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RESEARCH ARTICLE

Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance

Susan 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: susan.botham@sesiahs.health.nsw.gov.au

Sexual Health 10(4) 291-298 http://dx.doi.org/10.1071/SH12142
Submitted: 24 August 2012  Accepted: 26 February 2013   Published: 3 May 2013

Abstract

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.


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