Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillanceSusan J. Botham A H , Kelly-Anne Ressler A , Patrick Maywood B , Kirsty G. Hope B , Chris P. Bourne C D , Stephen J. Conaty B , Mark J. Ferson A D and Darren J. Mayne E F G
A Public Health Unit, South Eastern Sydney Local Health District, Locked Bag 88, Randwick, NSW 2031, Australia.
B Public Health Unit, South Western Sydney and Sydney Local Health District, PO Box 63, Camperdown, NSW 1450, Australia.
C Sydney Sexual Health Centre, Level 3, Nightingale Wing, Sydney Hospital, Macquarie St, Sydney, NSW 2000, Australia.
D School of Public Health and Community Medicine, Level 2 and 3 Samuels Building, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia.
E Public Health Unit, Illawarra Shoalhaven Local Health District, Locked Bag 9, Wollongong, NSW 2500, Australia.
F Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, Camperdown, NSW 2050, Australia.
G Illawarra Health and Medical Research Institute, University of Wollongong, Building 32, University of Wollongong, NSW 2522, Australia.
H Corresponding author. Email: firstname.lastname@example.org
Sexual Health 10(4) 291-298 https://doi.org/10.1071/SH12142
Submitted: 24 August 2012 Accepted: 26 February 2013 Published: 3 May 2013
Background: The resurgence of infectious syphilis in men who have sex with men (MSM) has been documented worldwide; however, HIV coinfection and syphilis reinfections in MSM in inner Sydney have not been published. Methods: For all laboratory syphilis notifications assessed as a newly notified case or reinfection, a questionnaire was sent to the requesting physician seeking demographic data and disease classification. Sex of partner and HIV status were collected for all infectious syphilis notifications in men received from 1 April 2006 to March 2011. Results: From April 2001 to March 2011, 3664 new notifications were received, 2278 (62%) were classified as infectious syphilis. Infectious syphilis notifications increased 12-fold from 25 to 303 in the first and last year respectively, and almost all notifications were in men (2220, 97.5%). During April 2006 to March 2011, 1562 infectious syphilis notifications in males were received and 765 (49%) of these men were HIV-positive and 1351 (86%) reported a male sex partner. Reinfections increased over time from 17 (9%) to 56 (19%) in the last year of the study and were significantly more likely to be in HIV-positive individuals (χ2 = 140.92, degrees of freedom= 1, P = <0.001). Conclusion: Inner Sydney is experiencing an epidemic of infectious syphilis in MSM and about half of these cases are in HIV-positive patients. Reinfections are increasing and occur predominantly in HIV-positive men. Accurate surveillance information is needed to inform effective prevention programs, and community and clinician education needs to continue until a sustained reduction is achieved.
Additional keywords: AIDS, gay men, public health.
References Fenton KA, Wasserheit JN. The courage to learn from our failures: syphilis control in men who have sex with men. Sex Transm Dis 2007; 34 162–5.
| The courage to learn from our failures: syphilis control in men who have sex with men.CrossRef | 17325602PubMed |
 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends in primary and secondary syphilis among men who have sex with men in the United States. Am J Public Health 2007; 97 1076–83.
| Trends in primary and secondary syphilis among men who have sex with men in the United States.CrossRef | 17463387PubMed |
 Savage EJ, Hughes G, Ison C, Lowndes CM. Syphilis and gonorrhoea in men who have sex with men: a European overview. Euro Surveill 2009; 14 40–7.
 Jebbari H, Simms I, Conti S, Marongiu A, Hughes G, Ward H, et al Variations in the epidemiology of primary, secondary and early latent syphilis, England and Wales: 1999 to 2008. Sex Transm Infect 2011; 87 191–8.
| Variations in the epidemiology of primary, secondary and early latent syphilis, England and Wales: 1999 to 2008.CrossRef | 21262786PubMed |
 Kerani RP, Handsfield HH, Stenger MS, Shafii T, Zick E, Brewer D, et al Rising rates of syphilis in the era of syphilis elimination. Sex Transm Dis 2007; 34 154–61.
| Rising rates of syphilis in the era of syphilis elimination.CrossRef | 17179773PubMed |
 The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2011 . Sydney: The Kirby Institute, the University of New South Wales; 2011.
 Drummond F, Guy R, Kaldor JM, Donovan B. The intersection between HIV and syphilis in men who have sex with men: some fresh perspectives. HIV Ther 2010; 4 661–73.
| The intersection between HIV and syphilis in men who have sex with men: some fresh perspectives.CrossRef |
 Dougan S, Evans BG, Elford J. Sexually transmitted infections in western Europe among HIV-positive men who have sex with men. Sex Transm Dis 2007; 34 783–90.
| 17495592PubMed |
 Fenton KA, Breban R, Vardavas R, Okano JT, Martin T, Aral S, et al Infectious syphilis in high-income settings in the 21st century. Lancet Infect Dis 2008; 8 244–53.
| Infectious syphilis in high-income settings in the 21st century.CrossRef | 18353265PubMed |
 NSW Ministry of Health. Health outcomes and information statistical toolkit (HOIST). Sydney: Communicable Diseases Branch and Centre for Epidemiology and Research, NSW Ministry of Health; 2012.
 Botham SJ, Ressler K-A, Bourne C, Ferson MJ. Epidemic infectious syphilis in inner Sydney – strengthening enhanced surveillance. Aust N Z J Public Health 2006; 30 529–33.
| Epidemic infectious syphilis in inner Sydney – strengthening enhanced surveillance.CrossRef | 17209268PubMed |
 Department of Health (DoH), Health Protection Branch. Surveillance of notifiable infectious diseases in Victoria, 2009. Melbourne: DoH; 2011.
 Australian Government Department of Health and Ageing (DoHA). National notifiable diseases surveillance system. Canberra: DoHA; Available online at:http://www9.health.gov.au/cda/Source/Rpt_4.cfm [verified February 2012].
 Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59 1–110.
| 21160459PubMed |
 Leslie DE, Higgins N, Fairley CK. Dangerous liaisons – syphilis and HIV in Victoria. Med J Aust 2008; 188 676–7.
| 18513180PubMed |
 Ogilvie GS, Taylor DL, Moniruzzaman A, Knowles L, Jones H, Hyeong-Jin Kim P, et al A population-based study of infectious syphilis rediagnosis in British Columbia, 1995–2005. Clin Infect Dis 2009; 48 1554–8.
| A population-based study of infectious syphilis rediagnosis in British Columbia, 1995–2005.CrossRef | 19402790PubMed |
 Bissessor M, Fairley CK, Leslie D, Howley K, Chen MY. 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.
| Frequent screening for syphilis as part of HIV monitoring increases the detection of early asymptomatic syphilis among HIV-positive homosexual men.CrossRef | 20585261PubMed |
 Cohen CE, Winston A, Asboe D, Boag F, Mandalia S, Azadian B, et al Increasing detection of asymptomatic syphilis in HIV patients. Sex Transm Infect 2005; 81 217–9.
| Increasing detection of asymptomatic syphilis in HIV patients.CrossRef | 1:STN:280:DC%2BD2MzgvFKrtg%3D%3D&md5=24fc9007074d631b60cd858aceb7da93CAS | 15923288PubMed |
 Sexually Transmissible Infections in Gay Men Action (STIGMA) Group. Sexually transmitted infection testing guidelines for men who have sex with men 2010. Sydney: STIGMA; 2010. Available online at: http://stigma.net.au/resources/STIGMA_MSM_Testing_Guidelines_ 2010.pdf [verified October 2012].
 Guy R, Wand H, Holt M, Mao L, Wilson DP, Bourne C, et al High annual syphilis testing rates among gay men in Australia, but insufficient retesting. Sex Transm Dis 2012; 39 268–75.
| High annual syphilis testing rates among gay men in Australia, but insufficient retesting.CrossRef | 22421692PubMed |
 Madeddu D, Grulich A, Richters J, Ferris J, Grierson J, Smith A, et al Estimating population distribution and HIV prevalence among homosexual and bisexual men. Sex Health 2006; 3 37–43.
| Estimating population distribution and HIV prevalence among homosexual and bisexual men.CrossRef | 16607973PubMed |
 Sexually Transmissible Infections in Gay Men Action STIGMA Group. STIGMA home page. Sydney: STIGMA; 2011. Available online at: http://stigma.net.au [verified August 2012].
 Bourne C, Edwards B, Shaw M, Gowers A, Rodgers C, Ferson M. Sexually transmissible infection testing guidelines for men who have sex with men. Sex Health 2008; 5 189–91.
| Sexually transmissible infection testing guidelines for men who have sex with men.CrossRef | 18588782PubMed |
 Bourne C, Zablotska I, Williamson A, Calmette Y, Guy R. Promotion and uptake of a new online partner notification and retesting reminder service for gay men. Sex Health 2012; 9 360–7.
| Promotion and uptake of a new online partner notification and retesting reminder service for gay men.CrossRef | 22877596PubMed |
 Allen K, Guy R, Leslie D, Goller J, Medland N, Roth N, et al The rise of infectious syphilis in Victoria and the impact of enhanced clinical testing. Aust N Z J Public Health 2008; 32 38–42.
| The rise of infectious syphilis in Victoria and the impact of enhanced clinical testing.CrossRef | 18290912PubMed |
 Hull P, Mao L, Kao S-C, Edwards B, Prestage G, Zablotska I, et al. Gay community periodic survey: Sydney, February 2012. Sydney: National Centre in HIV Social Research, The University of New South Wales; 2012 .
 Gray RT, Hoare A, Prestage GP, Donovan B, Kaldor JM, Wilson DP. Frequent testing of highly sexually active gay men is required to control syphilis. Sex Transm Dis 2010; 37 298–305.
| 20393383PubMed |
 Hotton AL, Gratzer B, Pohl D, Mehta SD. Factors associated with repeat syphilis testing at a large urban LGBT health clinic: Chicago, IL 2002–2008. Sex Transm Dis 2011; 38 205–9.
| Factors associated with repeat syphilis testing at a large urban LGBT health clinic: Chicago, IL 2002–2008.CrossRef | 20871493PubMed |
 Bourne C, Knight V, Guy R, Wand H, Lu H, McNulty A. Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men. Sex Transm Infect 2011; 87 229–31.
| Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men.CrossRef | 1:STN:280:DC%2BC3M3ot1Wqug%3D%3D&md5=99f08fa7afeef207cc36f455a76665b0CAS | 21296796PubMed |
 Ehlman DC, Jackson M, Saenz G, Novak DS, Kachur R, Heath JT, et al Evaluation of an innovative internet-based partner notification program for early syphilis case management, Washington, DC, January 2007–June 2008. Sex Transm Dis 2010; 37 478–85.
| 20539261PubMed |
 van Hal SJ, Hillman R, Stark DJ, Harkness JL, Marriott D. Lymphogranuloma venereum: an emerging anorectal disease in Australia. Med J Aust 2007; 187 309–10.
| 17767440PubMed |
 O’Sullivan B, Delpech V, Pontivivo G, Karagiannis T, Marriott D, Harkness J, et al Shigellosis linked to sex venues, Australia. Emerg Infect Dis 2002; 8 862–4.
| Shigellosis linked to sex venues, Australia.CrossRef | 12141976PubMed |