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RESEARCH ARTICLE

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

Phillip Read A B C , Christopher K. Fairley D E and Eric P. F. Chow D E F
+ Author Affiliations
- Author Affiliations

A The Kirketon Road Centre, PO Box 22, Kings Cross, NSW 1340, Australia.

B Sexual Health Program, The Kirby Institute, UNSW Australia, Kensington, NSW 2052, Australia.

C Holdsworth House Medical Practice, 32a Oxford Street, Darlinghurst, NSW 2010, Australia.

D Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.

E Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Carlton, Vic. 3053, Australia.

F Corresponding author. Email: Echow@mshc.org.au

Sexual Health 12(2) 155-163 https://doi.org/10.1071/SH14153
Submitted: 9 August 2014  Accepted: 20 November 2014   Published: 22 January 2015

Abstract

Background: The epidemiology of syphilis, and therefore the population most impacted, differs between countries. Many developed countries have reported an increase in syphilis notifications among men who have sex with men (MSM) over the past decade. Methods: The rates of syphilis notifications between 2000 and 2013 in the 31 countries categorised by the Organisation for Economic Co-operation and Development (OECD) as high income were investigated. Data was taken primarily from published national surveillance reports, and a male-to-female ratio substantially greater than two in syphilis notifications was taken as a proxy for the infection being disproportionately diagnosed in MSM. Results: Data was available for 27 high-income countries. The male-to-female ratio exceeded two in all but four countries. This ratio significantly increased across all geographical areas over time. Globally, the male-to-female ratio in these countries increased from 4.1 in 2000 to 7.9 in 2013 (P = 0.001). Furthermore, the proportion of male cases reported as being among MSM increased over time from 26.8% to 55.0% between 2000 and 2013 (P < 0.001). Conclusion: These data show 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.


References

[1]  Green T, Talbot M, Morton R. The control of syphilis, a contemporary problem: a historical perspective. Sex Transm Infect 2001; 77 214–7.
The control of syphilis, a contemporary problem: a historical perspective.CrossRef | 1:STN:280:DC%2BD3MzjsVCmtw%3D%3D&md5=a732071ecb8fc04aedc40a2f4cb58021CAS | 11402234PubMed |

[2]  Nakashima A, Rolfs R, Flock M, Kilmarx P, Greenspan J. Epidemiology of syphilis in the United States, 1941–1993. Sex Transm Dis 1996; 23 16–23.
Epidemiology of syphilis in the United States, 1941–1993.CrossRef | 1:STN:280:DyaK283ntFKitQ%3D%3D&md5=c81e803937d08d3439affb308e421a09CAS | 8801638PubMed |

[3]  The UK Collaborative Group for HIV and STI Surveillance. A complex picture. HIV and other sexually transmitted infections in the United Kingdom: 2006. London: Health Protection Agency, Centre for Infections; November 2006. Available online at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947365435 [verified 2 August 2014].

[4]  Public Health England. Sexually transmitted infections and chlamydia screening in England, 2012. Health Protection Weekly Report 2013; 7: 4–21. Available online at: http://webarchive.nationalarchives.gov.uk/20140714084352/; http://www.hpa.org.uk/hpr/archives/2013/hpr2313.pdf [verified 4 August 2014].

[5]  Communicable Disease Surveillance Centre Increased transmission of syphilis in Manchester. Commun Dis Rep CDR Wkly 2000; 10 89.
| 10761314PubMed |

[6]  Vilayleck MS. Continuing resurgence of syphilis in France. Euro Surveill 2001; 5 1686. Available online at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1686 [verified 22 June 2014].

[7]  Botham S, Ressler K, Maywood P, Hope K, Bourne C, Conaty S, Ferson M, Mayne D. Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance. Sex Health 2013; 10 291–8.
Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance.CrossRef | 23639847PubMed |

[8]  Hottes T, Lindegger M, Theodora Consolacion T, Wong S, Lester R, Montgomery C, Doupe G, Morshed M, Ogilive G, Gilber M. Infectious syphilis among gay, bisexual and other men who have sex with men in British Columbia 2003 to 2012. Vancouver: Clinical Prevention Services, BC Centre for Disease Control. Available online at: http://www.bccdc.ca/NR/rdonlyres/B917A2F2-54C5-4691-8015-4F80538CAC1E/0/CPS_Report_Infectious_Syphilis_MSMBC_20032012_20130624.pdf [verified 22 June 2014].

[9]  Read P, Donovan B. Clinical aspects of adult syphilis. Intern Med J 2012; 42 614–20.
Clinical aspects of adult syphilis.CrossRef | 1:STN:280:DC%2BC38jhs1ylsg%3D%3D&md5=20ead462b1bef997d165dbe065e8dc92CAS | 22697151PubMed |

[10]  Mehta S, Ghanem K, Rompalo A, Erbelding E.. HIV seroconversion among public sexually transmitted disease clinic patients: analysis of risks to facilitate early identification J Acquir Immune Defic Syndr 2006; 42 116–22.
HIV seroconversion among public sexually transmitted disease clinic patients: analysis of risks to facilitate early identificationCrossRef | 16763500PubMed |

[11]  Buchacz K, Patel P, Taylor M, Kerndt PR, Byers RH, Holmberg SD, Klausner JD. Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS 2004; 18 2075–9.
Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections.CrossRef | 15577629PubMed |

[12]  Read P, Fox J. Infectious syphilis unmasking drug resistance in an individual with long-term virological suppression on antiretroviral therapy. Sex Transm Infect 2010; 86 276–7.
Infectious syphilis unmasking drug resistance in an individual with long-term virological suppression on antiretroviral therapy.CrossRef | 20551233PubMed |

[13]  The World Bank. Country and lending groups. Available online at: http://data.worldbank.org/about/country-and-lending-groups#OECD_members [verified 20 May 2014].

[14]  Hull P, Mao L, Kao S-C, Edwards B, Prestage G, Zablotska I, De Wit J, Holt M. 2013, Gay community periodic survey: Sydney 2013. Sydney: University of New South Wales. Available online at: https://csrh.arts.unsw.edu.au/media/NCHSRFile/GCPS_Sydney_2013_Report.pdf [verified 6 July 2014].

[15]  Centers for Disease Control and Prevention Transmission of primary and secondary syphilis by oral sex: Chicago, Illinois, 1998–2002. MMWR Morb Mortal Wkly Rep 2004; 53 966–8.
| 15496825PubMed |

[16]  Chesson HW, Dee TS, Aral SO. AIDS mortality may have contributed to the decline in syphilis rates in the United States in the 1990s. Sex Transm Dis 2003; 30 419–24.
AIDS mortality may have contributed to the decline in syphilis rates in the United States in the 1990s.CrossRef | 12916133PubMed |

[17]  Savage EJ, Marsh K, Duffell S, Ison CA, Zaman A, Hughes G. Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011. Euro Surveill 2012; 17 20224. Available online at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20224 [verified 22 June 2014].
| 22835469PubMed |

[18]  de Vrieze N, van Rooijen M, Schim van der Loeff M, de Vries H. Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, The Netherlands: trends over time, symptomatology and concurrent infections. Sex Transm Infect 2013; 89 548–52.
| 23427272PubMed |

[19]  Phillips AN, Cambiano V, Nakagawa F, Brown AE, Lampe F, Rodger A, Miners A, Elford J, Hart G, Johnson AM, Lundgren J, Delpech VC. Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic. PLoS ONE 2013; 8 e55312
Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.CrossRef | 1:CAS:528:DC%2BC3sXjsVakur8%3D&md5=3c13060bcc4c3609104018a3ece68cf2CAS | 23457467PubMed |

[20]  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 |

[21]  Guy R, El-Hayek C, Fairley CK, Wand H, Carr A, McNulty A, Hoy J, Bourne C, McAllister J, Tee BK, Baker D, Roth N, Stoove M, Chen M. Opt-out and opt-in testing increases syphilis screening of HIV-positive men who have sex with men in Australia. PLoS ONE 2013; 8 e71436
Opt-out and opt-in testing increases syphilis screening of HIV-positive men who have sex with men in Australia.CrossRef | 1:CAS:528:DC%2BC3sXhtl2iu7jF&md5=7874166b008cbf98b0f7a2a897f8a807CAS | 24009661PubMed |

[22]  Tucker J, Bien C, Peeling R. Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013; 26 73–9.
Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control.CrossRef | 23242343PubMed |

[23]  Ibitoye M, Frasca T, Giguere R, Carballo-Diéguez A. Home testing past, present and future: lessons learned and implications for HIV home tests. AIDS Behav 2014; 18 933–49.
Home testing past, present and future: lessons learned and implications for HIV home tests.CrossRef | 24281697PubMed |

[24]  Bolan R, Beymer M, Klausner J, Flynn R, Leibowitz A. Doxycycline prophylaxis for syphilis in a persistently high risk HIV infected population. Sex Transm Infect 2013; 89 A283
Doxycycline prophylaxis for syphilis in a persistently high risk HIV infected population.CrossRef |

[25]  National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2008. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2008.

[26]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2013. Sydney: The Kirby Institute, The University of New South Wales; 2013.

[27]  Infectious Disease Surveillance Center, National Institute of Infectious Diseases. Annual surveillance reports. Available online at: http://www.nih.go.jp/niid/ja/all-surveillance/2270-idwr/nenpou/4317-kako2012.html [verified 20 June 2014].

[28]  Infectious Disease Surveillance Center, National Institute of Infectious Diseases. Infectious Agents Surveillance Report, 2014. vol 35 p 79–80. Available online at: http://www0.nih.go.jp/niid/idsc/iasr/35/409j.pdf [verified 22 June 2014].

[29]  Institute of Environmental Science and Research. STI Surveillance: annual report. Available online at: https://surv.esr.cri.nz/surveillance/annual_sti.php [verified 20 June 2014].

[30]  Psutka R, Dickson N and the Enhanced Syphilis Surveillance Steering Group. September 2013. Report to the New Zealand Sexual Health Society. Enhanced surveillance of infectious syphilis in New Zealand sexual health clinics - 2012. Dunedin: University of Otago; 2013.

[31]  European Centre for Disease Prevention and Control (ECDC). Sexually transmitted infections in Europe 2011. Stockholm: ECDC; 2013.

[32]  Public Health Agency of Canada. The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2013. Infectious disease - The never-ending Threat. Canada 2013. Available online at: http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/sti-its-eng.php [verified 20 June 2014].

[33]  Patton M, Su J, Nelson R, Weinstock H. Primary and secondary syphilis — United States, 2005–2013. MMWR Morb Mortal Wkly Rep 2014; 63 402–6.
| 24807239PubMed |

[34]  Centres for Disease Control and Prevention. 2012 Sexually transmitted diseases surveillance report. Available online at: http://www.cdc.gov/sTD/stats12/toc.htm [verified 24 June 2014].

[35]  Eidgenössisches Departement des Innern EDI. BAG Bulletin 20/14 HIV- und STI-Fallzahlen 2013. Available online at: http://www.bag.admin.ch/dokumentation/publikationen/01435/13591/index.html?lang=de [verified 20 June 2014].



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