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Sexual Health

Sexual Health

Volume 12 Number 2 2015

Syphilis

SH15025Syphilis: a fresh look at an old foe

Marcus Y. Chen, Jeffrey D. Klausner, Christopher Kit Fairley, Rebecca Guy, David Wilson and Basil Donovan
pp. 93-95

Syphilis remains a pressing public health problem globally across different populations including men who have sex with men and pregnant women. It is timely to review what international surveillance data tell us and the evidence behind public health interventions aimed at controlling syphilis. A reinvigorated response to the re-emergence of syphilis is required.

SH14173Evolution of the syphilis epidemic among men who have sex with men

Marc M. Solomon and Kenneth H. Mayer
pp. 96-102

This manuscript provides an overview of the evolution of the global syphilis epidemic among men who have sex with men (MSM). It chronicles the changes in syphilis epidemiology among MSM including its interface with the HIV/AIDS epidemic. Finally, it seeks to describe the recent resurgence of syphilis incidence in the 2000s among MSM after a prior sharp drop in cases in the 1990s and calls for innovative strategies to address the evolving epidemic.

SH14174Syphilis transmission: a review of the current evidence

Juliet E. Stoltey and Stephanie E. Cohen
pp. 103-109

Syphilis remains widespread worldwide, with increasing rates among men who have sex with men.  This paper reviews available evidence regarding syphilis transmission, and discusses how key prevention interventions, such as syphilis screening and treatment, condoms, and risk-reduction counselling modify syphilis transmission dynamics.


HIV-1 infected men who have sex with men (MSM) are disproportionately affected by syphilis in many higher income countries. Anal and oral intercourse may lead to transmission and primary ulcers at non-genital sites which go unrecognised. Moreover, the manifestations of symptomatic disease, especially neurosyphilis, may be altered by HIV-1. This review provides a summary of the clinical features of early syphilis (primary, secondary and early neurological involvement) and the ways in which these may be modified by HIV-1 infection in MSM.

SH14156Public health interventions to control syphilis

Thomas A. Peterman and Bruce W. Furness
pp. 126-134

Syphilis control strategies are old, but interventions have changed and there is now a more scientific approach to evidence of effectiveness. A review of the literature found few papers used high-quality research methodology and fewer evaluated impact on prevalence or incidence; most assessed intermediate outcomes. Syphilis can often be controlled by a combination of case finding, treatment and education. However, outbreaks are unique and ongoing evaluation is needed to see if interventions are producing intended intermediate outcomes at reasonable costs.

SH14168Management of syphilis in HIV-positive individuals

Fiona V. Cresswell and Martin Fisher
pp. 135-140

We explore the controversies that exist around the management of syphilis in HIV-positive individuals. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a lack of randomised controlled trial data. We discuss the factors associated with poorer serological outcomes whereby enhanced antibiotic therapy, which penetrates the central nervous system, may be of benefit.

SH14197The molecular epidemiology of Treponema pallidum subspecies pallidum

Daphne Y. Ma, Lorenzo Giacani and Arturo Centurión-Lara
pp. 141-147

Syphilis is a re-emerging sexually transmitted disease that, within the last few decades, has been on the rise globally. Treponema pallidum subspecies pallidum, the causative agent of syphilis, displays a substantial amount of interstrain diversity. These variants have been identified in various parts of the world, indicating transmission linkage between geographical regions. This review will highlight the genetic variation within Treponema pallidum strains, the methods utilized for genotyping, and the linkage between genetically distinct organisms and bacterial pathogenesis.

SH14195Neurosyphilis and the impact of HIV infection

Emily L. Ho and Serena S. Spudich
pp. 148-154

Neurosyphilis is a complication of systemic syphilis. This review of the clinical presentation, diagnostic laboratory findings, treatment and management of neurosyphilis discusses the impact of HIV and the specific challenges it brings, focusing on areas of controversy, and highlighting important questions that remain to be answered.

SH14153Increasing trends of syphilis among men who have sex with men in high income countries

Phillip Read, Christopher K. Fairley and Eric P. F. Chow
pp. 155-163

This paper examines the male and female syphilis notification rates in high-income countries from 2000 to 2013. The male to female ratio and proportion of cases reported as being in men who have sex with men is calculated. This paper shows that in countries with high income, there is a near universal finding of increasing rates of syphilis in MSM. It is therefore clear that no country has identified an effective method to control syphilis in this population.

SH14191Maternal and congenital syphilis in selected Latin America and Caribbean countries: a multi-country analysis using data from the Perinatal Information System

Suzanne J. Serruya, Pablo Duran, Gerardo Martinez, Mario Romero, Sonja Caffe, Monica Alonso and Mariangela F. Silveira
pp. 164-169

This paper aims to describe characteristics related to maternal and congenital syphilis in selected countries of Latin America and Caribbean for the period 2010–12. The main limitation of the analyses was data quality leading to the conclusion that countries must continue to be supported to build capacity for collecting high-quality data on intervention coverage and inequities, and to use it as a basis for decisions.

SH14140A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand

Edward Coughlan, Heather Young, Catherine Parkes, Maureen Coshall, Nigel Dickson, Rebecca Psutka, Peter Saxton, Ramon Pink and Katharine Adams
pp. 170-173

During 2012, Christchurch, New Zealand experienced a dramatic increase in cases of infectious syphilis among men who have sex with men. In 2012, 26 males and no females were diagnosed and of these 26, 22 reported only sex with men. The use of social is discussed.

SH14142Over reporting of congenital syphilis in Guangzhou, China

Xingdong Ye, Shao-Kai Tang, Xiangnong Dai, Wanping He, Huilan Zhu and Xibao Zhang
pp. 174-175

The present work described the congenital syphilis (CS) case reporting profile during 2012 in Guangzhou, the capital of Guangdong province, southern China. A total of 110 CS cases were reviewed, and the results suggested that 49.1% of the CS cases reviewed were identified as cases that should be reported; and 50.9% were identified as over reporting, although the CS incidence in Guangzhou is rising, it may be overestimated. It implied that, to decrease CS cases of over reporting, both antenatal care management and serum rapid plasma reagin titres follow up should be raised.


Syphilis incidence in HIV-Positive men who have sex with men (MSM) continues to rise, however there remains barriers to enhanced testing schedules. We demonstrate an increase in syphilis testing of HIV-positive patients and a three-fold increase in new syphilis diagnoses following a period of enhanced syphilis testing in HIV-positive MSM.

SH15008Syphilis among adolescents and young adults in Cincinnati, Ohio: testing, infection and characteristics of youth with syphilis infection

Sherine Patterson-Rose, Tanya L. Kowalczyk Mullins, Elizabeth A. Hesse, Corinne Lehmann and Lea E. Widdice
pp. 179-180

After a local syphilis outbreak, this study examines the rates of syphilis testing, syphilis infection and characteristics of those with syphilis among adolescents and young adults at a teen health clinic in Cincinnati, Ohio. In addition, the study explores the agreeability of syphilis staging and treatment between chart documentation and reviewers according to the Centers for Disease Control and Prevention Guidelines.

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