Syphilis surveillance and trends of the syphilis epidemic in Germany since the mid-90s

Recent surveillance reports from Europe and the United States show an increase in syphilis cases. Accurate epidemiological information about the distribution of syphilis is important for targeting screening and intervention programmes. The German syphilis notification system changed in 2001 from physician to laboratory-based reporting, which is complemented by a newly introduced sexually transmitted infection (STI) sentinel system. After reaching an all time low during the 1990s, syphilis notifications have increased significantly since 2001, coinciding with the introduction of the new reporting system. However, the increased reported incidence is reflecting a true rise in the number of cases and is not predominantly determined by more underreporting through the previous reporting system. The increase reflects syphilis outbreaks among men who have sex with men (MSM). The first of these outbreaks was observed in Hamburg in 1997. In 2003, incidence in men was ten times higher than in women. An estimated 75% of syphilis cases are currently diagnosed among MSM. A high proportion (according to sentinel data, up to 50%) of MSM diagnosed with syphilis are HIV positive. The continuously high number of syphilis cases diagnosed among heterosexuals in Germany in recent years compared with other western European countries may reflect the higher population movement between Germany and syphilis high incidence regions in south-east and eastern Europe.     

Infectious syphilis in high-income settings in the 21st century

In high-income countries after World War II, the widespread availability of effective antimicrobial therapy, combined with expanded screening, diagnosis, and treatment programmes, resulted in a substantial decline in the incidence of syphilis. However, by the turn of the 21st century, outbreaks of syphilis began to occur in different subpopulations, especially in communities of men who have sex with men. The reasons for these outbreaks include changing sexual and social norms, interactions with increasingly prevalent HIV infection, substance abuse, global travel and migration, and underinvestment in public-health services. Recently, it has been suggested that these outbreaks could be the result of an interaction of the pathogen with natural immunity, and that syphilis epidemics should be expected to intrinsically cycle. We discuss this hypothesis by examining long-term data sets of syphilis. Today, syphilis in western Europe and the USA is characterised by low-level endemicity with concentration among population subgroups with high rates of partner change, poor access to health services, social marginalisation, or low socioeconomic status.     

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.     

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...     

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。     

Management of sexually transmitted infections in HIV positive individuals

PURPOSE OF REVIEW: This review aims to summarize recent developments in the epidemiology and management of sexually transmitted infections in HIV positive individuals. It will also discuss briefly the legal aspects of disclosure in relation to HIV transmission. RECENT FINDINGS: There has been a dramatic increase in the reported number of cases of syphilis globally in recent years. In the United Kingdom this has mainly been observed among HIV positive men who have sex with men (MSM). Since 2003 there have been a series of outbreaks of lymphogranuloma venereum reported in several European cities occurring mostly in HIV positive MSM. Sexual transmission of hepatitis C is increasing and appears to be more common in HIV positive MSM. Legal issues regarding HIV transmission have also come to the fore, becoming an important part of the discussion of sexual health with an HIV positive patient. SUMMARY: Increases in sexually transmitted infection among HIV positive individuals suggest a worrying lack of adherence to safe sex guidelines and needs to be addressed urgently. The transmission of HIV is facilitated by the presence of certain sexually transmitted infections. Management of sexual health is an essential part of HIV care.     

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。     

Syphilis surveillance and epidemiology in the United Kingdom

The aim of this article is to describe trends in infectious syphilis in the UK, and specifically the epidemiology of the London syphilis outbreak, the largest in the UK to date. Analysis of routine surveillance data from genitourinary medicine (GUM) clinics was performed as well as data collection through enhanced surveillance systems. There have been substantial increases in diagnoses of infectious syphilis between 1998 and 2003, with a 25-fold increase seen in men who have sex with men (MSM) (from 43 to 1028 diagnoses); 6-fold (138 to 860) in heterosexual men and 3-fold (112 to 338) in women. The national rise in syphilis was driven by a series of local outbreaks, the first of which occurred in 1997. To date, 1910 cases have been reported in the London outbreak, first detected in April 2001. High rates of HIV co-infection were seen among MSM, with MSM likely to be of white ethnicity and born in the UK. In contrast, heterosexuals were more likely to be of black ethnicity and born outside the UK. Most syphilis infections were acquired in London. MSM bear the brunt of the national resurgence in infectious syphilis. Substantial rises in male heterosexual cases has resulted in a divergence between male heterosexual and female cases, which now requires further investigation.     

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.     

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.     

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.     

HIV, syphilis infection, and risky sexual behaviors among male university students who have sex with men in Beijing, China: a cross-sectional study

Young male university students who have sex with men are at high risk of HIV and sexually transmitted infections (STIs). We conducted a cross-sectional survey to assess the prevalence of risky sexual behaviors, HIV, and syphilis among male university students who have sex with men in Beijing, China; and to identify risk factors for unprotected anal intercourse (UAI). Among 157 study participants, HIV and syphilis prevalence were 2.5% and 7.0%, respectively. We found a high prevalence of UAI in our study population. Multiple logistic regression analysis revealed two significant predictors of UAI: believing it is not necessary to use a condom with a regular sex partner and not feeling anxious about being gay. Not using a condom during first sexual experience with a man was a marginally significant predictor of UAI. Male university students who have sex with men are especially vulnerable to HIV and STIs. Intensified education and HIV testing programs are needed to reduce risk in this population.     

Possible Increase in HIV and Syphilis Prevalence Among Men Who Have Sex with Men in Guangzhou, China: Results from a Respondent-Driven Sampling Survey

A respondent-driven sampling survey was conducted to investigate HIV related serological and behavioral characteristics of men who have sex with men (MSM) in Guangzhou, China, and to identify associated factors potentially driving the epidemic. Respondent- Driven Sampling Analysis Tool and SPSS were used to generate adjusted estimates and to explore associated factors. Three hundred seventy-nine eligible participants were recruited. The adjusted prevalence of HIV and current syphilis infection are 5.2% and 17.5% respectively. 60.3% have unprotected anal sex in the past 6 months. Unprotected anal sex, having receptive anal sex and current syphilis infection are significant factors associated with HIV infection. The potential for a rapid rise of HIV and syphilis infections among MSM in Guangzhou exists. Targeted interventions with voluntary counseling and testing (VCT) and sexually transmitted infection (STI) services are needed to address the epidemic, with a focus on such subgroups as those of with current syphilis, and non-official Guangzhou residence status.     

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.     

HIV,syphilis and heterosexual bridging among Peruvian men who have sex with men

OBJECTIVES: To determine prevalence of and risk factors associated with HIV and syphilis seropositivity and estimate incidence of HIV infection among Peruvian men who have sex with men (MSM) and characterize behaviors of men who report sex with both men and women ('bridgers'). DESIGN: Cross-sectional study of MSM in Lima, Peru. METHODS: Four-hundred and fifty-one MSM (of whom 442 responded to the question regarding sexual orientation) recruited through street outreach. Each was interviewed and underwent serologic testing for syphilis and HIV, including the less sensitive enzyme immunoassay test to estimate HIV incidence. RESULTS: Overall, HIV and syphilis prevalence were 18.5% and 16.0%, respectively, with highest prevalence among cross-dressers (33.3% and 51.1%, respectively). The estimated overall HIV seroincidence was 11.2% per year (95% confidence interval, 4.8-23.6). Overall, 47.1% of men reported ever having sex with a woman: 78.6% of men self-identifying as heterosexuals, 85.1% of bisexuals, 35.5% of homosexuals, and 12.5% of cross-dressers. Of these, 26.5% were 'bridgers', of whom 55% reported two or more female partners during the last year. 'Bridgers' were less likely to have always used condoms during the past year for vaginal sex (17%) than for insertive anal sex with men (25.5%). CONCLUSIONS: Among MSM in Peru, HIV and syphilis prevalence and HIV incidence were high, especially among cross-dressers. The high prevalence of bisexuality and low rates of consistent condom use, especially with female sexual partners indicates potential HIV transmission into the heterosexual population.     

深圳市男男性行为人群HIV梅毒及HCV新发感染的队列研究

目的了解深圳市男男性行为人群(MSM)艾滋病病毒(HIV)、梅毒及丙型肝炎病毒(HCV)抗体阳转情况。方法依托深圳市每年开展的时间场所抽样结合同伴推动抽样方法,于2009年5月招募325名MSM为前瞻性研究队列,在基线和一年随访时调查其高危行为情况,并采集血样检测HIV、梅毒和HCV抗体。结果队列随访一年,MSM队列保持率仅为56.2%,HIV血清抗体阳转率为4.44/100人年,梅毒阳转率为7.00/100人年,HCV血清抗体阳转率为1.61/100人年。结论深圳市MSM人群HIV、梅毒以及HCV的新发感染率均比较高,应考虑在现有干预方案基础上增加针对性的有效干预措施。     

重庆市男男性行为人群近1年HIV检测情况及影响因素

目的了解重庆市男男性行为人群(MSM)近1年艾滋病病毒(HIV)检测情况及其影响因素。方法于2009年9-10月,在重庆市通过同伴推动抽样法(Respondent-driven sampling,RDS)招募510名MSM进行问卷调查及HIV和梅毒血清学检测,用RDSAT和SAS进行统计学分析。结果 57.1%的MSM曾经做过HIV检测,近1年HIV检测率为39.7%,HIV和梅毒感染率分别为14.9%和6.3%。在多因素Logistic回归分析结果中,MSM近1年HIV检测的影响因素为:近6个月与最近1个男性性伴主动肛交时使用安全套(AOR=1.7,95%CI:1.1～2.6)、知道最近1个男性性伴的HIV感染状况(AOR=2.0,95%CI:1.2～3.4)和近12个月接受过免费的性病检查或治疗(AOR=7.2,95%CI:3.9～13.0);年龄(>25岁:AOR=0.5,95%CI:0.3～0.8)和担心检测结果阳性受到歧视(AOR=0.5,95%CI:0.3～0.8)。结论急需开展有针对性的宣传教育和干预工作,来促进MSM定期HIV检测以降低HIV的传播。     

The syphilis outbreak in Northern Ireland

Since the late 1990s, there has been a resurgence of infectious syphilis, with notable outbreaks in Brighton, Manchester, London and Dublin, predominantly among men who have sex with men (MSM). We report a similar outbreak in Northern Ireland. Genitourinary (GU) medicine clinic attendees were assessed from 1 July 2000 to 30 June 2005 to identify those who met the agreed criteria for primary, secondary or early latent syphilis. In total, 161 individuals were diagnosed with syphilis and 121 were MSM. Sixteen individuals indicated a contact in Dublin as the likely source of infection. Thirty were identified through contact tracing. Over half contracted the infection through oral intercourse. Most (106) had one or two partners in the previous three months. Twelve cases were HIV positive (nine were aware of their status at the time of presumed infection). In conclusion, initially, cases acquired their infection in Dublin and, as the outbreak gained momentum, syphilis was contracted within Northern Ireland. The cohort was not generally associated with a high number of sexual contacts, multiple anonymous partners or specific locations. The challenge is to educate both patients and health-care professionals to sexual health issues; specifically, the risk associated with casual oral sex by MSM.     

深圳市男男性行为人群HIV／梅毒发病密度研究

目的了解深圳市男男性行为人群（MSM）的艾滋病病毒（HIV）/梅毒发病密度,探索防治性病对预防控制艾滋病的作用。方法知情同意原则下,招募符合纳入标准的MSM;建立并保持队列,收集社会人口学、性行为和安全套使用等资料;抽血检测HIV/梅毒,随访观察HIV/梅毒转归结局。结果 609例入选队列,HIV阴转阳19例,观察总人年数249.7人年,发病密度7.6[95%可信区间（CI）：4.6～11.9]/100人年;梅毒酶联免疫吸附试验（ELISA）阴转阳18例,观察总人年数134.9人年,发病密度13.3（95%CI：7.9～21.1）/100人年;梅毒ELISA阳性队列HIV发病密度是梅毒ELISA阴性队列HIV发病密度的2.2倍。结论梅毒对HIV传播具有协同作用,有必要在该人群中实施有效的性病预防措施以控制HIV传播     

Bisexual behavior and infection with HIV and syphilis among men who have sex with men along the east coast of China

This study examined the correlates of bisexual behavior and infection with HIV/syphilis among men who have sex with men only (MSM-only) and those who have sex with both men and women (MSMW) in Shandong, China. Cross-sectional surveys probed sociodemographic information, sexual and drug use behaviors, knowledge, and use of prevention services; blood samples were tested for HIV/syphilis status. Of 2996 participants, 39.5% acknowledged being MSMW; 60.5% being MSM-only; 2.5% were HIV-infected with similar rates for MSMW (2.5%) and MSM-only (2.6%); 5.5% syphilis-infected with comparable rates for MSMW (5.6%) and MSM-only (5.5%). In multivariable models, MSMW were more likely than MSM-only to be older, local residents, recruited from outdoor cruising area, drug users, and less likely to have used a condom during last anal sex with a male partner. HIV-infected MSMW were more likely to have syphilis and other sexually transmitted diseases (STDs) and less likely to have received peer education. HIV-infected MSM-only were more likely to be older, nonlocal residents, and have syphilis and other STDs. MSMW with syphilis were more likely to be recruited from Jinan, Qingdao, and Zibo (versus Yantai), infected with HIV, and less likely to have received lubricant promotion. MSM-only with syphilis were more likely to be recruited from Jinan and Qingdao (versus Yantai), drug users, infected with HIV, and have had sex with male partners in the past 6 months. High prevalence of bisexual behavior and HIV/other STDs with common unprotected sex and multiple sexual partners among Shandong's gay community revealed in this study highlighted the importance of bisexuals as a potential epidemiologic bridge. Further research is needed to investigate the impact of bisexual behaviors on population transmission.