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Eijmael MJP, Bruin RGD, Hira V, Koster T. A peculiar case of syphilis infection: The great imitator is on the rise. IDCases 2022; 28:e01521. [PMID: 35646595 PMCID: PMC9136118 DOI: 10.1016/j.idcr.2022.e01521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
The incidence of syphilis is on the rise worldwide and can pose many diagnostic and therapeutic difficulties for doctors. Given the wide variety of presenting symptoms, syphilis is also known as the great imitator, which in turn frequently leads to a pronounced diagnostic- and therapeutic delay for patients. Here we present a case report of syphilitic uveitis and papillitis accompanied by acute vision loss, a rare presentation of a tertiary syphilis infection that clinically mimicked a giant cell arteritis (GCA) or arteritic anterior ischemic optic neuropathy (AAION). The patient was treated with high-dose intravenous benzyl penicillin after which full vision was restored. By presenting this case, we hope to raise awareness for the increasing incidence of syphilis infections and stress the importance of syphilis testing in patients with otherwise unexplained uveitis.
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Affiliation(s)
- MJP Eijmael
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - RG de Bruin
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - V. Hira
- Department of Medical Microbiology and Infection Prevention, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - T. Koster
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
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2
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Richardson D, Fitzpatrick C, Devlin J, Buss Z, Parkes L, Williams D. Primary syphilis lesion characteristics, serological response and management in HIV-positive and HIV-negative men who have sex with men. Int J STD AIDS 2020; 31:1359-1363. [PMID: 32996869 DOI: 10.1177/0956462420956859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The characteristics and serological responses of primary syphilis are not completely understood. We aimed to describe the characteristics, the serological responses and presumptive treatment of primary syphilis in HIV-positive and -negative men who have sex with men (MSM). We conducted a retrospective review of microbiological and demographic information from MSM presenting with primary syphilis. There were 111 cases of primary syphilis in MSM, the median age was 46 (IQR = 37-53years) and 40 (36%) were living with HIV. Fifty percent of MSM presented with painful lesions and 14% with extra-genital lesions. Extra-genital lesions were significantly more likely to be painful than non-genital lesions (OR 4.72; 95%CI = 1.25-17.83, p = 0.02). Overall, a reactive serological response demonstrated a sensitivity of 80% (57/71) compared with Treponema pallidum PCR. Serology was more sensitive in MSM with no previous syphilis (OR = 3.38, 95%CI = 1.00-11.43, p < 0.05). MSM presenting with painless lesions were more likely to be treated presumptively (OR = 3.39, 95%CI = 1.38-8.33, p < 0.002). There were no differences in the characteristics, serological responses or management according to HIV status. Fifty percent of MSM with primary syphilis presented with painful lesions; extra-genital lesions are more likely to be painful than genital lesions, serology is positive in 80% and there were no differences between HIV-positive and -negative MSM. Understanding the characteristics of primary syphilis will underpin public health campaigns.
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Affiliation(s)
- Daniel Richardson
- Brighton & Sussex University NHS Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | - John Devlin
- Brighton & Sussex University NHS Trust, Brighton, UK
| | - Zoe Buss
- Brighton & Sussex University NHS Trust, Brighton, UK
| | - Luke Parkes
- Brighton & Sussex University NHS Trust, Brighton, UK
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3
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Bandara HMHN, Samaranayake LP. Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management. Periodontol 2000 2019; 80:148-176. [PMID: 31090135 DOI: 10.1111/prd.12273] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.
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Affiliation(s)
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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4
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Abstract
BACKGROUND The success of an intervention to prevent syphilis will depend on the context and the goal of the intervention. To help programs choose interventions, we reviewed major changes in context and types of interventions that may be effective. METHODS We reviewed the literature on the changing context of syphilis in the United States and interventions to prevent syphilis, focusing on articles that included evidence of effectiveness. RESULTS Populations acquiring syphilis are constantly changing. Currently, incidence is very high among men who have sex with men (MSM). Among adults, late disease caused by syphilis has become rare. Congenital syphilis incidence has been low but is increasing, and morbidity and mortality remain high when babies are infected. Congenital syphilis now causes more deaths than syphilis among adults.Routine screening of MSM can identify and treat infections before they progress to disease (secondary prevention). Screening rates are highest when done as part of routine standing orders. Partner notification effectiveness has decreased, partly because many partners are anonymous. Most congenital syphilis can be prevented by screening pregnant women; it has been eliminated in areas where intense primary prevention efforts eliminated syphilis among women. CONCLUSIONS So far, no program has stopped the increasing rates of infection among MSM, but secondary prevention efforts have prevented most disability. Congenital syphilis is increasing, and can be decreased by screening pregnant women and stopped by intensive efforts to prevent infection among women.
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Affiliation(s)
- Thomas A Peterman
- From the Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
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5
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Chow EPF, Callander D, Fairley CK, Zhang L, Donovan B, Guy R, Lewis DA, Hellard M, Read P, Ward A, Chen MY. Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis. Clin Infect Dis 2018; 65:389-395. [PMID: 28419198 DOI: 10.1093/cid/cix326] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/12/2017] [Indexed: 11/14/2022] Open
Abstract
Background Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Methods Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. Results 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91%; Ptrend < .0001) and HIV-positive MSM (42% to 77%; Ptrend < .0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend < .0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend < .0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend < .0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend = .030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend < .0001), while secondary infections decreased from 45% to 26% (Ptrend = .0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87; P = .005) or frequency (r = -0.93; P = .001). Conclusions Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria
| | - Denton Callander
- The Kirby Institute.,Centre for Social Research in Health, UNSW Sydney
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria
| | - Basil Donovan
- The Kirby Institute.,Sydney Sexual Health Centre, Sydney Hospital
| | | | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta.,Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, New South Wales
| | - Margaret Hellard
- Burnet Institute.,Infectious Disease Unit, Alfred Hospital, Melbourne, Victoria
| | - Phillip Read
- The Kirby Institute.,Kirketon Road Centre, Kings Cross, Sydney, New South Wales
| | - Alison Ward
- Clinic 275, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria
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6
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Petrosky E, Neblett Fanfair R, Toevs K, DeSilva M, Schafer S, Hedberg K, Braxton J, Walters J, Markowitz L, Hariri S. Early Syphilis Among Men Who Have Sex with Men in the US Pacific Northwest, 2008-2013: Clinical Management and Implications for Prevention. AIDS Patient Care STDS 2016; 30:134-40. [PMID: 27308806 DOI: 10.1089/apc.2015.0306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Substantial increases in syphilis during 2008-2013 were reported in the US Pacific Northwest state of Oregon, especially among men who have sex with men (MSM). The authors aimed to characterize the ongoing epidemic and identify possible gaps in clinical management of early syphilis (primary, secondary, and latent syphilis ≤1 year) among MSM in Multnomah County, Oregon to inform public health efforts. Administrative databases were used to examine trends in case characteristics during 2008-2013. Medical records were abstracted for cases occurring in 2013 to assess diagnosis, treatment, and screening practices. Early syphilis among MSM increased from 21 cases in 2008 to 229 in 2013. The majority of cases occurred in HIV-infected patients (range: 55.6%-69.2%) diagnosed with secondary syphilis (range: 36.2%-52.4%). In 2013, 119 (51.9%) cases were diagnosed in public sector medical settings and 110 (48.0%) in private sector settings. Over 80% of HIV-infected patients with syphilis were in HIV care. Although treatment was adequate and timely among all providers, management differed by provider type. Among HIV-infected patients, a larger proportion diagnosed by public HIV providers than private providers were tested for syphilis at least once in the previous 12 months (89.6% vs. 40.0%; p < 0.001). The characteristics of MSM diagnosed with early syphilis in Multnomah County remained largely unchanged during 2008-2013. Syphilis control measures were well established, but early syphilis among MSM continued to increase. The results suggest a need to improve syphilis screening among private clinics, but few gaps in clinical management were identified.
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Affiliation(s)
- Emiko Petrosky
- 1 Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia
- 2 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Robyn Neblett Fanfair
- 2 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Kim Toevs
- 3 Adolescent Health Promotion and STD/HIV/HCV Programs , Multnomah County Public Health Department, Portland, Oregon
| | - Malini DeSilva
- 1 Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia
- 4 HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Sean Schafer
- 4 HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Katrina Hedberg
- 4 HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Jim Braxton
- 2 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Jaime Walters
- 3 Adolescent Health Promotion and STD/HIV/HCV Programs , Multnomah County Public Health Department, Portland, Oregon
| | - Lauri Markowitz
- 2 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Susan Hariri
- 2 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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7
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Towns JM, Leslie DE, Denham I, Azzato F, Fairley CK, Chen M. Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study. Sex Transm Infect 2015; 92:110-5. [PMID: 26378262 DOI: 10.1136/sextrans-2015-052219] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/31/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chancres, the hallmark of primary syphilis, are classically described as single, painless ulcers at the site of Treponema pallidum inoculation. We aimed to determine the frequency of painful or multiple anogenital lesions of primary syphilis among men, whether there was concurrent herpes simplex virus (HSV) infection and whether HIV status altered clinical presentations. METHODS This study was conducted among men with T. pallidum PCR-positive lesions, attending a clinic in Melbourne, Australia, between 2009 and 2014. Lesions were also tested with HSV PCR, and syphilis serology undertaken. RESULTS 183 men with T. pallidum PCR-positive primary anogenital lesions were included. 89% were men who have sex with men, and 10.9% were heterosexual. 38 men (20.8%) were HIV positive. Anal lesions were more common in HIV-positive men (34.2%) than in HIV-negative men (11.6%). Primary lesions were frequently painful (49.2%) or multiple (37.7%), and infrequently associated with HSV (2.7%). Of 37 men with both painful and multiple primary lesions, only 8% had concurrent HSV. Presentation was not significantly altered by HIV status. CONCLUSIONS Primary syphilis lesions are often painful and/or multiple in the absence of herpes coinfection, and may be clinically misdiagnosed.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia Central Clinical School, Monash University, Melbourne, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia Central Clinical School, Monash University, Melbourne, Australia
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8
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Tuite AR, Burchell AN, Fisman DN. Cost-effectiveness of enhanced syphilis screening among HIV-positive men who have sex with men: a microsimulation model. PLoS One 2014; 9:e101240. [PMID: 24983455 PMCID: PMC4077736 DOI: 10.1371/journal.pone.0101240] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Syphilis co-infection risk has increased substantially among HIV-infected men who have sex with men (MSM). Frequent screening for syphilis and treatment of men who test positive might be a practical means of controlling the risk of infection and disease sequelae in this population. PURPOSE We evaluated the cost-effectiveness of strategies that increased the frequency and population coverage of syphilis screening in HIV-infected MSM receiving HIV care, relative to current standard of care. METHODS We developed a state-transition microsimulation model of syphilis natural history and medical care in HIV-infected MSM receiving care for HIV. We performed Monte Carlo simulations using input data derived from a large observational cohort in Ontario, Canada, and from published biomedical literature. Simulations compared usual care (57% of the population screened annually) to different combinations of more frequent (3- or 6-monthly) screening and higher coverage (100% screened). We estimated expected disease-specific outcomes, quality-adjusted survival, costs, and cost-effectiveness associated with each strategy from the perspective of a public health care payer. RESULTS Usual care was more costly and less effective than strategies with more frequent or higher coverage screening. Higher coverage strategies (with screening frequency of 3 or 6 months) were expected to be cost-effective based on usually cited willingness-to-pay thresholds. These findings were robust in the face of probabilistic sensitivity analyses, alternate cost-effectiveness thresholds, and alternate assumptions about duration of risk, program characteristics, and management of underlying HIV. CONCLUSIONS We project that higher coverage and more frequent syphilis screening of HIV-infected MSM would be a highly cost-effective health intervention, with many potentially viable screening strategies projected to both save costs and improve health when compared to usual care. The baseline requirement for regular blood testing in this group (i.e., for viral load monitoring) makes intensification of syphilis screening appear readily practicable.
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Affiliation(s)
- Ashleigh R. Tuite
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Ann N. Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - David N. Fisman
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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9
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Tuite AR, Fisman DN, Mishra S. Screen more or screen more often? Using mathematical models to inform syphilis control strategies. BMC Public Health 2013; 13:606. [PMID: 23800206 PMCID: PMC3699384 DOI: 10.1186/1471-2458-13-606] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/20/2013] [Indexed: 11/15/2022] Open
Abstract
Background Syphilis incidence among men who have sex with men (MSM) continues to rise despite attempts to increase screening and treatment uptake. We examined the marginal effect of increased frequency versus increased coverage of screening on syphilis incidence in Toronto, Canada. Methods We developed an agent-based, network model of syphilis transmission, representing a core population of 2,000 high-risk MSM. Epidemiological and biological parameters were drawn from regional surveillance data and literature-derived estimates. The pre-intervention period of the model was calibrated using surveillance data to identify 1000 credible simulations per strategy. Evaluated strategies included: annual syphilis screening at baseline coverage, increased screening frequency at baseline coverage, and increased coverage of annual screening. Intervention impact was measured as annual prevalence of detected infectious cases and syphilis incidence per year over 10 years. Results Of the strategies evaluated, increasing the frequency of syphilis screening to every three months was most effective in reducing reported and incident syphilis infections. Increasing the fraction of individuals tested, without increasing test frequency, resulted a smaller decline in incidence, because reductions in infectious syphilis via treatment were counterbalanced by increased incident syphilis among individuals with prior latent syphilis. For an equivalent number of additional tests performed annually, increased test frequency was consistently more effective than improved coverage. Conclusions Strategies that focus on higher frequency of testing in smaller fractions of the population were more effective in reducing syphilis incidence in a simulated MSM population. The findings highlight how treatment-induced loss of immunity can create unexpected results in screening-based control strategies.
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Affiliation(s)
- Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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10
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Weerakoon AP, Fairley CK, Read TRH, Bradshaw C, Forrester C, Bissessor M, Denham I, Chen MY. Syphilis infection among homosexual men reporting contact with syphilis: a case control study. BMJ Open 2012; 2:bmjopen-2012-001339. [PMID: 22907046 PMCID: PMC3425903 DOI: 10.1136/bmjopen-2012-001339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE High rates of syphilis have been reported among men who have sex with men (MSM) internationally. Guidelines recommend presumptive treatment of sexual contacts of individuals with syphilis at the point of care. The aim of this study was to determine the proportion who were infected with syphilis and the factors predictive of infection among men reporting contact with a man with syphilis. DESIGN Contacts who were syphilis infected (cases) were compared with those who were uninfected (controls). SETTING This study was conducted at the main public sexually transmitted diseases clinic in Victoria, Australia. PARTICIPANTS One hundred and seventy-two MSM presenting as sexual contacts of men with syphilis at a sexual health service in Melbourne, Australia, between July 2007 and October 2011 were assessed for syphilis. OUTCOME MEASURES Proportion of MSM who are infected with syphilis and factors associated with infection. RESULTS Of the 172 men who presented reporting contact with syphilis, 26 (15%, 95% CI 10 to 20%) had syphilis. One man had primary syphilis, 4 had secondary syphilis, while the remaining 21 had early latent syphilis. Infection was associated with unprotected anal sex over the prior 3 months (adjusted OR 6.1, 95% CI 1.4 to 26.8). CONCLUSIONS One in seven men presenting as contacts of syphilis had syphilis infection, most of whom were latently infected. Contacts reporting recent unprotected anal sex were more likely to have syphilis.
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Affiliation(s)
- Ajith P Weerakoon
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Ministry of Health, Regional Health Training Centre, Kadugannawa, Colombo, Sri Lanka
- Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tim RH Read
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Forrester
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
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11
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Bissessor M, Fairley CK, Leslie D, Chen MY. Use of a computer alert increases detection of early, asymptomatic syphilis among higher-risk men who have sex with men. Clin Infect Dis 2011; 53:57-8. [PMID: 21653303 DOI: 10.1093/cid/cir271] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our study assessed the impact of a computer alert that reminded clinicians to test men who were at higher risk for syphilis on the rate of syphilis testing and diagnoses. The percentage of high-risk men who have sex with men who were tested for syphilis increased from 77% to 89% (P>.001), and the percentage of such men with asymptomatic syphilis increased from 16% to 53% (P=.001).
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12
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Zhang L, Fung Chow EP, Wilson DP. Men who have sex with men in China have relatively low numbers of sexual partners. Infect Dis Rep 2011; 3:e10. [PMID: 24470900 PMCID: PMC3892598 DOI: 10.4081/idr.2011.e10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/03/2011] [Accepted: 06/08/2011] [Indexed: 11/24/2022] Open
Abstract
HIV prevalence is increasing rapidly among men who have sex with men (MSM) in China and potentially associated with the number of male sexual partners that each man has on average. This study estimates the distribution of the number of male sexual partners among Chinese MSM through a comprehensive review of English and Chinese published literature. The overall median number of male sexual partners of Chinese MSM in the past 6 months China was estimated to be 1.5 (95% CI, 1.1–1.8) and 3.8 (95% CI 1.5–6.9) sexual partners in the past 6-month and 12-month periods respectively. An estimated 31% of sexual partners of MSM in China are regular partners, 54% are casual partners, and 16% are commercial partners. The reported numbers of sexual partners has not changed over time during the past decade. The numbers of male sexual partners reported by Chinese MSM is consistently lower than other settings and may not be sufficient to explain the recent rapid increase in HIV prevalence.
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Affiliation(s)
- Lei Zhang
- The Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia
| | - Eric Pui Fung Chow
- The Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia
| | - David P Wilson
- The Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia
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13
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Drummond F, Guy R, Kaldor JM, Donovan B. The intersection between HIV and syphilis in men who have sex with men: some fresh perspectives. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Syphilis is increasing in men who have sex with men and disproportionately affects HIV-infected men. Here we review the epidemiology, diagnostic techniques, treatment guidelines, follow-up procedures and control of syphilis. The difference in these factors in HIV-infected men and uninfected men and evidence for this is reviewed. We explain that HIV-infected men are at higher risk of syphilis acquisition as a result of different behavioral factors. Thus, some control strategies may be different for HIV-infected men owing to these factors and also because HIV-infected men are more closely linked with medical care. There is no strong evidence to suggest there should be any differences in diagnostic techniques, treatment guidelines or follow-up procedures between HIV-infected and uninfected men.
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Affiliation(s)
| | - Rebecca Guy
- National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney NSW 2052, Australia
| | - John M Kaldor
- National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney NSW 2052, Australia
| | - Basil Donovan
- National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney NSW 2052, Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
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14
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Frequent screening for syphilis as part of HIV monitoring increases the detection of early asymptomatic syphilis among HIV-positive homosexual men. J Acquir Immune Defic Syndr 2010; 55:211-6. [PMID: 20585261 DOI: 10.1097/qai.0b013e3181e583bf] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis continues to be a significant public health problem among HIV-positive men who have sex with men (MSM) internationally. This study aimed to determine whether the routine inclusion of syphilis serology with every blood test performed as part of HIV monitoring increases the detection of early asymptomatic syphilis among HIV-positive MSM. METHODS We examined the effect of this intervention, implemented in January 2007, on the detection of early asymptomatic syphilis among HIV-positive MSM attending the Melbourne Sexual Health Centre, Australia, and compared this with the previous clinic policy of annual syphilis screening. RESULTS In the 18 months before and after the intervention, the median number of syphilis tests performed per man per year was 1 and 2, respectively. The proportion of MSM diagnosed with early syphilis who were asymptomatic was 21% (3 of 14) and 85% (41 of 48) for the 2 respective periods (P = 0.006). The time between the midpoint since last syphilis serology and diagnosis of syphilis was a median of 107 days (range 9-362) and 45 days (range 23-325) for the 2 periods, respectively (P = 0.018). CONCLUSIONS The inclusion of routine syphilis serology with every blood test performed as part of HIV monitoring in HIV-positive MSM resulted in a large increase in the proportion of men diagnosed with early asymptomatic syphilis. This simple intervention probably also decreased the duration of infectiousness, enhancing syphilis control while also reducing morbidity.
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McVey M, Cameron W, MacPherson P. When infections collide—gummatous syphilis in an HIV-infected individual. Int J Infect Dis 2010; 14 Suppl 3:e283-6. [DOI: 10.1016/j.ijid.2009.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 11/25/2009] [Indexed: 10/19/2022] Open
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Syphilis: the renaissance of an old disease with oral implications. Head Neck Pathol 2009; 3:195-206. [PMID: 20596972 PMCID: PMC2811633 DOI: 10.1007/s12105-009-0127-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 07/02/2009] [Indexed: 10/20/2022]
Abstract
Syphilis is caused by Treponema pallidum an anaerobic filamentous spirochete. In recent years, striking outbreaks have occurred in USA, Canada, Russia, China and some areas of Central and Eastern Europe. Main epidemiology changes reflect sex industry, sexual promiscuity, decreasing use of barrier protection (i.e. condoms) due to false sense of security that nowadays sexually transmitted diseases are curable and lack of pertinent knowledge. Considering that the initial presentation of syphilis may be the oral cavity, it is of great relevance to include this disease in the differential diagnosis of unusual oral ulcerations and white patches. Primary syphilis is a highly infectious disease in which inappropriate treatment may be apparently curative while the patient remains highly infectious. It is then of pivotal importance that clinicians maintain a high clinical index of suspicion. At the present time, clinical-pathologic correlation together with serologic studies remain essential in establishing the diagnosis of syphilis.
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