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Abstract
Syphilis is a sexually transmitted infection caused by Treponema pallidum subsp. pallidum with an increasing incidence in Spain and in the rest of the world. Diagnosis is based mainly on serology, since direct diagnosis by dark field microscopy presents difficulties that limit its widespread use. Molecular biology techniques can be a useful tool for diagnosis in primary and secondary syphilis, although not all types of samples show the same behaviour. These techniques are also useful for the diagnosis of congenital syphilis. They are not recommended, however, for neurosyphilis, due to the low sensitivity of polymerase chain reaction in cerebrospinal fluid. These techniques have been used to study the controversial origin of syphilis, and, through the enhanced Centers for Disease Control method, to perform typing, which helps to elucidate the epidemiology of this infection. Finally, molecular techniques can detect mutations related to macrolide resistance, which are present in a very high percentage of infections.
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Affiliation(s)
- Luis Otero Guerra
- Servicio de Microbiología, Hospital Universitario de Cabueñes, Gijón, España; Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Grupo de Estudio de Infecciones de Transmisión Sexual. GEITS, SEIMC
| | - Fernando Vázquez Valdés
- Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Grupo de Estudio de Infecciones de Transmisión Sexual. GEITS, SEIMC; Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, España; Área de Microbiología, Facultad de Medicina, Universidad de Oviedo, España; Instituto Universitario Fernández Vega (IUFV) y Fundación de Investigación Oftalmológica (FIO), Oviedo, España.
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DI Tullio F, Mandel VD, Cuomo G, Coppini M, Guaraldi G, Mussini C, Pellacani G, Borghi V. HIV and syphilis: incidence rate of co-infection and syphilis re-infection in a cohort of newly diagnosed HIV patients. Ital J Dermatol Venerol 2021; 157:158-163. [PMID: 34282859 DOI: 10.23736/s2784-8671.21.07042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Syphilis represents a major public health concern disproportionately affecting HIV positive patients and in many cases both infections are newly diagnosed at the same time. To date, limited studies are available on syphilis incidence in patients with a new HIV diagnosis. METHODS Patients newly diagnosed with HIV in 2010-2018 were included in the study and screening tests for syphilis were performed at baseline and at least once a year. Primary aims were to analyse the incidence rate of HIV-syphilis co-infection and syphilis re-infection. Secondary objective was to identify characteristics independently associated with co-infection and re-infection. RESULTS Of 500 newly diagnosed HIV patients, 20% presented a concomitant positive syphilis serology. Among them, 54 patients had a serology indicative for an active syphilis requiring therapy, while 46 had a history of prior treatments. The independent factors for syphilis acquisition were: MSM contact (OR:2.64; 95%CI 1.48-4.72; p<0.001), male gender (OR:2.43; 95%CI 1.08-5.48; p=0.032), and age (OR:1.03; 95%CI 1.01-1.05; p=0.005 per year increasing). Presence of syphilis at the time of HIV diagnosis remained fairly stable during the study period (P for trend, p=0.689). We observed 52 syphilis re-infections related to 37 people. Patients with at least one re-infection were all males and 86.5% MSM. CONCLUSIONS Males and MSM with HIV presented high rates of syphilis co-infection and re-infection suggesting persistent high-risk sexual behaviours and the need for appropriate intervention strategies in order to early detect and treat syphilis avoiding life-threatening complications and the spread of the infection in the community.
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Affiliation(s)
- Francesca DI Tullio
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy - .,Dermatology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Gianluca Cuomo
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Maurizio Coppini
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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Review of sexualized drug use associated with sexually transmitted and blood-borne infections in gay, bisexual and other men who have sex with men. Drug Alcohol Depend 2020; 216:108237. [PMID: 33091811 DOI: 10.1016/j.drugalcdep.2020.108237] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of the present study was to quantify associations between sexualized drug use (SDU) and sexually-transmitted and blood-borne infection (STBBI) diagnoses in gay, bisexual and other men who have sex with men (GBMSM) with defined temporal proximity between SDU exposure and STBBI diagnoses. METHODS In May 2018 and June 2019, we searched the literature for primary studies that quantified the association between STBBI and SDU among GBMSM. A random-effects model was used to meta-analyze the data and estimate the association between SDU and STBBIs. RESULTS Nineteen studies met the inclusion criteria and fourteen studies were included in the meta-analyses. SDU was associated with higher odds of bacterial STI diagnoses, higher odds of HCV diagnoses, and higher odds of HIV diagnoses. Associations between SDU and diagnoses of bacterial STIs or HCV remained after adjustment for behavioral and sociodemographic factors. CONCLUSIONS Robust and consistent associations between SDU and STBBI identified in this review add to the evidence suggesting SDU is a potential contributor to bacterial STIs and HCV or a proxy indicator for other risk factors.
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Antebi-Gruszka N, Talan AJ, Reisner SL, Rendina HJ. Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men. Sex Transm Infect 2020; 96:422-427. [PMID: 32605930 DOI: 10.1136/sextrans-2020-054474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Transgender men who have sex with men (TMSM) represent an understudied population in relation to screening for HIV and sexually transmitted infections (STIs). We examined HIV and STI testing prevalence among TMSM along with the factors associated with testing in a diverse US nationwide sample of TMSM. METHODS Data from a cross-sectional online convenience sample of 192 TMSM were analysed using multivariable binary logistic regression models to examine the association between sociodemographic and behavioural factors and lifetime testing for HIV, bacterial STIs and viral STIs, as well as past year testing for HIV. RESULTS More than two-thirds of TMSM reported lifetime testing for HIV (71.4%), bacterial STIs (66.7%), and viral STIs (70.8%), and 60.9% had received HIV testing in the past year. Engaging in condomless anal sex with a casual partner whose HIV status is different or unknown and having fewer than two casual partners in the past 6 months were related to lower odds of lifetime HIV, bacterial STI, viral STI and past year HIV testing. Being younger in age was related to lower probability of testing for HIV, bacterial STIs and viral STIs. Furthermore, TMSM residing in the South were less likely to be tested for HIV and viral STIs in their lifetime, and for HIV in the past year. Finally, lower odds of lifetime testing for viral STIs was found among TMSM who reported no drug use in the past 6 months. CONCLUSIONS These findings indicate that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs, though at rates only somewhat lower than among cisgender MSM despite similar patterns of risk behaviour. Efforts to increase HIV/STI testing among TMSM, especially among those who engage in condomless anal sex, are needed.
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Affiliation(s)
| | - Ali J Talan
- Department of Psychology, Hunter College of the CIty University of New York (CUNY), New York, New York, USA
| | - Sari L Reisner
- Department of Epidemiology, The Fenway Institute at Fenway Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the CIty University of New York (CUNY), New York, New York, USA .,Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
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Diagnosis and Management of Syphilis in Patients With HIV Co-infection. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Atypical secondary syphilis presentation in a patient with human immunodeficiency virus infection: a case report. J Med Case Rep 2019; 13:360. [PMID: 31813380 PMCID: PMC6900840 DOI: 10.1186/s13256-019-2291-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Untreated syphilis may lead to severe complications. This infection has recently re-emerged in developed countries with a high number of cases coinfected with human immunodeficiency virus. In these patients, the skin lesions of secondary syphilis can be very atypical. Case presentation We report the case of a 38-year-old Bulgarian homosexual man who was coinfected with human immunodeficiency virus and syphilis. His skin contained multiple extensive necrotic lesions with abundant purulent secretion that covered his face, lips, scalp, and torso. Initial clinical diagnoses included varicella pustulosa and staphylococcal dermatitis. Human immunodeficiency virus infection in our patient had been established 2 years earlier in prophylactic studies, but had not been treated. Due to lack of penicillin, he was successfully treated with ceftriaxone, and the skin lesions underwent complete reversal. He also began antiretroviral therapy, which resulted in a significant effect on his immune status. Three months after the onset of antiretroviral therapy, he also achieved optimal viral suppression. Conclusion This case emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of any inflammatory cutaneous disorder in individuals infected with human immunodeficiency virus.
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Arando M, Caballero E, Curran A, Armengol P, Barberá M, Vall-Mayans M. The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Arando M, Caballero E, Curran A, Armengol P, Barberá MJ, Vall-Mayans M. The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:841-849. [PMID: 31587806 DOI: 10.1016/j.ad.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Since 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. METHODS Retrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. RESULTS A total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32-8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17-2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs. 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. CONCLUSION The epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment.
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Affiliation(s)
- M Arando
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
| | - E Caballero
- Departamento de Microbiología, Hospital Vall d'Hebron, Barcelona, España
| | - A Curran
- Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
| | - P Armengol
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
| | - M J Barberá
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
| | - M Vall-Mayans
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
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Arando M, Fernandez-Naval C, Mota-Foix M, Martinez D, Armengol P, Barberá MJ, Esperalba J, Vall-Mayans M. Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients. BMC Infect Dis 2019; 19:727. [PMID: 31420018 PMCID: PMC6697967 DOI: 10.1186/s12879-019-4269-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Since 2000, substantial increases in syphilis in men who have sex with men (MSM) have been reported in many cities. Condomless anal sex (CAS) is one of the factors, along with drugs for sex and sex in group. This study identified factors and clinical manifestations as well as Treponema pallidum (T.pallidum) strains that could be related to early syphilis in Barcelona. METHODS This prospective study was conducted in a sexually transmitted infections unit in 2015. Epidemiological, behavioral, clinical and microbiological variables were collected in a structured form. Univariate and multivariate statistical analyses were performed focusing on HIV-positive patients. RESULTS Overall, 274 cases were classified as having early syphilis (27.5% primary, 51.3% secondary, and 21.2% early latent syphilis). In all, 94% of participants were MSM and 36.3% were HIV-positive. The median number of sexual contacts in the last 12 months was 10; 72.5% practiced CAS, 50.6% had sex in group, and 54.7% consumed drugs. HIV-positive cases had more anonymous sex contacts (p = 0.041), CAS (p = 0.002), sex in group (p < 0.001) and drugs for sex (p < 0.001). In the multivariate analysis, previous syphilis (adjusted odds ratio [aOR] 4.81 [2.88-8.15]), previous Neisseria gonorrhoeae infection (aOR 3.8 [2.28-6.43]), and serosorting (aOR 20.4 [7.99-60.96]) were associated with having syphilis. Clinically, multiple chancres were present in 31% of cases with no differences on serostatus, but anal chancre was most common in HIV-positive patients (p = 0.049). Molecular typing did not conclusively explain clinical presentation in relation to specific T.pallidum strains. CONCLUSION Control of syphilis remains a challenge. Similar to prior studies, HIV-positive patients were found to engage more often in sexual behaviors associated with syphilis than HIV-negative patients. Clinical manifestations were rather similar in both groups, although anal chancre was most common in HIV-positive patients. Various strain types of syphilis were found, but no clinical associations were identified.
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Affiliation(s)
- Maider Arando
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Candela Fernandez-Naval
- Vall d’Hebron Institute of Research, Barcelona, Spain
- Genetics and Microbiology Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Miriam Mota-Foix
- Statistics and Bioinformatics Unit, Vall d’Hebron Institute of Research, Barcelona, Spain
| | - Desi Martinez
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
| | - Pere Armengol
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
| | - Maria Jesús Barberá
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
| | | | - Martí Vall-Mayans
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
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Abstract
Syphilis is an infectious disease caused by the spirochaete Treponema pallidum subsp. pallidum which is transmitted by sexual contact or vertical transmission during pregnancy. The incidence of syphilis has increased in the last years, mainly among men who have sex with men. Without treatment, the disease develops into different clinical stages, being able to present cardiovascular or irreversible neurological complications after a number of years. The disease is classified as early syphilis - primary, secondary and early latent syphilis (less than 12 months) - which is contagious, and as late syphilis - late latent and tertiary syphilis- which is rarely contagious. Diagnosis and management are often a challenge because of its diversity of manifestations and the difficulty of interpretation of serological tests. The treatment of syphilis is based on penicillin or doxycycline in allergic patients. Treatment failure because of resistance has been described with azithromycin. The follow up with a serological test is recommended in all patients with syphilis in order to ascertain cure after the treatment and to diagnose possible reinfections.
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Leyva-Moral JM, Feijoo-Cid M, Moriña D, Caylà JA, Arando M, Vall M, Barbera MJ, Armengol P, Vives A, Martin-Ezquerra G, Alsina M, García Olalla P. Gay Circuit Parties in Barcelona and Their Impact on Gonorrhea Incidence. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2027-2034. [PMID: 30014338 DOI: 10.1007/s10508-018-1220-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
This study explored the role of circuit parties on the incidence of gonorrhea among men who have sex with men (MSM) in Barcelona (Spain). Specifically, it aimed to detect cyclic peaks in the number of reported diagnoses of gonorrhea after gay circuit parties. We analyzed monthly cases of gonorrhea reported from January 2007 through December 2016 after the main annual gay circuit parties in Barcelona. We used the integer autoregressive model for time series with discrete values. The performance of the model was tested in heterosexual men and women, in whom the circuit parties could be expected to have no impact. A sensitivity analysis was conducted, changing post-event diagnosis windows to 1 week later/1 week before. In the study period, a total of 4182 of gonorrhea cases were detected, of which 74.8% (n = 2181) occurred in men who identified themselves as MSM. The average annual increase in gonorrhea cases reported among MSM was 32.57%. In an independent analysis of each gay circuit party, cases increased significantly in two of them. The results were also similar for same-sex practices among men only. On controlling for the increasing trend over the study period and the seasonal effect, an average of 1.16 gonorrhea cases in MSM (95% CI: 0.68, 1.64) were attributable to the celebration of one of the gay circuit parties considered. During the expected outbreak, an average of 13 gonorrhea cases were detected and between 5 and 13% were attributable to one of the circuit parties. In view of these findings, participants should consider seeking advice from their healthcare provider and practice safer sex using condoms to prevent sexually transmitted infections. Local public health services should be reinforced to ensure care for participants during and after gay circuit parties. More research is needed to design and implement preventive programs.
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Affiliation(s)
- Juan M Leyva-Moral
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain.
| | - David Moriña
- Unit of Infections and Cancer - Information and Interventions (UNIC-I&I), Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Joan A Caylà
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maider Arando
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Martí Vall
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - María Jesús Barbera
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Pere Armengol
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Alvaro Vives
- Sexually Transmitted Infection Unit, Fundació Puigvert, Barcelona, Spain
| | | | - Mercè Alsina
- Department of Dermatology, Hospital Clínic, Barcelona, Spain
| | - Patricia García Olalla
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Nyangoma EN, Olson CK, Painter JA, Posey DL, Stauffer WM, Naughton M, Zhou W, Kamb M, Benoit SR. Syphilis Among U.S.-Bound Refugees, 2009-2013. J Immigr Minor Health 2018; 19:835-842. [PMID: 26993114 DOI: 10.1007/s10903-016-0397-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
U.S. immigration regulations require clinical and serologic screening for syphilis for all U.S.-bound refugees 15 years of age and older. We reviewed syphilis screening results for all U.S.-bound refugees from January 1, 2009 through December 31, 2013. We calculated age-adjusted prevalence by region and nationality and assessed factors associated with syphilis seropositivity using multivariable log binomial regression models. Among 233,446 refugees, we identified 874 syphilis cases (373 cases per 100,000 refugees). The highest overall age-adjusted prevalence rates of syphilis seropositivity were observed among refugees from Africa (1340 cases per 100,000), followed by East Asia and the Pacific (397 cases per 100,000). In most regions, male sex, increasing age, and living in non-refugee camp settings were associated with syphilis seropositivity. Future analysis of test results, stage of infection, and treatment delivery overseas is warranted in order to determine the extent of transmission risk and benefits of the screening program.
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Affiliation(s)
- E N Nyangoma
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA.
| | - C K Olson
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA
| | - J A Painter
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA
| | - D L Posey
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA
| | - W M Stauffer
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - M Naughton
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA
| | - W Zhou
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA
| | - M Kamb
- Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S R Benoit
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA
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Bjekić M, Šipetić-Grujičić S, Begović-Vuksanović B, Rafailović N, Vlajinac H. Syphilis Resurgence in Belgrade, Serbia, in the New Millennium: An Outbreak in 2014. Cent Eur J Public Health 2018; 25:277-281. [PMID: 29346849 DOI: 10.21101/cejph.a4525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A worldwide syphilis incidence increase was recorded at the beginning of the new millennium, occurring primarily among men who have sex with men (MSM). The aim of this study was to analyse the epidemiological situation of syphilis in the Belgrade population between 2005 and 2014 and to examine the characteristics of an early syphilis outbreak among MSM in Belgrade in 2014. METHOD Reporting of syphilis is compulsory in Serbia. Routinely reported data were analysed along with data collected from patients' charts. RESULTS During the period observed, syphilis incidence increased from 1.07 per 100,000 in 2005 to 4.1 per 100,000 in 2014 (383.2%). From 2005 to 2009, syphilis rates in Belgrade were low, around 1 case per 100,000 people. The first outbreak was registered in 2010. The new incidence increase happened in 2012, and again in 2014 when it was the highest. These incidence changes were registered mainly in men, where the frequency of syphilis was much higher than in women. In 2014, primary syphilis was diagnosed in 20 cases, secondary syphilis in 42, and early latent syphilis in 9 patients. Fifty-seven were MSM, 10 were heterosexual men and 4 were women. Twenty-four cases, all MSM were co-infected with HIV. Majority of patients acquired infection in Belgrade, while in 42/71 cases oral sex was the only risk factor. In comparison with HIV negative, HIV positive syphilis patients were older, more frequently unemployed and MSM. They also more frequently had sex with unknown partners and were diagnosed in the secondary stage of infection. CONCLUSIONS Study results underline the need for coordinated and expeditious surveillance, partner services, enhanced screening of population at risk, health education, as well as early diagnosis and treatment.
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Affiliation(s)
- Milan Bjekić
- City Institute for Skin and Venereal Diseases, Belgrade, Serbia
| | | | | | | | - Hristina Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Tomori C, McFall AM, Solomon SS, Srikrishnan AK, Anand S, Balakrishnan P, Mehta SH, Celentano DD. Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India. Soc Sci Med 2018; 206:110-116. [PMID: 29615297 DOI: 10.1016/j.socscimed.2018.03.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Aylur K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - P Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
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Abstract
PURPOSE OF REVIEW Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income counties. RECENT FINDINGS World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries, however outbreaks among select populations need to be adequately addressed. SUMMARY Continued vigilance and investment is needed to address syphilis worldwide. The epidemiology of syphilis differs in high-income and low- and middle-income counties.
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Affiliation(s)
- Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, 90095
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, 90095
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90024
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Abstract
BACKGROUND After reaching an all-time low in 2000, syphilis incidence in the United States has increased as the burden shifted from heterosexuals to men who have sex with men (MSM). Houston, Texas, experienced 2 outbreaks of syphilis during this transformation in trends. Further evaluation is necessary to determine if these outbreaks occurred among the same subpopulations. METHODS Surveillance data collected on all reported infectious syphilis cases in Houston from 1971 to 2013 were analyzed. Trends in incidence among MSM and human immunodeficiency virus-positive Houston residents were examined. Peak syphilis years subsequent to 1999, years 2007 and 2012, were compared to determine if outbreaks arose in distinctive subpopulations. Categorical variables between these years were compared using chi-square and Fisher's exact tests, whereas further associations between the years were evaluated using multivariable logistic regression. RESULTS Incidence among MSM was 20.9 to 32.1 times higher than other men from 2005 to 2013. After adjusting for covariates, cases in 2012 were significantly more likely to be Hispanic (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [95% CI], 1.03-2.53), reported meeting partners via the Internet (AOR, 1.74; 95% CI, 1.18-2.58), and engaged in anonymous sex (AOR, 1.92; 95% CI, 1.40-2.63) in comparison to cases in 2007. CONCLUSIONS We found marked disparities of syphilis by subpopulation in Houston. Herein, we present evidence that outbreaks have been distinct in a major southern city with a high burden of syphilis.
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Albini T, Callaway NF, Pershing S, Wang SK, Moshfeghi AA, Moshfeghi DM. Trends in Hospitalization and Incidence Rate for Syphilitic Uveitis in the United States From 1998 to 2009. Am J Ophthalmol 2017; 180:133-141. [PMID: 28549847 DOI: 10.1016/j.ajo.2017.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluates the annual incidence of syphilitic uveitis in the US and trends in hospital admissions over time. DESIGN Retrospective, longitudinal incidence rate analysis of the National Inpatient Sample (NIS) data from 1998 to 2009. METHODS The NIS is a de-identified, random sample dataset of inpatient hospitalizations from 46 states. The number of cases of syphilitic uveitis was defined by (1) International Classification of Diseases, 9th Revision (ICD-9) code for syphilis and uveitis or (2) ICD-9 code for syphilitic uveitis. Annual case count, incidence rate, and trend over time were calculated. Multivariate logistic regression was used to evaluate associated factors for a syphilitic uveitis diagnosis. RESULTS The study included 455 310 286 hospitalizations during a 12-year study period with a mean of 37 942 524 patients annually. Syphilis and uveitis was recorded for 1861 patients (155 annually) and syphilitic uveitis was diagnosed in 204 subjects (average of 17 cases annually). There was no change in the incidence of syphilitic uveitis, using either definition, over the study period (P for trend = .46). The mean annual incidence of syphilis and uveitis was 0.0004%, or 4 per million. Syphilitic uveitis had an annual incidence of 0.000045%, or 0.45 per million. The odds of syphilitic uveitis were lower among women (odds ratio [OR] 0.40, CI 0.28-0.57) and increased with comorbid acquired immunodeficiency syndrome (OR 4.52, CI 3.01-6.79). CONCLUSIONS We report the first incidence of syphilitic uveitis in the United States. Fortunately, this remains a rare condition. The results demonstrate no change in the number of inpatient admissions for syphilitic uveitis during the study period.
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Affiliation(s)
- Thomas Albini
- Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, Miami, Florida
| | - Natalia F Callaway
- Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, Miami, Florida
| | - Suzann Pershing
- Byers Eye Institute at Stanford University School of Medicine, Palo Alto, California
| | - Sean K Wang
- Byers Eye Institute at Stanford University School of Medicine, Palo Alto, California
| | - Andrew A Moshfeghi
- Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, Miami, Florida; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Darius M Moshfeghi
- Byers Eye Institute at Stanford University School of Medicine, Palo Alto, California.
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Sociodemographic Factors, Sexual Behaviors, and Alcohol and Recreational Drug Use Associated with HIV Among Men Who Have Sex with Men in Southern Vietnam. AIDS Behav 2016; 20:2357-2371. [PMID: 26767537 DOI: 10.1007/s10461-015-1265-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A total of 2768 MSM participated in a survey in southern Vietnam. Univariate and multivariate logistic regression analyses were performed to determine predictors of HIV infection. The prevalence of HIV among MSM was 2.6 %. HIV infection was more likely in MSM who were older, had a religion, had engaged in anal sex with a foreigner in the past 12 months, previously or currently used recreational drugs, perceived themselves as likely or very likely to be infected with HIV, and/or were syphilis seropositive. MSM who had ever married, were exclusively or frequently receptive, sometimes consumed alcohol before sex, and/or frequently used condoms during anal sex in the past 3 months were less likely to be infected with HIV. Recreational drug use is strongly associated with HIV infection among MSM in southern Vietnam. HIV interventions among MSM should incorporate health promotion, condom promotion, harm reduction, sexually transmitted infection treatment, and address risk behaviors.
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Abstract
OBJECTIVES To evaluate the rates and types of sexually transmitted infections (STIs) in patients infected with the human immunodeficiency virus (HIV) attending a public STI clinic in Miami, Florida as compared with HIV-uninfected patients attending the same clinic. METHODS This was a retrospective review of medical records of individuals attending the Miami-Dade County Health Department STI clinic from March 2012 to May 2012. Demographic and clinical information was abstracted and transferred to an electronic database. Consecutive age-matched HIV-infected and HIV-uninfected patients were identified during the study period. Demographics, risk factors, and history and rates of STIs for HIV-infected and HIV-uninfected patients and for those with newly diagnosed and previously diagnosed HIV infection were compared. RESULTS A total of 175 medical records were reviewed (89 HIV-infected patients and 86 HIV-uninfected patients). The median age was 37 years. A history of STIs, including syphilis, was more common in HIV-infected than in HIV-uninfected patients. Individuals with a prior diagnosis of HIV were more likely to be older (older than 37 years of age, χ(2) = 15.3, P < 0.01), male (χ(2) = 4.74, P = 0.05), to have a new STI (χ(2) = 5.83, P = 0.01), to have a new diagnosis of syphilis (χ(2) = 5.15, P = 0.01), and to be under medical care (χ(2) = 31.19, P < 0.001) than those newly diagnosed as having HIV. CONCLUSIONS HIV-infected individuals who attended this urban STI clinic had high rates of new and past STIs, suggesting the persistence of high-risk sexual behaviors. STI clinics could be a premier site to identify individuals with HIV and high-risk sexual behaviors who could benefit from additional targeted interventions.
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Affiliation(s)
- Jose G Castro
- From the Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Maria Luisa Alcaide
- From the Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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Said MA, German D, Flynn C, Linton SL, Blythe D, Cooley LA, Balaji AB, Oster AM. Uptake of Testing for HIV and Syphilis Among Men Who Have Sex with Men in Baltimore, Maryland: 2004-2011. AIDS Behav 2015; 19:2036-43. [PMID: 26078117 DOI: 10.1007/s10461-015-1106-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Men who have sex with men (MSM) in Baltimore are at disproportionately high risk for HIV and syphilis infection. Testing and diagnosis are important first steps in receiving treatment and reducing transmission. We analyzed cross-sectional data collected in 2004-2005, 2008, and 2011 among MSM not reporting a previous positive HIV test (n = 1268) in Baltimore, Maryland as part of the National HIV Behavioral Surveillance System to determine the proportion of men tested for HIV and/or syphilis within the previous 12 months and examine the extent to which opportunities for testing were being missed in health care settings. Within the previous 12 months, 54 % of men had received an HIV test; 31 % had received a syphilis test; and only 23 % of men had received testing for both. Among 979 men who did not receive both tests, 72 % had seen a health care provider in the past year, suggesting missed testing opportunities.
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Arnold CA, Roth R, Arsenescu R, Harzman A, Lam-Himlin DM, Limketkai BN, Montgomery EA, Voltaggio L. Sexually transmitted infectious colitis vs inflammatory bowel disease: distinguishing features from a case-controlled study. Am J Clin Pathol 2015; 144:771-81. [PMID: 26486742 DOI: 10.1309/ajcpoid4jij6pisc] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Sexually transmitted infectious (STI) colitis often raises concern for inflammatory bowel disease (IBD). In this study, we compare histologic features of IBD with STI colitis caused by syphilis and lymphogranuloma venereum. METHODS The STI colitis group included 10 unique colorectal biopsy specimens in patients with clinically confirmed syphilis and/or lymphogranuloma venereum. The STI biopsy specimens were compared with patients matched for age, sex, and site with Crohn disease (n = 10) or ulcerative colitis (n = 10). All IBD controls had an established history of IBD (up to 276 months of follow-up, mean follow-up = 102 months). RESULTS Discriminating features (P < .05) of STI colitis included its exclusive identification in human immunodeficiency virus-positive men who have sex with men, anal pain, and anal discharge. STI colitis contained the triad of (1) minimal active chronic crypt centric damage, (2) a lack of mucosal eosinophilia, and (3) submucosal plasma cells, endothelial swelling, and perivascular plasma cells. Nondiscriminating features (P > .05) included rectal bleeding, endoscopic appearance, skip lesions, ulcerations, aphthoid lesions, granulomata, foreign body giant cells, neural hyperplasia, fibrosis, and lymphoid aggregates. CONCLUSIONS While STI colitis shares many overlapping features with IBD, histologic and clinical discriminating features may be helpful when confronted with that differential diagnosis.
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Maatouk I, Fahed M, Moutran R. Five cases of syphilis from an urban university hospital in Lebanon. Int J STD AIDS 2015; 25:973-4. [PMID: 25318856 DOI: 10.1177/0956462414546391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Roy Moutran
- Head of Dermatology Department, Mount Lebanon Hospital, Beirut, Lebanon
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23
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Tsai JC, Lin YH, Lu PL, Shen NJ, Yang CJ, Lee NY, Tang HJ, Liu YM, Huang WC, Lee CH, Ko WC, Chen YH, Lin HH, Chen TC, Hung CC. Comparison of serological response to doxycycline versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients: a multi-center observational study. PLoS One 2014; 9:e109813. [PMID: 25310367 PMCID: PMC4195693 DOI: 10.1371/journal.pone.0109813] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/01/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While doxycycline is recommended as an alternative treatment of syphilis in patients with penicillin allergy or intolerance, clinical studies to compare serological response to doxycycline versus benzathine penicillin in treatment of early syphilis among HIV-infected patients remain sparse. METHODS We retrospectively reviewed the medical records of HIV-infected patients with early syphilis who received doxycycline 100 mg twice daily for 14 days (doxycycline group) and those who received 1 dose of benzathine penicillin (2.4 million units) (penicillin group) between 2007 and 2013. Serological responses defined as a decline of rapid plasma reagin titer by 4-fold or greater at 6 and 12 months of treatment were compared between the two groups. RESULTS During the study period, 123 and 271 patients in the doxycycline and penicillin group, respectively, completed 6 months or longer follow-up. Ninety-one and 271 patients in the doxycycline and penicillin group, respectively, completed 12 months or longer follow-up. Clinical characteristics were similar between the two groups, except that, compared with penicillin group, doxycycline group had a lower proportion of patients with secondary syphilis (65.4% versus 41.5%, P<0.0001) and a higher proportion of patients with early latent syphilis (25.3% versus 49.6%, P<0.0001). No statistically significant differences were found in the serological response rates to doxycycline versus benzathine penicillin at 6 months (63.4% versus 72.3%, P = 0.075) and 12 months of treatment (65.9% versus 68.3%, P = 0.681). In multivariate analysis, secondary syphilis, but not treatment regimen, was consistently associated with serological response at 6 and 12 months of follow-up. CONCLUSIONS The serological response rates to a 14-day course of doxycycline and a single dose of benzathine penicillin were similar in HIV-infected patients with early syphilis at 6 and 12 months of follow-up. Patients with secondary syphilis were more likely to achieve serological response than those with other stages.
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Affiliation(s)
- Jen-Chih Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, Tzu-Chi Hospital and Tzu-Chi University College of Medicine, Hua-Lien, Taiwan
| | - Yu-Huei Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ni-Jiin Shen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yuag-Meng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Chi Huang
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsi-Hsun Lin
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Tun-Chieh Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
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Wang X, Lan G, Shen Z, Vermund SH, Zhu Q, Chen Y, Khoshnood K, Wu Z, Tang Z. HIV and syphilis prevalence trends among men who have sex with men in Guangxi, China: yearly cross-sectional surveys, 2008-2012. BMC Infect Dis 2014; 14:367. [PMID: 24993252 PMCID: PMC4091643 DOI: 10.1186/1471-2334-14-367] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/27/2014] [Indexed: 11/30/2022] Open
Abstract
Background Men who have sex with men (MSM) represent the fastest growing key population for incident HIV cases in China. We examined five consecutive years of HIV and syphilis prevalence and risk factors data among MSM in Guangxi Province with the second highest estimated number of people living with HIV/AIDS (PLWHAs) in China in 2011. Methods We collected demographic and behavioral data from national sentinel surveillance and HIV/syphilis blood samples in five annual cross-sectional surveys from 2008 to 2012. We analyzed HIV and syphilis prevalence trends stratified by social/behavioral characteristics. Results HIV prevalence climbed steadily from 1.7% (95% confidence interval [CI]: 1.0 to 3.0) in 2008 to 3.7% (95% CI: 3.0 to 5.0) in 2012. Syphilis prevalence increased steadily from 5.1% (95% CI: 4.0 to 6.0) in 2008 to 8.4% (95% CI: 7.0 to 10.0) in 2012. HIV prevalence rose notably among MSM who were ≤25 years of age, never married, did not engage in sexual intercourse with women in the past six months, and had not been tested for HIV in the past year. Syphilis prevalence rose notably among MSM who were >25 years of age, ever married or living with a partner, and engaged in sexual intercourse with women in the past six months. HIV prevalence was much higher in MSM with current syphilis than without. Finally, current syphilis was the most significant predictor of HIV infection, and age was the most significant predictor of syphilis infection. Conclusions HIV and the syphilis prevalence expansion among MSM suggest an urgent public health prevention challenge for Guangxi provincial health officials. Risk factors for each infection differed such that all MSM, each of whom might be at risk of HIV, syphilis or both, should be targets for heavy intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zhenzhu Tang
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, No, 18 Jinzhou Rd, Qingxiu District, Nanning 530028, Guangxi, PR China.
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25
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Paz-Bailey G, Shah N, Creswell J, Guardado ME, Nieto AI, Estrada MC, Cedillos R, Pascale JM, Monterroso E. Risk behaviors and STI prevalence among people with HIV in El Salvador. Open AIDS J 2012; 6:205-12. [PMID: 23049671 PMCID: PMC3462335 DOI: 10.2174/1874613601206010205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 09/06/2011] [Accepted: 09/19/2011] [Indexed: 11/22/2022] Open
Abstract
To date, there are no studies from El Salvador among people with HIV to inform prevention programs. We conducted a study in El Salvador in 2008 among people with HIV using audio computer-assisted interviews on risk behaviors and access to health care. Blood was tested for syphilis and herpes simplex type 2 (HSV-2). Active syphilis was defined as RPR titer ≥1:8. Genital specimens were tested for other sexually transmitted infections (STI) by PCR. We evaluated factors associated with unprotected sex with last stable partner of HIV-negative or unknown status among those reporting a stable partner. A total of 811 HIV-positive individuals participated: 413 men and 398 women. Prevalence of Chlamydia and gonorrhea was low (≤1%), while prevalence of other STI was high: Mycoplasma genitalium (14%), syphilis (15% seropositivity, active syphilis 3%) and HSV-2 (85%). In multivariate analysis, disclosing HIV status to partner (OR 0.2, 95% CI: 0.1-0.3, p<0.001), participation in HIV support groups (OR 0.3, 95% CI: 0.1-0.8, p=0.01), easy access to condoms (OR 0.4, 95% CI: 0.2-0.9, p=0.04) were protective factors for unprotected sex. Reporting a casual partner in the last 12 months (OR 3.6, 95% CI: 1.5-8.5, p=0.004). and having an STI (OR 2.6, 95% CI:1.3-5.5, p=0.02) were associated with an increased odds of unprotected sex. Prevention interventions among HIV-positives in El Salvador should focus on increasing condom access, promoting HIV disclosure and couples testing and reducing the number of partners. The positive role of support groups should be used to enhance behavioral change.
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Affiliation(s)
- G Paz-Bailey
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) Central American office,
Guatemala City, Guatemala
- Centre for Health Studies, Del Valle University, Guatemala City, Guatemala
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Shah
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Creswell
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) Central American office,
Guatemala City, Guatemala
- Centre for Health Studies, Del Valle University, Guatemala City, Guatemala
| | - ME Guardado
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) Central American office,
Guatemala City, Guatemala
| | - AI Nieto
- Ministry of Health, San Salvador, El Salvador
| | - MC Estrada
- United States Agency for International Development, San Salvador, El Salvador
| | - R Cedillos
- Hospital Rosales, San Salvador, El Salvador
| | - JM Pascale
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - E Monterroso
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, Brookmeyer R. Global epidemiology of HIV infection in men who have sex with men. Lancet 2012; 380:367-77. [PMID: 22819660 PMCID: PMC3805037 DOI: 10.1016/s0140-6736(12)60821-6] [Citation(s) in RCA: 1133] [Impact Index Per Article: 94.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. We sought to understand the epidemiological drivers of the global epidemic in MSM and why it continues unabated. We did a comprehensive review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and modelled the dynamics of HIV transmission with an agent-based simulation. Our findings show that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiological data show substantial clustering of HIV infections in MSM networks, and higher rates of dual-variant and multiple-variant HIV infection in MSM than in heterosexual people in the same populations. Prevention strategies that lower biological transmission and acquisition risks, such as approaches based on antiretrovirals, offer promise for controlling the expanding epidemic in MSM, but their potential effectiveness is limited by structural factors that contribute to low health-seeking behaviours in populations of MSM in many parts of the world.
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Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND In a largely rural region of North Carolina during 1998-2002, outbreaks of heterosexually transmitted syphilis occurred, tied to crack cocaine use and exchange of sex for drugs and money. Sexual partnership mixing patterns are an important characteristic of sexual networks that relate to transmission dynamics of sexually transmitted infections (STIs). METHODS Using contact tracing data collected by disease intervention specialists, we estimated Newman assortativity coefficients and compared values in counties experiencing syphilis outbreaks to nonoutbreak counties, with respect to race/ethnicity, race/ethnicity and age, and the cases' number of social/sexual contacts, infected contacts, sex partners, and infected sex partners, and syphilis disease stage (primary, secondary, early latent). RESULTS Individuals in the outbreak counties had more contacts and mixing by the number of sex partners was disassortative in outbreak counties and assortative nonoutbreak counties. Although mixing by syphilis disease stage was minimally assortative in outbreak counties, it was disassortative in nonoutbreak areas. Partnerships were relatively discordant by age, especially among older white men, who often chose considerably younger female partners. CONCLUSIONS Whether assortative mixing exacerbates or attenuates the reach of STIs into different populations depends on the characteristic/attribute and epidemiologic phase. Examination of sexual partnership characteristics and mixing patterns offers insights into the growth of STI outbreaks that complement other research methods.
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Solomon TM, Halkitis PN, Moeller RM, Siconolfi DE, Kiang MV, Barton SC. Sex parties among young gay, bisexual, and other men who have sex with men in New York City: attendance and behavior. J Urban Health 2011; 88:1063-75. [PMID: 21698548 PMCID: PMC3232420 DOI: 10.1007/s11524-011-9590-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Very little information exists with regard to sex party behaviors in young men who have sex with men (YMSM), often defined as men ranging in age from 13 to 29 years. The current analysis examines sex party attendance and behavior in a sample of 540 emergent adult gay, bisexual, and other YMSM in New York City, ages 18-29 years. Findings indicate that 8.7% (n = 47) of the sample had attended a sex party 3 months prior to assessment. Sex party attendees reported that parties included both HIV-positive and HIV-negative men; attendees also reported unprotected sex and limited access to condoms and lubricant. As compared with those who did not attend sex parties, those who did indicated significantly more lifetime and recent (last 3 months) casual sex partners, drug use (both number of different drugs used and total lifetime use), psychosocial burden (history of partner violence and number of arrests), and total syndemic burden (a composite of unprotected anal sex, drug use and psychosocial burden). These results indicate that while only a small percentage of the overall sample attended sex parties, the intersection of both individual risk factors coupled with risk factors engendered within the sex party environment itself has the potential to be a catalyst in the proliferation of the HIV/AIDS epidemic in urban settings. Lastly, given that sex parties are different than other sex environments, commercial and public, with regard to how they are accessed, public health strategies may need to become more tailored in order to reach this potentially highly risky group.
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Affiliation(s)
- Todd M Solomon
- Center for Health, Identity, Behavior, and Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA.
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Liao M, Kang D, Jiang B, Tao X, Qian Y, Wang T, Bi Z, Xiao Y, Li C, Wu P, Vermund SH, Jia Y. Bisexual behavior and infection with HIV and syphilis among men who have sex with men along the east coast of China. AIDS Patient Care STDS 2011; 25:683-91. [PMID: 21923416 DOI: 10.1089/apc.2010.0371] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Meizhen Liao
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Dianming Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Baofa Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province, P.R. China
| | - Xiaorun Tao
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Yueshen Qian
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Tongzhan Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Yan Xiao
- National AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, P.R. China
| | - Chunmei Li
- National AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, P.R. China
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Yujiang Jia
- Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Institute for Global Health, Vanderbilt University, Nashville, Tennessee
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Abstract
PURPOSE OF REVIEW Clinicians should be aware of the shift in the cutaneous infectious disease burden in human immunodeficiency virus-infected individuals as a reflection of immune restoration in the era of highly active antiretroviral therapy (HAART). RECENT FINDINGS As in the general population but to greater extent, methicillin-resistant Staphylococcus aureus (MRSA) soft-tissue infection is a rising problem among those with human immunodeficiency virus (HIV). Human papilloma virus (HPV) is exceedingly prevalent and persistent despite HAART, and HPV-associated malignancy is increasing as those with HIV live longer. Herpes, syphilis, and Kaposi's sarcoma continue to plague individuals with HIV. Immune reconstitution inflammatory syndrome (IRIS) is common and often presents with infectious cutaneous manifestations. SUMMARY This review implicates the importance of the acknowledgment of MRSA infections risk factors, screening for HPV-related neoplasia, continuance of trials to establish the efficacy of herpes vaccines, and awareness of prevalent cutaneous infections presenting with IRIS in those with HIV.
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Repiso B, Frieyro M, Rivas-Ruiz F, De Troya M. Uso de preservativo y número de parejas sexuales en hombres que tienen sexo con hombres con sífilis. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study. AIDS 2010; 24:1907-16. [PMID: 20616699 DOI: 10.1097/qad.0b013e32833bfe21] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. METHODS Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. RESULTS Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:>or=32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. CONCLUSION Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.
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Xiao Y, Sun J, Li C, Lu F, Allen KL, Vermund SH, Jia Y. Prevalence and correlates of HIV and syphilis infections among men who have sex with men in seven provinces in China with historically low HIV prevalence. J Acquir Immune Defic Syndr 2010; 53 Suppl 1:S66-S73. [PMID: 20104113 DOI: 10.1097/qai.0b013e3181c7db43] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess HIV and syphilis infection among men who have sex with men (MSM) in Chinese regions with historically low HIV prevalence. METHOD A cross-sectional survey was conducted in 20 cities or districts across 4 provinces, 2 autonomous regions, and a municipality. Socioeconomic/behavioral risk factors were measured. Blood samples were tested for HIV via enzyme-linked immunosorbent assay and Western blot confirmation and syphilis via rapid plasma reagin and passive particle agglutination test for detection of Treponema pallidum Antibodies. RESULTS Of 4983 MSM participants, 2.9% were HIV infected (range: 0%-15.1%) and 9.8% were syphilis infected (1.3%-29.3%). Syphilis infection was associated with older age [adjusted odds ratio (AOR) = 2.9; 95% confidence interval (CI): 2.0 to 4.3], not being married or cohabiting (AOR = 0.7; 95% CI: 0.5-0.9), less education (AOR = 1.3; 95% CI: 1.0 to 1.7), inconsistent condom use during anal sex with men (AOR = 1.4; 95% CI: 1.0 to 1.8), and living in inner Mongolia (AOR = 23.9; 95% CI: 9.7 to 58.6), Jilin (AOR = 7.9; 95% CI: 3.4 to 18.3), Heilongjiang (AOR = 7.1; 95% CI: 3.1 to 16.6), Liaoning (AOR = 6.1; 95% CI: 2.6 to 14.2), or Chongqing (AOR = 5.9; 95% CI: 2.5 to 13.9). HIV infection was associated with older age (AOR = 3.7; 95% CI: 2.0 to 6.7), less education (AOR = 2.9; 95% CI: 1.8 to 4.7), inconsistent condom use during anal sex with men (AOR = 1.9; 95% CI: 1.2 to 3.2), syphilis infection (AOR = 2.1; 95% CI: 1.3 to 3.4), and living either in Liaoning (AOR = 8.2; 95% CI: 1.1 to 61.4) or Chongqing (AOR = 57.2; 95% CI: 7.9 to 414.4). CONCLUSIONS HIV and syphilis have reached alarming rates in China's MSM population, thus, appropriate responses are urgently needed.
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Affiliation(s)
- Yan Xiao
- National Center for AIDS/STD Control and Prevention, Beijing, People's Republic of China
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Prevalence and correlates of HIV and syphilis infections among men who have sex with men in Chongqing Municipality, China. Sex Transm Dis 2010; 36:647-56. [PMID: 19955876 DOI: 10.1097/olq.0b013e3181aac23d] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the prevalence and correlates of HIV/syphilis infections and sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Chongqing, China. METHOD Cross-sectional surveys were conducted to provide information, including sociodemographics, sexual and drug use behaviors, HIV knowledge, and HIV-related services in 2006 and 2007, respectively. Multiple methods, including venue-based recruitment, community outreach, Internet advertisements, and peer referral, were used to identify men in Chongqing willing to participate in this study. RESULTS Of the 1692 participants, 10.8% were HIV-infected (range by district: 7.0%-15.0%), 8.6% were syphilis-infected, and 15.3% self-reported STD-related symptoms. HIV infection was associated with older age, recruitment from bathhouses/saunas, less education, more male sex partners, sex with a woman in the past 6 months, syphilis infection, and STD-related symptoms. Syphilis infection was associated with older age, less education, inconsistent condom use with a man, STD-related symptoms, and HIV infection. STD-related symptoms were associated with older age, being of nonlocal residency, inconsistent condom use with a humans, having ever paid for sex with a humans, HIV infection, and being from District 1. CONCLUSIONS HIV and syphilis infections have reached alarmingly high rates in Chongqing's MSM population. Better targeted, in-depth and comprehensive intervention strategies are needed urgently, including education, condom promotion and distribution, STD control, drug use-related intervention, and advocacy for HIV counseling and testing with bridges to HIV prevention and care services. Widespread testing for HIV, syphilis, and other major STDs in this risk group should be considered as measures for control.
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Repiso B, Frieyro M, Rivas-Ruiz F, De Troya M. Condom Use and Number of Sexual Partners among Male Syphilis Patients who Report Having Sex with Men. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70731-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Leber A, MacPherson P, Lee BC. Epidemiology of infectious syphilis in Ottawa. Recurring themes revisited. Canadian Journal of Public Health 2009. [PMID: 19009926 DOI: 10.1007/bf03405250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the epidemiology of an outbreak of infectious syphilis in Ottawa. METHODS A retrospective chart review of infectious syphilis cases in Ottawa from 2001-2006. RESULTS Rates of syphilis have risen more than tenfold. The epidemic was centered in men, with the majority of cases (83.5%) occurring among men who have sex with men (MSM). These individuals differed from the general MSM population residing in Ottawa in their being older, more likely to be HIV positive, and more sexually promiscuous. Inconsistent condom use by MSM engaged in either oral or anal sex was pervasive. Thirty-seven percent of MSM reported sexual encounters with men from Montreal and Toronto. Visceral manifestations of syphilis, including neurosyphilis, were more common in persons co-infected with HIV. As a result, this subgroup was more likely to have received an extended antibiotic treatment regimen. There was a substantial delay between serological diagnosis and treatment. Less than half of treated cases returned for a six-month evaluation. CONCLUSIONS Multiple sexual partners, unprotected oral sex, and increased age among MSM were the predominant risk factors contributing to this syphilis epidemic. Co-infection with HIV modified the clinical presentation of syphilis, necessitating a more intensive diagnostic and therapeutic approach. The interconnection of urban sexual networks has likely contributed to the dynamics of local syphilis transmission and suggests that effective interventions will require a coordinated national approach.
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Affiliation(s)
- Aviva Leber
- Department of Medicine, University of Ottawa, Ottawa, ON
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Kee HY, Choi BS, Seo JJ, Kim SH, Kim MJ, Kim ES, Park JT, Chung JK. The Distribution of Seropositivities for Human Immunodeficiency Virus and, Syphilis and the Gonorrhea Positive Rates in Gwangju (2002-2006). Infect Chemother 2009. [DOI: 10.3947/ic.2009.41.4.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Young Kee
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
| | - Byeong-Sun Choi
- Division of AIDS, Center for Immunology and Pathology, Korea National Institute of Health, Seoul, Korea
| | - Jin Jong Seo
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
| | - Sun Hee Kim
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
| | - Min Ji Kim
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
| | - Eun Sun Kim
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
| | - Jong Tae Park
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
| | - Jae Keun Chung
- Health Research Department, Health and Environment Institute of Gwangju, Gwangju, Korea
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Park WB, Jang HC, Kim SH, Kim HB, Kim NJ, Oh MD, Choe KW. Effect of highly active antiretroviral therapy on incidence of early syphilis in HIV-infected patients. Sex Transm Dis 2008; 35:304-6. [PMID: 18157070 DOI: 10.1097/olq.0b013e31815b0148] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the incidence of early syphilis based on time from initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients. STUDY DESIGN Five hundred thirty-nine HIV-positive patients undergoing HAART were followed up to 4 years to identify early (primary or secondary) syphilis. Incidence rate trends according to time from HAART initiation were evaluated by Poisson regression after adjustment for calendar year. RESULTS With median follow-up of 2.9 years, 56 (10.4%) patients experienced early syphilis, 17 (3.2%) with primary syphilis, and 39 (7.2%) with secondary syphilis. The overall incidence rate of early syphilis for 4 years after the start of HAART was 4.57 per 100 person-years (95% confidence interval, 3.45-5.93). The incidence rate of early syphilis significantly increased in proportion to the years after the start of HAART (3.4-6.1 per 100 person-year, P for trend <0.001). CONCLUSIONS Early syphilis incidence in HIV-infected patients increased in proportion to HAART duration. The finding suggests that screening for syphilis in HIV-infected patients who initiate HAART should be encouraged with attention to the time passed since HAART initiation.
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Affiliation(s)
- Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Maves RC, Cachay ER, Young MA, Fierer J. Secondary syphilis with ocular manifestations in older adults. Clin Infect Dis 2008; 46:e142-5. [PMID: 18462103 DOI: 10.1086/588483] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe 4 patients (age, >50 years) with secondary syphilis. All patients presented with ocular syphilis, and 2 presented with syphilis-negative rapid plasma reagin titers due to a prozone phenomenon. Three male patients reported sildenafil use. The presentation of these patients with ocular syphilis suggests the need for additional clinical studies involving older patients.
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Affiliation(s)
- Ryan C Maves
- United States Naval Medical Research Center Detachment, Lima, Peru.
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Chesson HW, Collins D, Koski K. Formulas for estimating the costs averted by sexually transmitted infection (STI) prevention programs in the United States. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:10. [PMID: 18500996 PMCID: PMC2426671 DOI: 10.1186/1478-7547-6-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 05/23/2008] [Indexed: 01/30/2023] Open
Abstract
Background Sexually transmitted infection (STI) prevention programs can mitigate the health and economic burden of STIs. A tool to estimate the economic benefits of STI programs could prove useful to STI program personnel. Methods We developed formulas that can be applied to estimate the direct medical costs and indirect costs (lost productivity) averted by STI programs in the United States. Costs and probabilities for these formulas were based primarily on published studies. Results We present a series of formulas that can be used to estimate the economic benefits of STI prevention (in 2006 US dollars), using data routinely collected by STI programs. For example, the averted sequelae costs associated with treating women for chlamydia is given as (Cw)(0.16)(0.925)(0.70)($1,995), where Cw is the number of infected women treated for chlamydia, 0.16 is the absolute reduction in the probability of pelvic inflammatory disease (PID) as a result of treatment, 0.925 is an adjustment factor to prevent double-counting of PID averted in women with both chlamydia and gonorrhea, 0.70 is an adjustment factor to account for the possibility of re-infection, and $1,995 is the average cost per case of PID, based on published sources. Conclusion The formulas developed in this study can be a useful tool for STI program personnel to generate evidence-based estimates of the economic impact of their program and can facilitate the assessment of the cost-effectiveness of their activities.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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HIV Incidence Among Men Diagnosed With Early Syphilis in Atlanta, San Francisco, and Los Angeles, 2004 to 2005. J Acquir Immune Defic Syndr 2008; 27:634-9. [PMID: 18580252 DOI: 10.1097/qai.0b013e31815e4011] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Decreases in AIDS Mortality and Increases in Primary and Secondary Syphilis in Men Who Have Sex With Men in the United States. J Acquir Immune Defic Syndr 2008; 27:640-3. [DOI: 10.1097/qai.0b013e31815e4062] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manning SE, Pfeiffer MR, Nash D, Blank S, Sackoff J, Schillinger J. Incident sexually transmitted infections among persons living with diagnosed HIV/AIDS in New York City, 2001-2002: a population-based assessment. Sex Transm Dis 2008; 34:1008-15. [PMID: 17621243 DOI: 10.1097/olq.0b013e3180eaa243] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/GOAL To describe the incidence of 3 bacterial sexually transmitted infections (STIs) among persons living with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) (PLWHA) in New York City (NYC) and to identify predictors for STI acquisition. STUDY DESIGN The surveillance registry of PLWHA diagnosed with HIV through December 31, 2000, and reported to the NYC Department of Health and Mental Hygiene was matched with the surveillance registry of persons diagnosed with other STIs during 2001-2002. Incident STIs were defined as cases of gonorrhea, chlamydia, or early syphilis acquired after HIV diagnosis. RESULTS Among 62,264 NYC PLWHA, 1466 (2.4%) had an incident STI diagnosed during 2001-2002. Two-year cumulative STI incidence was highest among PLWHA who were men (2.6%), non-Hispanic white (3.2%), aged 13-24 years (8.4%), men who have sex with men (4.5%), and persons living with HIV (non-AIDS) (4.1%). Predictors of STI acquisition among PLWHA varied substantially by STI type. CONCLUSIONS This population-based surveillance registry cross-match reveals that high-risk sexual practices occur among specific segments of the NYC PLWHA population. To decrease associated morbidity and prevent the secondary spread of HIV and STIs, prevention efforts should focus on PLWHA who continue to engage in high-risk sexual activity.
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Affiliation(s)
- Susan E Manning
- New York City Department of Health and Mental Hygiene, New York City, New York, USA.
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Niccolai LM, Livingston KA, Richardson W, Jenkins H. Sex partner meeting venues and out-of-state sex partners among men who have sex with men with early syphilis in Connecticut. Sex Transm Dis 2008; 34:887-91. [PMID: 17565333 DOI: 10.1097/olq.0b013e3180646422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine sex partner meeting venues and out-of-state sex partners among men who have sex with men (MSM) with syphilis in Connecticut, a state with moderate syphilis prevalence. GOAL To better understand transmission dynamics in the current syphilis epidemic. STUDY DESIGN Review of health department records. RESULTS A total of 185 MSM were diagnosed with early syphilis in Connecticut from 2000 to 2005 (mean age, 36 years; 56% white, 37% HIV-positive). Fifty-two percent of cases reported meeting sex partners at venues that facilitate multiple and/or anonymous sexual encounters including gay clubs or bars (22%), Internet (18%), and adult bookstores (12%). Meeting sex partners in venues increased over time and was associated with nonmetropolitan residence of the case. Forty-three percent of cases had an out-of-state sex partner during the time in which they likely acquired their infection. Having out-of-state sex partners decreased during the study period. Throughout 2000-2005, having out-of-state sex partners was positively associated with bathhouse use and negatively associated with use of adult bookstores. CONCLUSIONS The observed pattern of increased meeting sex partners in venues located within the state and decreased out-of-state sex partners over time is suggestive of increasing transmission within the state of Connecticut.
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Affiliation(s)
- Linda M Niccolai
- Yale University Department of Epidemiology and Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA.
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Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 2007; 21:2083-91. [PMID: 17885299 DOI: 10.1097/qad.0b013e3282e9a64b] [Citation(s) in RCA: 440] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States. METHODS A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies. RESULTS Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53-0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45-0.92), less gay identity (OR, 0.29; 95% CI, 0.17-0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30-0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30-0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07-2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history. CONCLUSIONS Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.
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Affiliation(s)
- Gregorio A Millett
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Ruan Y, Li D, Li X, Qian HZ, Shi W, Zhang X, Yang Z, Zhang X, Wang C, Liu Y, Yu M, Xiao D, Hao C, Xing H, Hong K, Shao Y. Relationship between syphilis and HIV infections among men who have sex with men in Beijing, China. Sex Transm Dis 2007; 34:592-7. [PMID: 17325622 DOI: 10.1097/01.olq.0000253336.64324.ef] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about risk of HIV and other STDs among men who have sex with men (MSM) in China. OBJECTIVE To survey the prevalence and risk factors of HIV and syphilis and evaluate correlation of two infections among MSM in the Chinese capital city. METHODS A community-based sample of 526 MSM was recruited in 2005 through Internet advertising, community outreach, and peer referring. Interviewer-administered interviews were conducted to collect information on demographics and sexual and other risk behaviors, and blood samples were collected to test for syphilis and HIV infections. RESULTS Seventeen (3.2%) participants were HIV seropositive and 59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants who did not have Beijing residence. Forty percent had >10 lifetime male sex partners and 28.8% reported having ever had sex with women. Consistent condom use with primary male sex partners ranged from 21% to 24%, with nonprimary male sex partners from 35% to 42%, and with female partners around 33%. Illicit drug use was not common; only 2.5% reported using Ecstasy or ketamine in the past 6 months. Multivariate logistic regression analyses demonstrated that >10 lifetime male sex partners were independently associated with seropositivity of both syphilis (OR, 1.9; 95% CI, 1.1-3.4) and HIV (OR, 4.3; 95% CI, 1.4-13.6). In addition, HIV infection is significantly associated with syphilis seropositivity (OR, 3.8; 95% CI, 1.3-10.8). CONCLUSIONS High mobility, multiple sexual partners, and high prevalence of unprotected sex behaviors and syphilis infection suggest a potential rapid spread of HIV in Chinese MSM.
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Affiliation(s)
- Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Faissol DM, Swann JL, Kolodziejski B, Griffin PM, Gift TL. The role of bathhouses and sex clubs in HIV transmission: findings from a mathematic model. J Acquir Immune Defic Syndr 2007; 44:386-94. [PMID: 17279050 DOI: 10.1097/qai.0b013e31803220dd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bathhouses and sex clubs were identified as primary venues for HIV transmission during the original HIV epidemic. Because HIV incidence is increasing in some high-risk groups, their potential role in HIV transmission is being examined again. We present an extension of the Bernoulli process model of HIV transmission to incorporate subpopulations with different behaviors in sex acts, condom use, and choice of partners in a single period of time. With this model, we study the role that bathhouses and sex clubs play in HIV transmission using data from the 1997 Urban Men's Health Study. If sexual activity remains the same, we find that bathhouse closures would likely lead to a small increase in HIV transmission in the period examined by this study, although this impact is less than that which would be achieved through a 1% change in current condom use rates. If, conversely, bathhouse closure leads to a reduction of the sexual activity that was in the bathhouse by at least 2%, HIV transmission would be lowered.
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Affiliation(s)
- Daniel M Faissol
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0205, USA
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Drumright LN, Strathdee SA, Little SJ, Araneta MRG, Slymen DJ, Malcarne VL, Daar ES, Gorbach PM. Unprotected anal intercourse and substance use before and after HIV diagnosis among recently HIV-infected men who have sex with men. Sex Transm Dis 2007; 34:401-7. [PMID: 17091117 DOI: 10.1097/01.olq.0000245959.18612.a1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess associations between unprotected anal intercourse (UAI) and substance use before and after HIV diagnosis among recently HIV-infected MSM. STUDY DESIGN Two hundred seven MSM completed computer-assisted self-interviews regarding type and timing of sexual activity and substance use with their last 3 partners. Date of HIV diagnosis was extracted from medical records. Generalized estimating equations, including interaction terms, were used to assess associations between substance use and UAI before and after HIV diagnosis. RESULTS Among partners with whom sexual activity occurred before diagnosis, UAI was associated with methamphetamine use alone (odds ratio = 7.12) and a combination of methamphetamine and other substances (odds ratio = 4.06). However, after HIV diagnosis, UAI was associated with use of substances other than methamphetamine (odds ratio = 3.36), but not methamphetamine alone. CONCLUSIONS Use of illicit substances may be differentially associated with UAI based on knowledge of HIV status and could have implications for prevention of HIV transmission.
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Affiliation(s)
- Lydia N Drumright
- Antiviral Research Center, Department of Medicine, University of California, San Diego, California, USA.
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Choi KH, Ning Z, Gregorich SE, Pan QC. The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China. J Acquir Immune Defic Syndr 2007; 45:77-84. [PMID: 17325608 DOI: 10.1097/qai.0b013e3180415dd7] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze characteristics of social and sexual networks and their role as risk factors for HIV and syphilis among men who have sex with men (MSM) in Shanghai, China. DESIGN : A cross-sectional study. METHODS We recruited 477 participants using a snowball sampling method. We administered a face-to-face questionnaire and provided testing and counseling for HIV and syphilis. RESULTS The prevalences of HIV and markers for syphilis were 1.47% (95% confidence interval [CI]: 0.59 to 3.01) and 13.47% (95% CI: 10.53 to 16.88), respectively. The independent factors associated with lower risk for syphilis infection were having a contact network, overlap of social and sexual networks, meeting other MSM at the gym or through the Internet, having 3 to 5 lifetime male anal sex partners, and having a female steady sex partner. A larger male sexual network size, having been married, being more knowledgeable about HIV, having 6 or more lifetime male anal sex partners, and having steady male or female sex partners were independently associated with having unprotected anal or vaginal intercourse. CONCLUSIONS Significant associations were found between network characteristics and syphilis infection and unprotected sex. Network-based interventions should be developed to reduce this HIV risk among MSM in China.
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Affiliation(s)
- Kyung-Hee Choi
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94105, USA.
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Abstract
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.
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Affiliation(s)
- Thomas A Peterman
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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