture (LP) on every co-infected patient in order to diagnose neurosyphilis is controversial. Current clinical guidelines specify the indications for LP, but fall short of recommending LP in certain clinical situations such as early syphilis without neurological involvement. This article reviews the current literature on the relative utility and indications for LP in syphilis/HIV co-infected patients and new research in this area.     

梅毒合并HIV感染43例临床特征分析

目的分析梅毒合并艾滋病病毒（HIV）感染者的临床特征,了解其治疗效果。方法对武义县疾病预防控制中心诊治的43例梅毒合并HIV感染病例的资料做回顾性分析。结果43例病例中,显性梅毒占65．12％、隐性梅毒占34．88％。显性一期梅毒硬下疳大多不典型,可出现多个形态不一的溃疡面。二期梅毒疹皮损较非HIV感染者严重、复杂。经抗梅毒治疗后梅毒甲苯胺红不加热血清学试验（TRUST）阳性的转阴率低,持续时间长,血清固定比例增加。结论梅毒合并HIV感染会加重病情,增加治疗难度。临床工作中必须对所有梅毒患者或HIV感染者同时作梅毒血清学检查和HIV抗体筛查,避免误诊、漏诊。     

Patterns of HIV and syphilis infection in Northern Thailand 1998-2001

Northern Thailand has been the epicentre of a largely heterosexually transmitted HIV epidemic that has recently involved married women. In preparation for HIV-prevention trials, we investigated patterns of HIV and syphilis risk through annually measured HIV and syphilis prevalence among northern Thai, peri-urban, community-dwelling men (n=2564) and women (n=3907) aged 18-35 years between 1998 and 2001. Crude HIV and syphilis prevalence were 3.3% and 2.7% for men and 2.3% and 2.1% for women, respectively. In logistic regression models of HIV and syphilis, compared with married men/women, widowers and widows were at increased risk (odds ratio; 95% confidence interval) of syphilis (7.86; 1.56-39.6 and 3.3; 1.14-9.61, respectively) and HIV (12.68; 3.23-49.8 and 41.3; 24.3-70.3, respectively). The oldest women were at lower risk of HIV (0.43; 0.22-0.85). For men and women, those with syphilis were approximately three times more likely to have HIV. These unique population data illustrate evolving sex parity of HIV burden in northern Thailand.     

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.     

Clinical manifestations of primary syphilis in homosexual men

At the beginning of a new millennium, syphilis incidence has been increasing worldwide, occurring primarily among men who have sex with men (MSM). The clinical features of primary syphilis among MSM is described, a case-note review of the primary syphilis (PS) patients who attended the Institute of Skin and Venereal Diseases. The diagnosis was assessed based upon the clinical features and positive syphilis serology tests. Among 25 patients with early syphilis referred during 2010, PS was diagnosed in a total of 13 cases. In all patients, unprotected oral sex was the only possible route of transmission, and two out of 13 patients had HIV co-infection. Overall, 77% of men presented with atypical penile manifestation. The VDRL test was positive with low titers. The numerous atypical clinical presentations of PS emphasize the importance of continuing education of non-experienced physicians, especially in countries with lower reported incidence of syphilis.     

One-Year Follow-Up of Relapse to Risky Behaviors and Incidence of Syphilis Among Patients Enrolled in the HIV Case Management Program

A longitudinal prospective study was conducted at an AIDS designated hospital in Taiwan. The study aimed to determine the incidence of syphilis and to identify risk factors predicting new onset syphilis and relapse into risky behaviors among 117 patients enrolled in the HIV case management program for 1 year. Having a new episode of syphilis was defined as patients had a fourfold increase of serum rapid plasma reagin titers from baseline to 12-month follow-up. After enrollment, 17% relapsed in unprotected sexual intercourse. New onset syphilis was noted in ten (10.4%) participants, and all were men having sex with men. The incidence of syphilis was 5.8 per 100 person-years. Predictors of a new episode of syphilis were higher CD4 cell counts [hazard ratio (HR), 1.003; 95% confidence interval (CI), 1.00–1.006], and recreational drug use (HR, 18.89; 95% CI, 2.78–128.15). Regular screening for syphilis among patients retaining in HIV care remains necessary.     

Prevalence and risk factors associated with syphilis in a cohort of HIV positive individuals in Brazil

Individuals with syphilis have higher chance of having HIV, and syphilis' genital ulcers increases HIV transmission rate. Nevertheless, there are few well-documented studies about HIV and syphilis co-infection and its risk factors. The study was based on 2262 HIV infected individuals from South Brazilian HIV cohort, which began in 1991, and this analysis included individuals who were included in the cohort until November 2008. Inclusion criteria were having CD4 + T cell count and viral load at baseline, and syphilis serology tests (venereal disease research laboratory [VDRL] > 1:64 or a positive VDRL plus a positive treponemal test). A total of 1012 patients were included; 580 were men (57%); mean age at HIV diagnosis was 33 years; 591 (58%) had previous diagnosis of AIDS; most of the individuals acquired HIV from sexual contact (47.9% heterosexual and 31.7% men who had sex with men [MSM]); and 759 (75%) were on antiretroviral therapy. The prevalence of syphilis was 20.5% (208). After multivariate analysis, being male (2.01; 95% CI, 1.23-3.27; p = 0.005) and MSM (1.91; 95% CI, 1.25-2.90; p = 0.002) were significantly associated to HIV and syphilis co-infection. Males and MSM were associated with higher risk of this co-infection. Our findings may reflect that this particular population is still engaging in unprotected sexual intercourse, and efforts should be made to better target this specific group as they might perpetuate these infections.     

Recent syphilis trends in Belgium and enhancement of STI surveillance systems

Over the past five years, a series of syphilis outbreaks mainly occurring among gay men have been observed in Europe. One of these outbreaks was reported in the city of Antwerp, Belgium, during the first quarter of 2001. This outbreak is still ongoing in 2004. Furthermore, active syphilis diagnoses reported by the Sentinel Laboratory Network rose by 89% in the country during the fourth quarter of 2003. An increase in Brussels was also observed during the same quarter (+300%; 24 cases reported). Overall, the sentinel network of clinicians reported that 93.4% of patients were male; among them, 79.9% were men having sex with men (MSM). The overall proportion of patients co-infected with HIV was 50.5% (MSM: 58.6%; male heterosexuals: 23.8%; females: 8.3%); 76.1% of co-infected patients were already aware of their HIV infection at the time they were diagnosed with syphilis.     

Syphilis and HIV: Old and new foes aligned against us

Syphilis and HIV infections frequently occur simultaneously because they affect the same risk groups. The declining incidence of syphilis during the 1990s reversed beginning in 2001, with most of the new cases occurring in men who have sex with men. This group is at highest risk of having or acquiring HIV infection. The clinical presentation of syphilis may be altered in persons with HIV infection and the response to therapy may be affected by immunosuppression. Syphilis may also subtly affect HIV infection, at least transiently. This article reviews the epidemiology, clinical manifestations, and treatment of syphilis in the setting of HIV infection.     

北京市大学生男男性行为人群HIV与梅毒感染相关流行病学调查

目的了解北京市大学生男男性行为人群(MSM)的艾滋病病毒(HIV)与梅毒的现患状况、艾滋病相关认知与行为。方法采用自填式问卷,调查社会人口学信息、艾滋病相关知识、同/异性性行为等,并进行HIV和梅毒的血清学检测。结果 157位调查对象,HIV、梅毒以及合并感染率分别为2.5%、7.0%和1.3%。由于同性性取向,5.1%有过自杀行为。近6个月曾与偶遇性伴发生过性行为者("419")约占到45%,其HIV和梅毒的感染率均高于无"419"行为者。不足20%曾发生异性性行为。结论大学生MSM中普遍存在HIV高危同性性行为,也存在异性性行为,亟须开展有效的健康教育和行为干预。     

Uptake of HIV and syphilis testing of pregnant women and their male partners in a programme for prevention of mother-to-child HIV transmission in Uganda

Objective To describe uptake of HIV and syphilis testing in a prevention of mother‐to‐child HIV transmission programme in Uganda. Methods Analysis of data from routine HIV and syphilis testing at Entebbe Hospital antenatal services. Results A total of 20 738 women attended antenatal services. Exactly 62.8% of women, but only 1.8% of their male partners, accepted testing for HIV; 82.2% of women, but only 1.1% of their male partners accepted syphilis testing. Partners of women with positive HIV results were more likely to come for subsequent testing. Of 200 couples whose partners accepted HIV‐testing within 30 days of one another, 19 (9.5%) were HIV‐discordant, representing 65.5% of couples with at least one partner HIV‐positive. HIV prevalence was 12.6% for women and 10.8% for men; syphilis prevalence was 4.0% for women and 6.2% for men. Conclusion Uptake of HIV and syphilis testing was fairly good among pregnant women attending antenatal clinics at Entebbe Hospital, but very low among their male partners. The level of HIV‐discordant couples was high. These clinics should be made more couples‐friendly to identify both HIV‐positive men for treatment and discordant couples for HIV prevention.     

Sensitivity of treponemal tests for detecting prior treated syphilis during human immunodeficiency virus infection

To evaluate the sensitivity of treponemal tests as a marker of prior syphilis in individuals with human immunodeficiency virus (HIV) infection, the syphilis serology of 109 homosexual men with a documented history of treated syphilis was compared with records of prior results and confirmed on stored serum samples. None of the HIV-seronegative individuals lost reactivity to a treponemal test, whereas 7% of the seropositive asymptomatic individuals and 38% of those with symptomatic HIV infection had loss of reactivity. Symptomatic HIV infection was associated with loss of reactivity, as a T4 lymphocyte count less than 200 X 10(6)/1, a T4-to-T8 ratio less than 0.6, a single prior episode of syphilis, and a low VDRL titer at the time of the last documented episode of syphilis. Although no conclusions can be drawn about the sensitivity of treponemal tests in patients with active syphilis and HIV infection, these data suggest that treponemal tests may not identify those previously infected with Treponema pallidum.     

204例MSM人群HIV／梅毒感染状况及行为学特征分析

目的了解天津市部分男男同性性行为人群（MSM）艾滋病相关危险行为,以及艾滋病病毒（HIV）、梅毒（SP）感染状况,为预防性病、艾滋病传播提供依据。方法采用横断面调查,对进入酒吧的男同性恋者进行问卷调查,同时抽取血样进行梅毒和HIV的实验室检测。结果调查的204人中,HIV感染率为5．9％,梅毒感染率为18．7％。艾滋病知识知晓率为81．4％,近6个月每次性行为均使用安全套的比例为47．9％,HIv感染者安全套使用率低,仅为11．1％,71．4％的HIV感染者最近6个月存在多性伴现象。结论天津市MSM人群危险性行为普遍存在,安全套使用率低,HIV、梅毒感染率较高,应加强对该人群艾滋病性病相关的宣传教育及干预工作,控制HIv的传播。     

长沙市男男性行为者HIV和梅毒感染现状及影响因素分析

目的 了解长沙地区男男性行为者(MSM)艾滋病病毒(HIV)和梅毒感染状况及其影响因素.方法 2018年10月至2019年6月期间,委托非政府组织(NGOs)应用滚雪球的方法招募MSM,开展问卷调查和HIV及梅毒检测.采用多因素Logistic回归模型分析HIV和梅毒感染的影响因素.结果 共招募1 220名MSM,其中...     

Syphilis resurgence in Dublin, Ireland

A large outbreak of syphilis was reported in Dublin, Ireland, in 2001. The mean age of patients in 2001 was 35 years and 22.5% of patients were HIV-positive. The number of new cases decreased from 2003 on, however, new diagnoses have again increased. All positive syphilis serology results from 2007-09 were identified. Patients were included if they had a newly positive syphilis serology or, in the case of patients with previously treated syphilis, had a four-fold rise in rapid plasma reagin titre. Four hundred and thirty-nine new diagnoses of syphilis were made. The mean age of patients at diagnosis was 35.7 years (range 17-73 years). Four hundred and twelve (93.8%) cases occurred in men. Three hundred and eighty-one (86.8%) cases occurred in men who have sex with men (MSM). The estimated crude incidence rate among MSM is 378.16 per 100,000 population. Where known, 126/421 (28.7%) occurred in HIV-positive patients. Sixty-eight (15.5%) episodes of syphilis infection were diagnosed in patients who had had previously been diagnosed and treated for syphilis; 43/68 (63.2%) cases of re-infection occurred in HIV-positive patients. The rising number of syphilis diagnoses and high associated HIV co-infection rate is concerning and prevention efforts must continue to decrease the number of new syphilis cases.