Publications & Reports

Increased syphilis testing of men who have sex with men: greater detection of asymptomatic early syphilis and relative reduction in secondary syphilis.

Chow EPF, Callander D, Fairley CK, Zhang L, Donovan B, Guy R, Lewis DA, Hellard M, Read P, Ward A, Chen MY; ACCESS collaboration.

Abstract

Background Syphilis rates have increased markedly among men who have sex with men (MSM) in many countries. This study examined trends in syphilis testing and detection of early syphilis among MSM in Australia.

Methods Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 sexual health clinics in Australia between 2007 and 2014.

Results There were 359,313 clinic visits included in the analysis, with 32% of clinic visits for HIVpositive MSM. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91%, ptrend<0.0001) and HIV-positive MSM (42% to 77%, ptrend<0.0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIVnegative MSM (ptrend<0.0001) and from 1.6 to 2.3 in HIV-positive men (ptrend<0.0001). 2,799 and 1,032 early syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM the proportion of syphilis infections that were early latent increased from 27% to 44% (ptrend<0.0001), while the proportion that were secondary decreased from 24% to 19% (ptrend=0.030). Among HIV-positive MSM the proportion of syphilis infections that were early latent increased from 23% to 45% (ptrend<0.0001), while the proportion that were secondary decreased from 45% to 26% (ptrend=0.0003). Among HIVpositive MSM there was a correlation between decreasing proportion of secondary syphilis and increasing testing coverage (r=-0.87;p=0.005) or frequency (r=-0.93;p=0.001).

Conclusions Major increases in screening for syphilis were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIVpositive and HIV-negative MSM nationally, suggesting interruption of syphilis progression

Link to publisher’s web site

Publication

  • Journal: Clinical Infectious Diseases
  • Published: 01/08/2017
  • Volume: 65
  • Issue: 3
  • Pagination: 389-395

Author