Prevalence of syphilis among people living with HIV and its implication for enhanced coinfection monitoring and management in China: A meta-analysis

Prevalence, trends, and correlates of HIV, syphilis, and HCV infections among male attendees at STD clinics in Southwest China: a 13-year cross-sectional study (2010-2022)

BACKGROUND

Sexually transmitted infections (STIs) impose a substantial health burden and pose a significant threat to human health. However, data regarding long-term epidemiology patterns of STIs among high-risk groups are scarce. This study aimed to evaluate the prevalence, trends, and correlates of HIV, syphilis, and HCV among male attendees at sexually transmitted disease (STD) clinics in Southwest China.

METHODS

Serial cross-sectional surveys were performed annually among male STD clinic attendees in Southwest China from 2010 to 2022. Blood specimens were collected to test HIV, syphilis, and HCV infections. Mann-Kendall trend test was used to assess the trends of HIV, syphilis, and HCV prevalence. Rare even logistic regression model (relogit) was used to identify correlates of HIV, syphilis, and HCV infections.

RESULTS

This study included a total of 23,964 male attendees at STD clinics. The prevalence of HIV, syphilis, and HCV among participants was 0.98%, 2.16%, and 0.61%, respectively. While the prevalence of syphilis and HCV decreased from 3.64% to 1.81% in 2010 to 1.05% and 0.38% in 2022, the HIV prevalence did not show a downward trend. Relogit analysis revealed that participants with a history of STD had significantly increased risks of HIV (aOR = 1.90, 95%CI: 1.14-3.15) and HCV (aOR = 4.91, 95%CI: 3.22-7.49) infections. Participants who had ever engaged in homosexual behavior had significantly increased risks of HIV (aOR = 14.66, 95%CI: 5.49-39.14) and syphilis (aOR = 3.95, 95%CI:1.41-13.71) infections. Age also played a role, with those aged 50 years and above having a higher likelihood of HIV infection (aOR = 2.55, 95%CI: 1.91-3.39), while those under 50 years were more likely to be infected with HCV (aOR = 1.94, 95%CI: 1.19-3.16). Moreover, individuals of Han ethnicity were more likely to be infected with syphilis (aOR = 2.12, 95%CI: 1.75-2.57) and HCV (aOR = 1.65, 95%CI: 1.16-2.33). Being married or cohabiting increased the likelihood of syphilis infection (aOR = 1.40, 95%CI: 1.09-1.80), and a history of intravenous drug use (IDU) significantly increased the risk of HCV infection (aOR = 10.97, 95%CI: 5.21-23.12).

CONCLUSIONS

This study found a low prevalence of HIV, syphilis, and HCV among male attendees at STD clinics. Despite the declining prevalence of syphilis and HCV, HIV prevalence did not show a downward trend. This underscores the crucial need for continued and targeted prevention efforts, especially promoting STIs testing for men who have sex with men (MSM) and individuals with a history of intravenous drug use (IDU).

Analysis of seroprevalence and risk factors for syphilis and HIV among female sex workers and transgender individuals in different cities of Sindh, Pakistan

INTRODUCTION

Co-infections of syphilis and HIV have been found to exacerbate the impact on sexual and reproductive health, especially among key population groups such as Female Sex Workers (FSWs) and Transgender Individuals (TGs). The data on the prevalence and determinants of syphilis and HIV in Pakistan, particularly in Sindh province, is limited. This prospective cross-sectional study aimed to determine the seroprevalence and risk factors for HIV and syphilis infections among FSWs and TGs in different cities of Sindh, Pakistan.

METHODS

A total of 1120 participants (531 FSWs and 589 TGs) were recruited from Karachi, Sukkur, Hyderabad, and Larkana. Community-based serological testing for HIV and syphilis was performed using Abbot Bioline HIV/syphilis Duo test kits, and sociodemographic and risk factor data were collected through questionnaires. Chi-square and logic regression were applied to determine variables associated significantly with syphilis in TGs and FSWs.

RESULTS

TGs exhibited higher rates of syphilis (16.29%) and syphilis-HIV (6.79%) as compared to FSWs (syphilis: 15.63%; syphilis-HIV: 0.75%). Inconsistent condom use was more common among FSWs (75.32%), and over half reported STI symptoms. Regression analysis showed that for TGs, having five years (adjusted OR: 0.52, p = 0.04) and graduate-level education (adjusted OR: 0.40, p = 0.04) was associated with a lower risk of syphilis, while an income between 30,000 and 50,000 Pakistani rupees (OR: 1.93, p = 0.028) and more than three years in profession (adjusted OR: 2.20, p = 0.04) was associated with a higher risk. For FSWs, five (OR: 0.34, p = 0.03) and ten (OR: 0.02, p = 0.02) years of education were associated with a lower risk of syphilis, whereas an income between 30,000 and 50,000 PKR (OR: 3.05, p < 0.01) and self-reported HIV-negative status (OR: 3.08, p = 0.01) were associated with a higher risk of syphilis mono-infection.

CONCLUSION

In conclusion, the results of the study show higher rates of syphilis and HIV co-infection among TG compared to FSW from Sind. The study findings provide valuable insights for national health agencies and policymakers to devise data-driven strategies for preventing and controlling syphilis and HIV infections among FSW and TG populations in Sind.

Clinical performance evaluation of an HIV Duo assay: From HIV screening to acute and non-acute HIV infection detection

BACKGROUND

Evaluating the clinical performance of Elecsys HIV Duo assay for primary human immunodeficiency virus (HIV) screening and acute HIV infection detection.

METHODS

This study was conducted from April 2022 to April 2023 and involved two distinct populations. For the HIV screening population, three HIV Duo results [HIV Duo, HIV antigen (Ag), and HIV antibody (Ab)] in primary screening were obtained (January 2021 to June 2021). In the diagnosed HIV population, retrospective samples from November 2016 to March 2023 were measured.

RESULTS

The HIV screening population included 111,383 samples from a real-world screening program. The assay demonstrated a specificity of 99.91 % (95 % CI: 99.89 %, 99.93 %) and a PPV of 0.8516 (95 % CI: 0.8225, 0.8776). Regarding the diagnosed HIV population, 836 HIV patients were enrolled, including 14 acute HIV infectious patients with only HIV Ag + and a Western Blot (WB) confirmation rate of 0 %. The median (IQR) of the numeric cut-off index (COI) ratios of HIV Duo Ab and Ag significantly differed among the Ag + Ab-, Ag-Ab+, and Ag + Ab + subgroups.

CONCLUSION

The Elecsys HIV Duo assay is suitable for primary HIV screening and can be integrated into a novel laboratory HIV testing algorithm to improve acute HIV detection in Chinese clinical practice.

ABBREVIATIONS

HIV, Human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; Ag, antigen; Ab, antibody; WB, Western Blot; COI, numeric cut-off index; CI, confidence interval; NAT, nucleic acid tests; EDC, electronic data capture systems; CDC, Chinese Centers for Disease Control and Prevention; IQR, interquartile range; PPV, positive predictive value; HCV, hepatitis C virus; HBV, hepatitis B virus; CI, confidence interval; ND, not able to define; F, female; M, male.

Disparities in Syphilis Trends and the Impact of the COVID-19 Pandemic: A Joinpoint Analysis of Florida Surveillance Data (2013-2022)

INTRODUCTION

Syphilis, a sexually transmitted infection caused by the bacterium ​​​​​​Treponema pallidum, has reemerged at an increasing rate globally in recent years, posing a significant public health concern. Visualizing and analyzing time series trends of syphilis across various demographics and geographic regions, and how syphilis trends varied during the pandemic coronavirus disease 2019 (COVID-19), would help public health policymakers develop targeted strategies and interventions to effectively address the rising rates of syphilis, ultimately improving overall public health outcomes.

METHODS

 A retrospective study was conducted using surveillance data on infectious syphilis cases reported to the Florida Department of Health, between 2013 and 2022. Age-standardized syphilis rates (ASSRs) per 100,000 persons were calculated using the 2000 U.S. standard population data. The average annual percentage change (AAPC) in the ASSRs was analyzed according to age, gender, race, geographic locations, and the COVID-19 pandemic period to quantify the epidemiological syphilis trends using joinpoint regression models.

RESULTS

 In Florida, the ASSR significantly increased from 8.65/100,000 in 2013 to 23.08/100,000 in 2022 across different demographic groups, with an overall AAPC of 11.47 (95% confidence interval (CI): 9.85-13.43). This increase in the AAPC was more pronounced in females (AAPC = 20.97; 95% CI, 18.61-24.49) than in males (AAPC = 10.34; 95% CI, 8.19-12.98). The increasing trends of infectious syphilis were observed across all age groups, with greater increases among those aged 25-49 years (AAPC = 12.32; 95% CI, 10.09-15.18), aged 50-69 years (AAPC = 13.42; 95% CI, 9.41-18.89), and aged over 70 years (AAPC = 13.63; 95% CI, 9.23-21.95), compared to those aged less than 24 years (AAPC = 7.86; 95% CI, 7.06-8.81). The increasing trends were comparable across racial groups, with an AAPC of 8.08 (95% CI, 5.47-11.15) for Hispanics, 11.84 (95% CI, 10.02-14.09) for non-Hispanic Whites, 10.49 (95% CI, 8.75-12.66) for non-Hispanic Blacks, and 11.29 (95% CI, 5.28-19.57) for non-Hispanic individuals of other races, respectively. The AAPC for the COVID-19 pandemic period was 12.99 (95% CI, 8.48-16.21), which was comparable to the pre-pandemic period (AAPC = 11.58; 95% CI, 10.17-12.76), indicating that this upward trend in infectious syphilis persisted throughout the COVID-19 pandemic. At the county level, over the 10-year period, the average ASSRs ranged from 0.89/100,000 in 2013 to 25.41/100,000 in 2022, with the estimated AAPCs varied from 2.47 (95% CI, -1.89 to 6.92) in Monroe County to 50.01 (95% CI, 37.71-62.27) in Okaloosa County.

CONCLUSIONS

 The trend of infectious syphilis increases substantially from 2013 to 2022, with notable differences observed among age, gender, and geographic regions in Florida. Females experienced a greater rise in infectious syphilis cases compared to males. This upward trend in infectious syphilis persisted throughout the COVID-19 pandemic. Efforts are needed to implement strategies to address the rising syphilis rates within high-incidence groups and communities across the state.

Serological evaluation of recombinant protein antigen Tp0608 for the diagnosis of syphilis

OBJECTIVE

To evaluate the serological diagnosis value of recombinant protein antigen Tp0608 for syphilis.

METHOD

406 patients with various stages of syphilis were enrolled. A recombinant protein antigen Tp0608 was established and ELISA was used to detect patients with various stages of syphilis. The results were compared with the conventional rapid plasma reagin test (RPR) and Treponema pallidum particle agglutination test (TPPA). The sensitivity of Tp0608 recombinant protein and RPR+TPPA screening was 96.6 % and 93.1 % respectively for patients with various stages of syphilis. For patients who may have cross reactivity, the specificity of Tp0608 recombinant protein screening is 98.9 %, and the AUC of the ROC curve is 0.99; The specificity of RPR+TPPA screening was 97.3 %, and the AUC of the ROC curve was 0.96. The sensitivity and specificity of Tp0608 recombinant protein in syphilis screening are higher than conventional RPR+TPPA methods, especially in congenital syphilis and primary syphilis.

CONCLUSION

The Tp0608 recombinant protein is a promising diagnostic antigen for syphilis screening, but its intracellular location and protective response have not been determined, and further verification is needed.

Relapse of secondary syphilis in a PLHIV - A new entity

Syphilis and other bacterial sexually transmitted infections (STIs) are on the verge of resurge throughout the world. Coinfection of syphilis and HIV is quite common as they both share a common mode of transmission. The behavior of syphilis is quite altered in the presence of HIV. Relapse of secondary syphilis after the recommended treatment is quite unusual. One such case has been reported, and possible pathogenesis was discussed.

Current syphilis infection in virally suppressed people living with HIV: a cross-sectional study in eastern China

Background

Antiretroviral therapy (ART) has been shown to reduce human immunodeficiency virus (HIV) viral replication and ultimately achieve viral suppression and eliminate HIV transmission. However, little is known about the impact of viral suppression on high-risk behaviors and sexually transmitted infections (STIs).

Objective

This study aimed to assess the rates of current syphilis infection in virally suppressed people living with HIV (PLWH) and whether with the duration of ART can reduce the current syphilis infection in eastern China.

Method

We conducted a cross-sectional survey of PLWH in Zhejiang Province, China, in 2022. PLWH who were on ART >6 months and were virally suppressed (viral load <50 copies/mL) were included in the study. Data were collected from the National Epidemiological Database of Zhejiang Province and all participants were tested for viral load and current syphilis. Multivariable logistic regression was used to identify risk factors associated with current syphilis infection.

Result

A total of 30,744 participants were included in the analysis. 82.7% of participants were male, the mean age was 44.9 ± 14.1 years, 84.9% had received ART in a hospital setting, the mean time on ART was 5.9 ± 3.1 years and 5.6% of participants were infected with current syphilis. Multivariable logistic regression showed that being male [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.69-2.66], high level of education (aOR: 1.23, 95% CI: 1.02-1.49), homosexual route of HIV infection (aOR: 1.80, 95% CI: 1.60-2.04), non-local registered residence (aOR: 1.29, 95% CI: 1.11-1.51), had history of STIs before HIV diagnosis (aOR: 1.95, 95 % CI: 1.75-2.18) and treatment provided by a municipal hospital (aOR: 2.16, 95% CI: 1.31-3.55) were associated with increased risk of current syphilis infection. Being married (aOR: 0.67, 95% CI: 0.58-0.76) was associated with a decreased risk of current syphilis infection.

Conclusion

Our findings revealed a high rate of current syphilis infection among virally suppressed PLWH in eastern China. Duration of ART did not reduce the prevalence of current syphilis infection. Targeted interventions to reduce current syphilis infection should be prioritized for subgroups at higher risk.

Case Report: Concomitant presence of two STIs in a male patient

Background

The spirochaete Treponema pallidum subsp. pallidum, which causes the infectious disease syphilis, can be spread through sexual contact or perinatal transmission. In recent years, cases of syphilis have increased, especially among individuals engaging in behaviour that makes them more vulnerable (condomless sex and multiple sexual partners). Condylomata acuminata (external genital warts) is one of the most common viral sexually transmitted infections (STIs). Individuals who are behaviourally vulnerable are also highly prone to two or more STIs. Our case exemplifies the occurrence of two STIs in a young man who was behaviourally vulnerable to acquiring STIs.

Case

We report a case of a 21-year-old year old heterosexual man presenting with concomitant primary syphilis and genital warts. He presented with a painless genital ulcer and warty growths on his glans penis. Examination showed a painless indurated ulcer and multiple genital warts. Serology was positive for quantitative Venereal disease research laboratory test (1:16 titre). The patient was diagnosed with two concomitant STIs. He was treated as per the latest Centers for Disease Control and Prevention (CDC) guidelines for primary syphilis and podophyllin resin for genital warts. After four weeks, the genital ulcer showed complete healing and there was a significant reduction of genital warts.

Conclusions

Individuals with multiple sexual partners engaging in sexual activity without the use of prevention tools are at a greater chance of acquiring two or more STIs. To reduce concomitant transmission, preventive measures against genital ulcer diseases like syphilis, herpes, and chancroid, such as early identification and treatment, and condom distribution, must be strengthened as part of national STI prevention. Patients with two or more STIs should be followed regularly to assess the progress of infection and should be offered timely medical treatment.

Prevalence, Trends and Correlates of HIV, Syphilis and HCV Infection Among Chinese Local and Cross-border Migrant Female Sex Workers in the Sino-Vietnam Border Area of Guangxi, 2016-2021

Female sex workers (FSWs) are considered a high-risk group for sexually transmitted infections (STIs). However, limited data exist on the prevalence and trends of HIV, syphilis and HCV among FSWs in the Sino-Vietnam border area. To determine the prevalence, trends and correlates of STIs among Chinese local FSWs (CL-FSWs) and cross-border migrant FSWs (CM-FSWs), we conducted consecutive cross-sectional surveys from 2016 to 2021, recruiting 7747 CL-FSWs and 932 CM-FSWs. The overall HIV, syphilis and HCV prevalence declined from 1.0%, 8.8% and 1.7% to 0.1%, 0.9% and 0.3%, respectively. There was no significant downward trend in the overall HIV and syphilis prevalence. However, HCV prevalence showed a decreasing trend among CL-FSWs. CM-FSWs had higher HIV prevalence (2.5% vs. 0.6%). Similarities and differences in STIs-related factors existed between CM-FSWs and CL-FSWs. For instance, receiving HIV-related services in the last year reduced the risk of HIV infection (for CM-FSWs: aOR = 0.234, 95% CI: 0.055-0.993; for CL-FSWs: aOR = 0.182, 95% CI: 0.058-0.567). Serving male clients at least 50 years old increased the risk of syphilis infection (for CM-FSWs: aOR = 4.277, 95% CI: 1.535-11.917; for CL-FSWs: aOR = 1.404, 95% CI: 1.087-1.815). Moreover, CM-FSWs with past-year STIs history had a higher risk of HIV (aOR = 34.976, 95% CI: 5.338-229.176) and HCV infection (aOR = 17.649, 95% CI: 1.846-168.846), both of which were associated with multiple factors in CL-FSWs. It is therefore necessary to develop effective, accessible, high-quality and targeted interventions for CM-FSWs and CL-FSWs.

Syphilis Prevalence Among People Living With and Without HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BACKGROUND

Syphilis is a curable sexually transmitted infection that, untreated, is associated with significant morbidity and mortality. In people living with HIV (PLWH), syphilis carries greater risks of disease progression. We estimated syphilis prevalence among PLWH in the general population in sub-Saharan Africa and compared the prevalence among PLWH and without HIV.

METHODS

We searched for studies published January 1, 2011, to March 28, 2022, reporting syphilis prevalence among PLWH in sub-Saharan Africa (PROSPERO No. CRD42020167328). We excluded studies in high-risk subpopulations. We estimated pooled syphilis prevalence among PLWH using random-effects modeling and compared the prevalence with people without HIV when included in the same study. We examined influences of region, study setting, and test type in subgroup analyses.

RESULTS

We identified 926 studies; 53 were included in the meta-analysis. Pooled syphilis prevalence among PLWH was 7.3% (95% confidence interval [CI], 6.3%-8.5%). Prevalence differed by region: 3.1% (95% CI, 2.2%-4.0%) in Southern, 5.5% (95% CI, 2.3%-9.3%) in West/Central, and 10.5% (95% CI, 8.0%-13.1%) in Eastern Africa. Prevalence also differed by study setting: 13.8% (95% CI, 5.7%-23.0%) in sexual and reproductive health/sexually transmitted infection care, 8.7% (95% CI, 5.0%-12.8%) in HIV care, 7.1% (95% CI, 5.8%-8.5%) in antenatal care, and 3.8% (95% CI, 2.0%-5.8%) in household/community-based settings. Syphilis prevalence was higher among PLWH than without HIV (relative risk, 3.5; 95% CI, 2.8-4.5).

CONCLUSIONS

Syphilis is highly prevalent among PLWH in sub-Saharan Africa and is more common among PLWH than without HIV. Integration of syphilis screening and management into HIV care may reduce complications of HIV-syphilis coinfection among PLWH in sub-Saharan Africa.

Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study

Background

Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic.

Methods

A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis.

Results

In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14).

Conclusion

This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.

HIV/STD prevalence and test uptake among african in Guangzhou, China: an analysis of data from hospital-based surveillance

Human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs) cause substantial morbidity and mortality both in African and China. However, there is limited data available on the prevalence of HIV/STDs and the uptake of testing experience ever during in China among African migrants. A venue-based survey was conducted at a tertiary hospital in Guangzhou to investigate the prevalence of HIV/STDs through laboratory testing and identify the associated factors. A total of 200 eligible participants completed the survey and bring into the analysis from April to October 2019, and the temporary visitors were excluded. The prevalence rates of HIV, syphilis, NG, CT, and HBsAg among the participants were 1.0%, 2.5%, 1.0%, 1.5%, and 5.5%, respectively. The overall reported rate of HIV/STD testing was 37.0%, with rates of 23.0% for HIV, 16.5% for syphilis, 12.5% for NG, 6.5% for genital herpes, 5.0% for condyloma acuminata, and 2.5% for CT. HIV/STD testing was associated with living environment in Guangzhou, having medical insurance in China, and utilizing health services in China in the past year. HIV/STDs are prevalent among Africans in Guangzhou, and the epidemic is likely to spread due to a significant proportion of unprotected sexual behaviors and low rates of HIV/STD testing. Urgent interventions, including targeted health education, promotion of health service utilization, and active surveillance of HIV/STDs, are needed to reduce the risk of HIV/STD transmission.