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Nieuwenburg SA, Jongen VW, Schim van der Loeff M, de Vries H, van Dam A. Seroconversion in syphilis screening without positive confirmatory tests points at early infection. Sex Transm Infect 2024; 100:138-142. [PMID: 38253515 DOI: 10.1136/sextrans-2023-055973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/02/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The chemiluminescence immunoassay (CLIA) is a widely used screening test for syphilis. A CLIA seroconversion in the absence of a positive line immunoassay (LIA) or rapid plasma reagin (RPR) could indicate either an early incubating syphilis or a false positive result. We aimed to evaluate the diagnostic value of such seroconversions. METHODS We retrospectively analysed data of clients visiting the Centre for Sexual Health Amsterdam between July 2013 and August 2021 with a positive CLIA and a negative RPR and negative or indeterminate LIA (at time To), and a preceding visit (T-1) with a negative CLIA <6 months of To ('unconfirmed CLIA seroconversion'). If available, data of follow-up visits (T1) <2 months of To were also included. A syphilis diagnosis was confirmed if darkfield microscopy or PCR for Treponema pallidum was positive at T0 or T1, or if RPR and/or LIA were positive at T1. RESULTS We included data of 107 clients with unconfirmed CLIA seroconversion. The value of CLIA seroconversion could not be established in 13 (12.1%) clients. In the remaining 94 clients, the unconfirmed CLIA seroconversion was confirmed as early syphilis in 72 (76.6%) clients and probable syphilis in 6 (6.4%) clients. In 16 (17.0%) clients, the unconfirmed CLIA seroconversion was regarded as a false positive reaction of whom 4 (5.3%) clients had a seroreversion of the CLIA at T1. CONCLUSION The majority of unconfirmed CLIA seroconversions represented early syphilis infections. Therefore, additional T. pallidum PCR, a follow-up consultation or early treatment is recommended.
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Affiliation(s)
- Silvia Achia Nieuwenburg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - Vita Willemijn Jongen
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Henry de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Dermatology, Meibergdreef 9, Amsterdam, Amsterdam UMC location University of Amsterdam, Department of Dermatology, the Netherlands
| | - Alje van Dam
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Medical Microbiology, Amsterdam Health Service, Mebergdreef 9, Amsterdam, the Netherlands
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2
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Sadeghi Y, Nelson P, Sullivan A, Allen V, Hasso M, Liu J, Tran V, Tan DHS. Can laboratory HIV and infectious syphilis data inform future pre-exposure prophylaxis use in women in Ontario, Canada? Sex Transm Infect 2024; 100:184-186. [PMID: 38290811 DOI: 10.1136/sextrans-2023-055985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES Infectious syphilis has been proposed as an indication for HIV pre-exposure prophylaxis (PrEP) in women. We explored how many women experienced HIV seroconversion after being diagnosed with syphilis in Ontario between 20 April 2010 and 31 December 2021. METHODS Through deterministic linkage of laboratory data at the Public Health Ontario laboratory, which conducts the vast majority of syphilis and HIV testing in Ontario, we quantified the number of females with positive syphilis diagnoses who subsequently exhibited HIV seroconversion between April 2010 and December 2021. New HIV cases were identified by diagnostic serology or HIV viral load test result of ≥20 copies/mL at least 60 days after the positive syphilis test. We report aggregate numbers of women with new laboratory evidence of HIV infection after their first positive syphilis test. RESULTS Among 7957 women with positive syphilis tests during the study period, 6554 (82.4%) had linkable HIV serology tests and 133 (1.7%) ever tested HIV positive. With further linkage to viral load data, the number of women who ever had laboratory evidence of HIV infection increased to 184 (2.3%). However, when restricting to women whose first positive HIV test or HIV viral load occurred after their first positive syphilis test, this number decreased to 34 (0.4%). The median (IQR) time between the positive syphilis test and the first laboratory evidence of HIV was 551 (IQR=226-1159) days. CONCLUSION Although it is clinically appropriate to recommend HIV PrEP to women with syphilis, Ontario surveillance data suggest that the population-level impact of this strategy on the HIV epidemic in Ontario would have been modest during this 11-year period. Future studies should explore additional ways of prioritising women for PrEP.
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Affiliation(s)
- Yasamin Sadeghi
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Paul Nelson
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Vanessa Allen
- Public Health Ontario, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
- Division of Infectious Diseases, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Maan Hasso
- Public Health Ontario, Toronto, Ontario, Canada
| | - Juan Liu
- Public Health Ontario, Toronto, Ontario, Canada
| | - Vanessa Tran
- Public Health Ontario, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Darrell H S Tan
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, ON, Canada
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Huang ZY, Cornelisse VJ, Burdon RM. Painful proctitis associated with anorectal mpox, syphilis, HSV, LGV, gonorrhoea and Mycoplasma genitalium in a person living with virologically suppressed HIV and vaccinated against mpox. Sex Transm Infect 2024; 100:106-107. [PMID: 38124214 DOI: 10.1136/sextrans-2023-056033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
A gay man with well-controlled HIV and vaccinated against mpox presented with severe proctitis. Testing revealed anorectal mpox, herpes simplex virus, lymphogranuloma venereum, Neisseria gonorrhoeae and Mycoplasma genitalium Serology was indicative of infectious syphilis. This case highlights the need to consider a wide range of concurrent sexually transmitted infections in patients with proctitis, including those vaccinated against mpox.
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Affiliation(s)
- Zoe Y Huang
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rachel M Burdon
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia
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4
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Alberto C, Lambeng N, Deffert C, Breville G, Gayet-Ageron A, Lalive P, Calmy A, Coste A, Papadimitriou-Olivgeris M, Braun D, Lienhard R, Bosshard PP, Fontao L, Toutous Trellu L. Multicentric evaluation of a specific intrathecal anti- Treponema pallidum IgG index as a diagnostic biomarker of neuro syphilis: results from a retro-prospective case-control study. Sex Transm Infect 2024; 100:63-69. [PMID: 38071543 DOI: 10.1136/sextrans-2023-055913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of neurosyphilis (NS) lacks a true 'gold standard', making the diagnosis challenging while consequences of a misdiagnosis are potentially severe. The aim of this study was to evaluate the diagnostic performance of measuring an antibody index (AI) for the intrathecal synthesis of specific anti-Treponema pallidum (T. pallidum) IgG for the diagnosis of NS. METHODS Specific anti-T. pallidum IgG were measured simultaneously in paired cerebrospinal fluid (CSF)-serum samples collected retrospectively and prospectively between 2007 and 2022, from patients suspected of NS, in Switzerland. An AI was calculated to account for blood-brain barrier integrity. Area under the receiver operating characteristic curve, sensitivity/specificity and positive/negative predictive values of AI test were estimated. Two NS definitions were used: NS1 included patients with NS suspicion presenting with neurological symptoms and/or acute neurosensory signs, and positive T. Pallidum Hemagglutinations Assay (TPHA)/T. pallidum particle agglutination assay (TPPA) serology and CSF-TPHA/TPPA ≥320, and either CSF-leucocytes >5 cells/mm3 and/or CSF-protein >0.45 g/L and/or a reactive CSF-venereal disease research laboratory (VDRL)/rapid plasma reagin (RPR) test. NS2 included patients with suspected NS presenting with acute ocular and/or otologic symptoms, and positive TPHA/TPPA serology, and a favourable response to NS treatment. Controls were patients diagnosed with any other central nervous system (CNS) pathologies and with positive TPHA/TPPA serology. RESULTS The study included 71 NS (43 NS1 and 28 NS2) and 110 controls. With a threshold of ≥1.7, sensitivity and specificity of the specific AI test were 90.7% (CI 77.7 to 97.4) and 100% (CI 96.7 to 100.0), respectively, for NS1 and 14.3% (CI 4 to 32.7) and 100% (CI 96.7 to 100.0) for NS2. In patients suspected of NS with a CNS involvement (NS1 group), NS could be confirmed by the positivity of this specific AI. CONCLUSIONS Measurement of an intrathecal synthesis index of specific anti-T. pallidum IgG in patients with CSF inflammatory signs appears to be a valuable diagnostic test. However, in otic or ocular syphilis, presenting few CSF abnormalities, AI is not sufficient alone to confirm NS diagnosis. TRIAL REGISTRATION Swiss Association of Research Ethics Committees number 2019-00232.
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Affiliation(s)
- Chloé Alberto
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Nathalie Lambeng
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Deffert
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gautier Breville
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- CRC & Division of Clinical Epidemiology, Department of Community Health and Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice Lalive
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Alix Coste
- Microbiology Institute, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Dominique Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Lionel Fontao
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
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5
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Freese J, Segura ER, Gutierrez J, Lake JE, Cabello R, Clark JL, Blair C. Sexual network characteristics and partnership types among men who have sex with men diagnosed with syphilis, gonorrhoea and/or chlamydia in Lima, Peru. Sex Transm Infect 2024; 100:84-90. [PMID: 38124224 PMCID: PMC10922481 DOI: 10.1136/sextrans-2023-055910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Sexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various partnership types within these networks. METHODS Our cross-sectional survey analysed data from 1376 MSM screened for a partner management intervention in Lima, Peru. Participants were tested for HIV, syphilis, gonorrhoea (NG) and chlamydia (CT) and completed surveys on their demographics, sexual identity/role, HIV status, partnership types and sexual network from the prior 90 days. χ2 and Wilcoxon rank-sum tests compared participants without an STI to those diagnosed with (1) syphilis, (2) NG and/or CT (NG/CT) and (3) syphilis and NG/CT coinfection (coinfection). RESULTS 40.8% (n=561/1376) of participants were diagnosed with an STI (syphilis: 14.9%, NG/CT: 16.4%, coinfection: 9.5%). 47.9% of all participants were living with HIV and 8.9% were newly diagnosed. A greater proportion of participants with syphilis and coinfection were living with HIV (73.5%, p<0.001; 71.0%, p<0.001) compared with those with NG/CT (47.8%) or no STI (37.8%). Participants with syphilis more often reported sex-on-premises venues (SOPVs) as the location of their last sexual encounter (51.7%, p=0.038) while those with NG/CT tended to meet their last sexual partner online (72.8%, p=0.031). Respondents with coinfection were the only STI group more likely to report transactional sex than participants without an STI (31.3%, p=0.039). CONCLUSIONS Sexual networks and partnership types of Peruvian MSM are associated with differential risks for STIs. Participants diagnosed with syphilis tended to meet single-encounter casual partners at SOPV, while MSM with NG/CT were younger and often contacted casual partners online. Coinfection had higher frequency of transactional sex. These findings suggest the potential importance of public health interventions through combined syphilis/HIV screening at SOPV, syphilis screening at routine clinic appointments for MSM living with HIV and directed advertisements and/or access to NG/CT testing through online platforms.
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Affiliation(s)
- Jonathan Freese
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, Los Angeles, California, USA
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | | | - Jesse L Clark
- Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
| | - Cherie Blair
- Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
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6
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Kuitunen I. Record high incidence of syphilis cases in Finland in 2022. Sex Transm Infect 2024; 100:58-59. [PMID: 37833056 DOI: 10.1136/sextrans-2023-055962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Affiliation(s)
- Ilari Kuitunen
- Department of Pediatrics, Institute of Clinical Medicine, Kuopio, Finland
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7
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Bates M, Blackaby J, Davis B, Norcross C, Richardson D. Transitioning HIV-negative men who have sex with men and transgender women diagnosed with early syphilis to HIV-pre-exposure prophylaxis. Sex Transm Infect 2023:sextrans-2023-055854. [PMID: 37248039 DOI: 10.1136/sextrans-2023-055854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Maddie Bates
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Bethan Davis
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Claire Norcross
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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8
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Ghaznavi C, Tanoue Y, Kawashima T, Eguchi A, Yoneoka D, Sakamoto H, Ueda P, Ishikane M, Ando N, Miyazato Y, Nomura S. Recent changes in the reporting of STIs in Japan during the COVID-19 pandemic. Sex Transm Infect 2023; 99:124-127. [PMID: 35459754 PMCID: PMC9985712 DOI: 10.1136/sextrans-2021-055378] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has had variable effects on the rates of STIs reported across the globe. This study sought to assess how the number of STI reports changed during the pandemic in Japan. METHODS We used national infectious disease surveillance data from the National Institute of Infectious Diseases (Tokyo, Japan) for the period between January 2013 and December 2021. We compared reported rates of chlamydia, gonorrhoea, condyloma acuminata and genital herpes, as well as total notifications for HIV/AIDS and syphilis during the pandemic versus previous years in Japan. We used a quasi-Poisson regression to determine whether any given week or month between January 2018 and December 2021 had a significant excess or deficit of STIs. Notification values above or below the 95% upper and lower prediction thresholds were considered as statistically significant. The start of the pandemic was defined as January 2020. RESULTS Chlamydia generally remained within predicted range during the pandemic period. Reporting of gonorrhoea was significantly higher than expected throughout early-to-mid 2021 but otherwise generally remained within predicted range prior to 2021. Condyloma, herpes and HIV/AIDS reporting were transiently significantly lower than expected throughout the pandemic period, but no significant periods of higher-than-expected reporting were detected. Syphilis showed widespread evidence of significantly lower-than-predicted reporting throughout 2020 but eventually reversed, showing significantly higher-than-predicted reporting in mid-to-late 2021. CONCLUSIONS The COVID-19 pandemic was associated with variable changes in the reporting of STIs in Japan. Higher-than-predicted reporting was more likely to be observed in the later phases of the pandemic. These changes may have been attributable to pandemic-related changes in sexual behaviour and decreased STI clinic attendance and testing, but further research on the long-term impact of the pandemic on STIs is necessary.
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Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, Keio University, Tokyo, Japan .,Medical Education Program, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Yuta Tanoue
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Takayuki Kawashima
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Department of Mathematical and Computing Science, Tokyo Institute of Technology, Tokyo, Japan
| | - Akifumi Eguchi
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.,Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Peter Ueda
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naokatsu Ando
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
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9
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Zhang Y, Goh SM, Mello MB, Baggaley RC, Wi T, Johnson CC, Asiedu KB, Marks M, Pham MD, Fairley CK, Chow EPF, Mitjà O, Toskin I, Ballard RC, Ong JJ. Improved rapid diagnostic tests to detect syphilis and yaws: a systematic review and meta-analysis. Sex Transm Infect 2022; 98:608-616. [PMID: 36180209 PMCID: PMC9685714 DOI: 10.1136/sextrans-2022-055546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Current rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests (RDTs) which can better distinguish an active infection of syphilis or yaws. METHODS We conducted a systematic review and meta-analysis, searching five databases between January 2010 and October 2021 (with an update in July 2022). A generalised linear mixed model was used to conduct a bivariate meta-analysis for the pooled sensitivity and specificity. Heterogeneity was assessed using the I2 statistic. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) to assess the risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to evaluate the certainty of evidence. RESULTS We included 17 studies for meta-analyses. For syphilis, the pooled sensitivity and specificity of the treponemal component were 0.93 (95% CI: 0.86 to 0.97) and 0.98 (95% CI: 0.96 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.90 (95% CI: 0.82 to 0.95) and 0.97 (95% CI: 0.92 to 0.99), respectively. For yaws, the pooled sensitivity and specificity of the treponemal component were 0.86 (95% CI: 0.66 to 0.95) and 0.97 (95% CI: 0.94 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.80 (95% CI: 0.55 to 0.93) and 0.96 (95% CI: 0.92 to 0.98), respectively. CONCLUSIONS RDTs that can differentiate between active and previously treated infections could optimise management by providing same-day treatment and reducing unnecessary treatment. PROSPERO REGISTRATION NUMBER CRD42021279587.
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Affiliation(s)
- Ying Zhang
- School of Public Health, The University of Sydney, Campertown, New South Wales, Australia
| | - Su Mei Goh
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | | | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | | | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK,Hospital for Tropical Diseases, University College London Hospital, London, UK,Division of Infection and Immunity, University College London, London, UK
| | - Minh D Pham
- Burnet Institute, Melbourne, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Catalonia, Spain
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ronald C Ballard
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Jason J Ong
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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10
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Towns JM, Chow EPF, Wigan R, Fairley CK, Williamson D, Azzato F, Graves S, Zhang L, Chen MY. Anal and oral detection of Treponema pallidum in men who have sex with men with early syphilis infection. Sex Transm Infect 2022; 98:570-574. [PMID: 35618414 DOI: 10.1136/sextrans-2021-055370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We aimed to characterise patterns of anal and oral detection of Treponema pallidum among men who have sex with men (MSM) with early syphilis. METHODS 200 MSM with serologically confirmed primary, secondary and early latent syphilis were tested with T. pallidum polA PCR using an anal canal swab, oral rinse, plus swabs from any anal and oral lesions in a prospective, cross-sectional study. Anal and oral T. pallidum cycle threshold values were compared between subsets of men and according to rapid plasma reagin (RPR) titre. RESULTS Of 200 men with early syphilis, 45 and 48 had anal and oral T. pallidum detected, respectively. Cycle threshold values were lower with anal compared with oral T. pallidum whether lesions were present or not. Among 27 and 42 men with anal and oral T. pallidum detected, respectively, and no anal or oral primary lesion, frequency of detection increased with increasing RPR titre, with 95% (25/27) and 98% (41/42) of shedding from respective sites occurring with RPR titres ≥1:16. 6.5% (13/200) of men with syphilis had concurrent detection of T. pallidum from both anal and oral sites: 9/13 with secondary syphilis, 7/9 of whom had anal lesions with a median duration of 30 days (range 7-180 days). CONCLUSIONS These data suggest T. pallidum load at the anus is higher than at the oral cavity and that a subset of men with secondary syphilis and prolonged anal lesions may be relatively infectious. Earlier detection and treatment of syphilis, when RPR titres are lower than 1:16, could potentially reduce infectiousness from anal and oral sites.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Deborah Williamson
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stephen Graves
- Barwon Health, Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
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11
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Towns JM, Denham I, Chow EPF, Graves S, Fairley CK, Williamson D, Azzato F, Chen MY. Clinical and laboratory aspects of condylomata lata lesions of syphilis. Sex Transm Infect 2022; 99:162-166. [PMID: 35732476 DOI: 10.1136/sextrans-2021-055385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Condylomata lata are a less common but distinctive syphilitic lesion. Variable theories as to their nature and origin exist. The aim of this study was to determine the clinical and laboratory characteristics of condylomata lata by determining (1): the most closely aligned stage of syphilis, based on the rapid plasma reagin (RPR) titre; (2) symptom duration and (3) Treponema pallidum PCR cycle threshold (CT) values, as an indicator of organism load. METHODS This was a retrospective study of patients with T. pallidum PCR-positive condylomata lata lesions, attending a clinic in Melbourne, Australia, between 2011 and 2021. Syphilis serology was undertaken and RPR titres compared between condylomata lata, primary and secondary syphilis cases. RESULTS 51 cases with T. pallidum PCR-positive condylomata lata were included. 41 cases were in men, 40 of whom were men who have sex with men (MSM), and 10 in women. Twelve of 51 (24%) cases were in HIV-positive MSM. Thirty-three of 51 (65%) had other mucocutaneous signs of secondary syphilis; 18 (35%) had no other signs of secondary syphilis. The median RPR titre among the 51 condylomata lata cases was 1:128, compared with the median RPR titre of primary syphilis (1:4) and of secondary syphilis (1:128). The median duration of lesions was 24 (IQR 10-60) days, with no significant difference between those with and without other signs of secondary syphilis (p=0.75). Median CT values for condylomata lata (CT=31) and primary syphilis (CT=31) were significantly lower than for other secondary syphilis lesion types (CT=33), indicating higher T. pallidum loads for condylomata lata and primary lesions compared with other secondary syphilis lesion types. DISCUSSION These findings support condylomata lata as lesions that occur during the secondary stage of syphilis and which are likely to be highly infectious.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Stephen Graves
- Barwon Health, Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Deborah Williamson
- Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
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12
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Jongen VW, Zimmermann HML, Goedhart M, Bogaards JA, Davidovich U, Coyer L, de Vries HJC, Prins M, Hoornenborg E, Schim van der Loeff MF. Can we screen less frequently for STI among PrEP users? Assessing the effect of biannual STI screening on timing of diagnosis and transmission risk in the AMPrEP Study. Sex Transm Infect 2022; 99:149-155. [PMID: 35584898 PMCID: PMC10176338 DOI: 10.1136/sextrans-2022-055439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In many countries, HIV pre-exposure prophylaxis (PrEP) users are screened quarterly for STIs. We assessed the consequences of less frequent STI testing. We also assessed determinants of asymptomatic STI and potential for onward transmission. METHODS Using data from the AMPrEP study, we assessed the proportion of syphilis, and genital, anal, and pharyngeal chlamydia and gonorrhoea diagnoses which would have been delayed with biannual versus quarterly screening. We assessed the potential for onward transmission by examining reported condomless anal sex (CAS) in periods after to-be-omitted visits when screening biannually. We assessed determinants of incident asymptomatic STIs using Poisson regression and calculated individual risk scores on the basis of the coefficients from this model. RESULTS We included 366 participants. Median follow-up was 47 months (IQR 43-50). 1,183STIs were diagnosed, of which 932(79%) asymptomatic. With biannual screening, 483 asymptomatic STIs (52%) diagnoses would have been delayed at 364 study visits. Of these visits, 129 (35%), 240 (66%) and 265 (73%) were followed by periods of CAS with steady, known casual or unknown casual partners, respectively. Older participants had a lower risk of asymptomatic STI (incidence rate ratio (IRR) 0.86/10-year increase, 95% CI 0.80 to 0.92), while CAS with known (IRR 1.36, 95% CI 1.10 to 1.68) and unknown (IRR 1.86, 95% CI 1.48 to 2.34) casual partners and chemsex (IRR 1.51, 95% CI 1.28 to 1.78) increased the risk. The individual risk scores had limited predictive value (sensitivity=0.70 (95% CI 0.66 to 0.74), specificity=0.50 (95% CI 0.48 to 0.51)). CONCLUSION Reducing the STI screening frequency to biannually among PrEP users will likely result in delayed diagnoses, potentially driving onward transmission. Although determinants for asymptomatic STIs were identified, predictive power was low.
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Affiliation(s)
- Vita W Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Hanne M L Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Marit Goedhart
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Bogaards
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, location VUmc, Amsterdam, Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Social Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Infection and Immunity (AII), Amsterdam, Netherlands
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Infection and Immunity (AII), location Academic Medical Centre, Amsterdam, Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Infection and Immunity (AII), Amsterdam, Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Infection and Immunity (AII), Amsterdam, Netherlands
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13
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Liu GL, Zhou XY, Dong RJ, Cao YK, Albarmaqi RA, Li YY. False-positive TPPA and TRUST syphilis test results in a patient with antiphospholipid syndrome and monoclonal immunoglobulinaemia. Sex Transm Infect 2022; 98:313. [PMID: 35301256 PMCID: PMC9120389 DOI: 10.1136/sextrans-2021-055386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Guai-Li Liu
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiao-Yan Zhou
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rong-Jing Dong
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,School of Medicine, Hubei Polytechnic University, Huangshi, China
| | - Ying-Kui Cao
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rowida A Albarmaqi
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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14
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Seppings L, Hamill M. A review of an early syphilis outbreak in West Berkshire and Reading 2014-2015. Sex Transm Infect 2018; 92:364. [PMID: 27440932 DOI: 10.1136/sextrans-2016-052579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/31/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Louise Seppings
- Department of Genitourinary Medicine, Berkshire Healthcare NHS Trust, Slough, UK
| | - Matthew Hamill
- Department of Genitourinary Medicine, Berkshire Healthcare NHS Trust, Slough, UK
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15
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Rekart ML, Ndifon W, Brunham RC, Dushoff J, Park SW, Rawat S, Cameron CE. A double-edged sword: does highly active antiretroviral therapy contribute to syphilis incidence by impairing immunity to Treponema pallidum? Sex Transm Infect 2017; 93:374-378. [PMID: 28093460 PMCID: PMC5537507 DOI: 10.1136/sextrans-2016-052870] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/17/2016] [Accepted: 10/29/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS Recently, the world has experienced a rapidly escalating outbreak of infectious syphilis primarily affecting men who have sex with men (MSM); many are taking highly active antiretroviral therapy (HAART) for HIV-1 infection. The prevailing hypothesis is that HAART availability and effectiveness have led to the perception among both individuals who are HIV-1 infected and those who are uninfected that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhoea, chlamydia and syphilis. However, syphilis incidence has increased more rapidly than other STDs. We hypothesise that HAART downregulates the innate and acquired immune responses to Treponema pallidum and that this biological explanation plays an important role in the syphilis epidemic. METHODS We performed a literature search and developed a mathematical model of HIV-1 and T. pallidum confection in a population with two risk groups with assortative mixing to explore the consequence on syphilis prevalence of HAART-induced changes in behaviour versus HAART-induced biological effects. CONCLUSIONS AND IMPLICATIONS Since rising syphilis incidence appears to have outpaced gonorrhoea and chlamydia, predominantly affecting HIV-1 positive MSM, behavioural factors alone may be insufficient to explain the unique, sharp increase in syphilis incidence. HAART agents have the potential to alter the innate and acquired immune responses in ways that may enhance susceptibility to T. pallidum. This raises the possibility that therapeutic and preventative HAART may inadvertently increase the incidence of syphilis, a situation that would have significant and global public health implications. We propose that additional studies investigating the interplay between HAART and enhanced T. pallidum susceptibility are needed. If our hypothesis is correct, HAART should be combined with enhanced patient management including frequent monitoring for pathogens such as T. pallidum.
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Affiliation(s)
- Michael L Rekart
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wilfred Ndifon
- African Institute for Mathematical Sciences, Muizenberg, Cape Town, South Africa
| | - Robert C Brunham
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Dushoff
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Sang Woo Park
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Sanjana Rawat
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia, Canada
| | - Caroline E Cameron
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia, Canada
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16
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Tuite AR, Shaw S, Reimer JN, Ross CP, Fisman DN, Mishra S. Can enhanced screening of men with a history of prior syphilis infection stem the epidemic in men who have sex with men? A mathematical modelling study. Sex Transm Infect 2017; 94:105-110. [PMID: 28705938 DOI: 10.1136/sextrans-2017-053201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine the transmission impact of using prior syphilis infection to guide a focused syphilis screening intervention among men who have sex with men (MSM). METHODS We parameterised a deterministic model of syphilis transmission in MSM to reflect the 2011-2015 syphilis outbreak in Winnipeg, Canada. Enhanced screening of 75% of men with prior syphilis every 3 months (A) was compared with distributing equivalent number tests to all MSM (B) or those with the highest partner number (C). We compared early syphilis incidence, diagnoses and prevalence after 10 years, relative to a base case of 30% of MSM screened annually. RESULTS Strategy A was expected to avert 52% of incident infections, 44% of diagnosed cases and reduce early syphilis prevalence by 89%. Strategy B had the least impact. Strategy C was most effective, averting 59% of incident cases. When screening frequency was semiannual or annual, strategy A was the most effective. CONCLUSIONS Enhanced screening of MSM with prior syphilis may efficiently reduce transmission, especially when identification of high-risk men via self-reported partner numbers or high-frequency screening is difficult to achieve.
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Affiliation(s)
- Ashleigh R Tuite
- T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Souradet Shaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Joss N Reimer
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Craig P Ross
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - David N Fisman
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
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17
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Obure CD, Gaitan-Duarte H, Losada Saenz R, Gonzalez L, Angel-Muller E, Laverty M, Perez F. A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia. Sex Transm Infect 2017; 93:482-486. [PMID: 28495681 PMCID: PMC5739853 DOI: 10.1136/sextrans-2016-052961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/28/2017] [Accepted: 04/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited. Methods A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated. Results A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US$10.26 and US$607.99, respectively in the single RDT arm. For the dual RDTs, the cost per pregnant woman tested for HIV and syphilis and cost per woman treated for syphilis were US$15.89 and US$1859.26, respectively. Overall costs per woman tested for HIV and syphilis and cost per woman treated for syphilis were lower in Cali compared with Bogota across both intervention arms. Staff costs accounted for the largest proportion of costs while treatment costs comprised <1% of the preventive programme. Conclusions Findings show lower average costs for single RDTs compared with dual RDTs with costs sensitive to personnel costs and the scale of output at the health facilities. Trial registration number NCT02454816; results.
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Affiliation(s)
- Carol Dayo Obure
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hernando Gaitan-Duarte
- Obstetrics and Gynecology Department, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ricardo Losada Saenz
- Obstetrics and Gynecology Department, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Lina Gonzalez
- Obstetrics and Gynecology Department, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Edith Angel-Muller
- Obstetrics and Gynecology Department, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Maura Laverty
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Freddy Perez
- Communicable Diseases and Health Analysis Department, HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit, Pan American Health Organization, Washington DC, USA
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18
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Menezes LJ, Pokharel U, Sudenga SL, Botha MH, Zeier M, Abrahamsen ME, Glashoff RH, Engelbrecht S, Schim van der Loeff MF, van der Laan LE, Kipping S, Taylor D, Giuliano AR. Patterns of prevalent HPV and STI co-infections and associated factors among HIV-negative young Western Cape, South African women: the EVRI trial. Sex Transm Infect 2017; 94:55-61. [PMID: 28490581 DOI: 10.1136/sextrans-2016-053046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and describe the patterns of concurrent human papillomavirus (HPV) and STIs and associated factors among HIV-negative young Western Cape, South African women participating in the Efficacy of HPV Vaccine to Reduce HIV Infection (EVRI) trial. METHODS HIV-negative women aged 16-24 years old were enrolled in the EVRI trial (NCT01489527) and randomised to receive the licensed four-valent HPV vaccine or placebo. At study entry, participants were clinically evaluated for five STIs: herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis and disease-causing HPV genotypes (6/11/16/18/31/33/35/39/45/51/52/56/58/59/68). Demographic and sexual history characteristics were compared among women with STI co-infections, single infection and no infection using Pearson χ2 and Mann-Whitney tests. ORs were calculated to evaluate factors associated with STI co-infection prevalence. RESULTS Among 388 young women, STI co-infection prevalence was high: 47% had ≥2 concurrent STIs, 36% had a single STI and 17% had none of the five evaluated STIs. HPV/HSV-2 (26%) was the most prevalent co-infection detected followed by HPV/HSV-2/Chlamydia trachomatis (CT) (17%) and HPV/CT (15%). Co-infection prevalence was independently associated with alcohol use (adjusted OR=2.01, 95% CI 1.00 to 4.06) and having a sexual partner with an STI (adjusted OR=6.96, 95% CI 1.53 to 30.08). CONCLUSIONS Among high-risk young women from underserved communities such as in Southern Africa, a multicomponent prevention strategy that integrates medical and behavioural interventions targeting both men and women is essential to prevent acquisition of concurrent STI infections and consequent disease. TRIAL REGISTRATION NUMBER NCT01489527; Post-results.
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Affiliation(s)
- Lynette J Menezes
- Division of Infectious Disease and International Medicine, University of South Florida, Tampa, Florida, USA
| | - Ubin Pokharel
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Staci L Sudenga
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Matthys H Botha
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Michele Zeier
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa
| | - Martha E Abrahamsen
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Richard H Glashoff
- Division of Medical Virology, Stellenbosch University and NHLS Tygerberg, Cape Town, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and NHLS Tygerberg, Cape Town, South Africa
| | | | - Louvina E van der Laan
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Siegfried Kipping
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | | | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
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19
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Glidden DV, Mayer K, Grant RM. Response to: A double-edged sword: does highly active antiretroviral therapy contribute to syphilis incidence by impairing immunity to Treponema pallidum? Sex Transm Infect 2017; 93:313. [PMID: 28408646 DOI: 10.1136/sextrans-2017-053212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- David V Glidden
- University of California, San Francisco, San Francisco, California, USA
| | | | - Robert M Grant
- University of California, San Francisco, San Francisco, California, USA
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20
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Korenromp EL, Mahiané G, Rowley J, Nagelkerke N, Abu-Raddad L, Ndowa F, El-Kettani A, El-Rhilani H, Mayaud P, Chico RM, Pretorius C, Hecht K, Wi T. Estimating prevalence trends in adult gonorrhoea and syphilis in low- and middle-income countries with the Spectrum-STI model: results for Zimbabwe and Morocco from 1995 to 2016. Sex Transm Infect 2017; 93:599-606. [PMID: 28325771 PMCID: PMC5739862 DOI: 10.1136/sextrans-2016-052953] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2017] [Accepted: 01/14/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To develop a tool for estimating national trends in adult prevalence of sexually transmitted infections by low- and middle-income countries, using standardised, routinely collected programme indicator data. Methods The Spectrum-STI model fits time trends in the prevalence of active syphilis through logistic regression on prevalence data from antenatal clinic-based surveys, routine antenatal screening and general population surveys where available, weighting data by their national coverage and representativeness. Gonorrhoea prevalence was fitted as a moving average on population surveys (from the country, neighbouring countries and historic regional estimates), with trends informed additionally by urethral discharge case reports, where these were considered to have reasonably stable completeness. Prevalence data were adjusted for diagnostic test performance, high-risk populations not sampled, urban/rural and male/female prevalence ratios, using WHO's assumptions from latest global and regional-level estimations. Uncertainty intervals were obtained by bootstrap resampling. Results Estimated syphilis prevalence (in men and women) declined from 1.9% (95% CI 1.1% to 3.4%) in 2000 to 1.5% (1.3% to 1.8%) in 2016 in Zimbabwe, and from 1.5% (0.76% to 1.9%) to 0.55% (0.30% to 0.93%) in Morocco. At these time points, gonorrhoea estimates for women aged 15–49 years were 2.5% (95% CI 1.1% to 4.6%) and 3.8% (1.8% to 6.7%) in Zimbabwe; and 0.6% (0.3% to 1.1%) and 0.36% (0.1% to 1.0%) in Morocco, with male gonorrhoea prevalences 14% lower than female prevalence. Conclusions This epidemiological framework facilitates data review, validation and strategic analysis, prioritisation of data collection needs and surveillance strengthening by national experts. We estimated ongoing syphilis declines in both Zimbabwe and Morocco. For gonorrhoea, time trends were less certain, lacking recent population-based surveys.
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Affiliation(s)
| | - Guy Mahiané
- Avenir Health, Glastonbury, Connecticut, USA
| | | | | | - Laith Abu-Raddad
- Weill Cornell Medical College-Qatar, Cornell University, Doha, Qatar
| | - Francis Ndowa
- Skin & Genito-Urinary Medicine Clinic, Harare, Zimbabwe
| | - Amina El-Kettani
- Ministry of Health, Direction de l'Epidémiologie & Service de Maladies Sexuellement Transmissibles, Rabat, Morocco
| | | | | | | | | | | | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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21
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Bingham JS. Then and now: a vignette. Sex Transm Infect 2017; 93:297. [PMID: 28264902 DOI: 10.1136/sextrans-2016-053019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/11/2017] [Indexed: 11/04/2022] Open
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22
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Tomkins A, Ahmad S, Cousins DE, Thng CM, Vilar FJ, Higgins SP. Screening for asymptomatic neuro syphilis in HIV patients after treatment of early syphilis: an observational study. Sex Transm Infect 2017; 94:337-339. [PMID: 28196838 DOI: 10.1136/sextrans-2016-052938] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/16/2017] [Accepted: 01/23/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the prevalence of asymptomatic neurosyphilis (ANS) in HIV-positive individuals after treatment of early syphilis with single-dose benzathine penicillin G (BPG) or oral antibiotic alternatives. METHODS Patients at high risk of neurosyphilis (defined by serum rapid plasma reagin (RPR) titre ≥1:32 and/or peripheral blood CD4 lymphocyte count ≤350/μL) underwent lumbar puncture (LP) at a median time of 8.2 months post treatment. ANS was diagnosed by a reactive cerebrospinal fluid (CSF) RPR test or CSF white blood cells (WBC) >20/μL plus a reactive CSF Treponema pallidum particle agglutination (TPPA) ≥1:640. RESULTS Of 133 eligible patients, all were men who have sex with men. Of these, 64 consented to LP. Full CSF results were available for 59 patients. Inclusion criteria were serum RPR (21/59), CD4 count (22/59) and combined RPR and CD4 (16/59). The LP patients were white British (82%), median age 40. Syphilis stages were primary (17%) secondary (43%) and early latent (41%). Syphilis was treated with BPG (47/59), doxycycline 100 mg two times per day for 14 days (10/59) and for 21 days (1/59). Azithromycin 500 mg one time per day for 10 days was given to 1/59. At the time of LP, 100% of patients had achieved serological cure, and 66% were taking antiretroviral treatment. Only 1/59 was diagnosed with ANS. The CSF showed: RPR non-reactive (59/59); TPPA non-reactive in 54/59; WBC ≤5/μL in 51/59. CONCLUSIONS Although the number of patients in our study is modest, single-dose BPG appears to be highly effective even in patients at high risk of neurosyphilis.
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Affiliation(s)
- Andrew Tomkins
- Department of Sexual Health and HIV, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK
| | - Shazaad Ahmad
- Department of Infectious Diseases, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK
| | - Darren E Cousins
- Department of Sexual Health and HIV, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK
| | - Caroline M Thng
- Department of Sexual Health and HIV, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK
| | - Francisco Javier Vilar
- Department of Infectious Diseases, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK
| | - Stephen P Higgins
- Department of Sexual Health and HIV, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK
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23
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Tuddenham S, Shah M, Ghanem KG. Syphilis and HIV: Is HAART at the heart of this epidemic? Sex Transm Infect 2017; 93:311-312. [PMID: 28093459 DOI: 10.1136/sextrans-2016-052940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maunank Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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24
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van Aar F, den Daas C, van der Sande MAB, Soetens LC, de Vries HJC, van Benthem BHB. Outbreaks of syphilis among men who have sex with men attending STI clinics between 2007 and 2015 in the Netherlands: a space-time clustering study. Sex Transm Infect 2016; 93:390-395. [PMID: 27986969 DOI: 10.1136/sextrans-2016-052754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Infectious syphilis (syphilis) is diagnosed predominantly among men who have sex with men (MSM) in the Netherlands and is a strong indicator for sexual risk behaviour. Therefore, an increase in syphilis can be an early indicator of resurgence of other STIs, including HIV. National and worldwide outbreaks of syphilis, as well as potential changes in sexual networks were reason to explore syphilis trends and clusters in more depth. METHODS National STI/HIV surveillance data were used, containing epidemiological, behavioural and clinical data from STI clinics. We examined syphilis positivity rates stratified by HIV status and year. Additionally, we performed space-time cluster analysis on municipality level between 2007 and 2015, using SaTScan to evaluate whether or not there was a higher than expected syphilis incidence in a certain area and time period, using the maximum likelihood ratio test statistic. RESULTS Among HIV-positive MSM, the syphilis positivity rate decreased between 2007 (12.3%) and 2011 (4.5%), followed by an increasing trend (2015: 8.0%). Among HIV-negative MSM, the positivity rate decreased between 2007 (2.8%) and 2011 also (1.4%) and started to increase from 2013 onwards (2015: 1.8%). In addition, we identified three geospatial clusters. The first cluster consisted of MSM sex workers in the South of the Netherlands (July 2009-September 2010, n=10, p<0.001). The second cluster were mostly HIV-positive MSM (58.5%) (Amsterdam; July 2011-December 2015; n=1123, p<0.001), although the proportion of HIV-negative MSM increased over time. The third cluster was large in space (predominantly the city of Rotterdam; April-September 2015, n=72, p=0.014) and were mostly HIV-negative MSM (62.5%). CONCLUSIONS Using SaTScan analysis, we observed several not yet recognised outbreaks and a rapid resurgence of syphilis among known HIV-positive MSM first, but more recently, also among HIV-negative MSM. The three identified clusters revealed locations, periods and specific characteristics of the involved MSM that could be used when developing targeted interventions.
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Affiliation(s)
- F van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - C den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - L C Soetens
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - H J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - B H B van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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25
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Schwartz S, Lambert A, Phaswana-Mafuya N, Kose Z, Mcingana M, Holland C, Ketende S, Yah C, Sweitzer S, Hausler H, Baral S. Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: findings from a respondent-driven sampling study. Sex Transm Infect 2016; 93:290-296. [PMID: 27888205 DOI: 10.1136/sextrans-2016-052773] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/18/2016] [Accepted: 11/05/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are disproportionately affected by HIV, even in the context of broadly generalised HIV epidemics such as South Africa. This has been observed in spite of the individual and population-level benefits of HIV treatment. We characterise the HIV care cascade among FSWs and relationships with antiretroviral therapy (ART) use. METHODS FSWs ≥18 years were recruited through respondent-driven sampling into a cross-sectional study in Port Elizabeth, South Africa. Participants completed questionnaires and received HIV and syphilis testing; CD4 counts were assessed among women living with HIV. Engagement in the HIV care cascade is described, and correlates of self-reported ART use among treatment-eligible previously diagnosed FSWs were estimated using robust Poisson regression. RESULTS Between October 2014 and April 2015, 410 FSWs participated in study activities. Overall, 261/410 were living with HIV (respondent-driven sampling-weighted prevalence 61.5% (95% bootstrapped CI 54.1% to 68.0%)). Prior diagnosis of HIV was relatively high (214/261, 82%); however, ART coverage among FSWs living with HIV was 39% (102/261). In multivariate analyses, FSWs were less likely to be on ART if they had not disclosed their HIV status to non-paying partners (adjusted prevalence ratio (aPR) 0.43, 95% CI 0.22 to 0.86, where the reference is FSWs without non-paying partners), and also if they engaged in mobile healthcare services (aPR 0.71, 95% CI 0.57 to 0.89). CONCLUSIONS HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated.
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Affiliation(s)
- Sheree Schwartz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Nancy Phaswana-Mafuya
- The Human Sciences Research Council, Port Elizabeth, South Africa.,Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Zamakayise Kose
- The Human Sciences Research Council, Port Elizabeth, South Africa
| | - Mfezi Mcingana
- The TB/HIV Care Association, Port Elizabeth, South Africa
| | - Claire Holland
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sosthenes Ketende
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Clarence Yah
- The Human Sciences Research Council, Port Elizabeth, South Africa
| | - Stephanie Sweitzer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Harry Hausler
- The TB/HIV Care Association, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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26
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Bissio E, Cisneros V, Lopardo GD, Cassetti LI. Very high incidence of syphilis in HIV-infected men who have sex with men in Buenos Aires city: a retrospective cohort study. Sex Transm Infect 2016; 93:323-326. [PMID: 27856515 DOI: 10.1136/sextrans-2016-052893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/20/2016] [Accepted: 10/29/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The incidence of sexually transmitted infections (STIs), particularly syphilis, is high and continues to rise among some populations, especially among men who have sex with men (MSM). Furthermore, a higher incidence of STIs has been reported in HIV-positive than in HIV-negative MSM. OBJECTIVE To determine the incidence of syphilis in a cohort of men with HIV in Buenos Aires city. METHODS Retrospective cohort study. We examined the records and visits made by men with HIV aged >18 years in our institution during a 1-year period. Venereal Disease Reference Laboratory (VDRL) results for all the men in our cohort during the study period were analysed. We considered a case of syphilis as incident if a person had a VDRL result of ≥16 DILS, provided that this was increased at least fourfold compared with a previous determination. All VDRL results ≤8 were investigated, and analysed together with the medical records, to determine if they were new cases. RESULTS We analysed the VDRL results and the clinical records of 1150 men followed up in our centre during the study period. Mean age was 40.9 years. According to the definition used, we registered 171 new cases of syphilis-that is, an incidence of 14.9/100 patients/year (95% CI 12.9 to 17.0). No significant differences in incidence according to age group were found, but there was a trend towards a lower incidence in older men. Ten men had two new episodes during the study. CONCLUSIONS The incidence of syphilis in this cohort of men with HIV (predominantly MSM) was very high. In addition to maintaining high surveillance for early diagnosis and treatment, it is necessary to implement newer and more effective measures to prevent syphilis and other STIs in this population.
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Affiliation(s)
- E Bissio
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina
| | - V Cisneros
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina
| | - G D Lopardo
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina.,Hospital Bernardo Houssay, Vicente López, Provincia de Buenos Aires, Argentina
| | - L I Cassetti
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina.,HELIOS SALUD, Ciudad de Buenos Aires, Argentina
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27
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Girometti N, Gutierrez A, Nwokolo N, McOwan A, Whitlock G. High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy? Sex Transm Infect 2016; 93:320-322. [PMID: 28729516 DOI: 10.1136/sextrans-2016-052865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) is becoming a pivotal strategy for HIV prevention. Understanding the impact of risk factors for HIV transmission to identify those at highest risk would favour the implementation of PrEP, currently limited by costs. In this service evaluation, we estimated the incidence of bacterial STIs in men who have sex with men (MSM) diagnosed with early syphilis attending a London sexual health clinic according to their HIV status. In addition, we estimated the incidence of HIV infection in HIV-negative MSM, following a diagnosis of early syphilis. METHODS We undertook a retrospective case note review of all MSM patients diagnosed with early syphilis between January and June 2014. A number of sexual health screens and diagnoses of chlamydia, gonorrhoea and HIV were prospectively analysed following the syphilis diagnosis. RESULTS 206 MSM were diagnosed with early syphilis. 110 (53%) were HIV-negative at baseline, 96 (47%) were HIV-positive. Only age (37 vs 32 years, p=0.0005) was significantly different according to HIV status of MSM at baseline. In HIV-negative versus HIV-positive MSM, incidence of rectal chlamydia infection at follow-up was 27 cases vs 50/100 person-years of follow-up (PYFU) (p=0.0039), 33 vs 66/100 PYFU (p=0.0044) for rectal gonorrhoea and 10 vs 26/100 PYFU (p=0.0044) for syphilis reinfection, respectively. Total follow-up for 110 HIV-negative MSM was 144 person-years. HIV incidence was 8.3/100 PYFU (CI 4.2 to 14). CONCLUSIONS A diagnosis of early syphilis carries a high risk of consequent HIV seroconversion and should warrant prioritised access to prevention measures such as PrEP and regular STI screening to prevent HIV transmission.
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Affiliation(s)
- Nicolò Girometti
- Infectious Diseases Unit, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.,Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Nneka Nwokolo
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan McOwan
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
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28
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Pastuszczak M, Gozdzialska A, Jakiela B, Obtulowicz A, Jaskiewicz J, Wojas-Pelc A. Robust pro-inflammatory immune response is associated with serological cure in patients with syphilis: an observational study. Sex Transm Infect 2016; 93:11-14. [PMID: 27356549 DOI: 10.1136/sextrans-2016-052681] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Approximately 15% of adequately treated patients with early syphilis remain serofast. Pathogenesis and clinical significance of this phenomenon is unclear. The objective of this study was to determine whether there is any association between host immune response and treatment outcome (serofast state or proper serological response). METHODS Forty-four patients with secondary syphilis were enrolled to this study. Levels of pro-inflammatory cytokines such as interferon-γ, tumour necrosis factor-α and interleukin-6 were measured before treatment and 8 hours after injection of antibiotic. RESULTS After 1 year, based on the serological response patients were stratified into two groups: (1) proper serological response (n=31) and (2) serofast state (n=9). The serological cure rate was 77.5% at 12 months after treatment. Patients with proper serological response had significantly higher levels of analysed cytokines (at baseline and 8 hours after treatment) compared with the serofast state group (p<0.05). CONCLUSIONS We showed that robust host pro-inflammatory immune response to infection may be the predictive factor of serological cure. The treatment outcome may be also associated with the magnitude of immune reaction occurring during the treatment.
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Affiliation(s)
- Maciej Pastuszczak
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
| | | | - Bogdan Jakiela
- Department of Medicine, Jagiellonian University School of Medicine, Cracow, Poland
| | - Aleksander Obtulowicz
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
| | | | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
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29
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DeSilva M, Hedberg K, Robinson B, Toevs K, Neblett-Fanfair R, Petrosky E, Hariri S, Schafer S. A case-control study evaluating the role of internet meet-up sites and mobile telephone applications in influencing a syphilis outbreak: Multnomah County, Oregon, USA 2014. Sex Transm Infect 2016; 92:353-8. [PMID: 27188272 DOI: 10.1136/sextrans-2015-052509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Early syphilis in Multnomah County, Oregon, USA, increased 16-fold during 2007-2013. Cases predominantly occurred among men who have sex with men (MSM); 55% were HIV coinfected. We conducted a case-control study to evaluate the association between meeting sex partners online and early syphilis. METHODS Cases subjects (cases) were Multnomah County resident, English speaking, MSM, aged ≥18 years with laboratory-confirmed early syphilis reported 1 January to 31 December 2013. We recruited two MSM controls subjects (controls) per case, frequency matched by HIV status and age. Participants completed self-administered questionnaires. We performed multivariable logistic regression. RESULTS Seventy per cent (40/57) of cases and 42% (50/119) of controls met partners online (p<0.001). Cases more frequently met partners online (adjusted OR (aOR)=3.0; 95% CI 1.2 to 6.7), controlling for presumptive confounders. Cases reported more partners than controls (medians 5, 2; p<0.001). When including number of partners, aOR decreased to 1.4 (95% CI 0.5 to 3.9). CONCLUSIONS Early syphilis was associated with meeting partners online. We believe this association may be related to number of sex partners acting as an intermediate variable between use of online resources to meet sex partners and early syphilis. Online meet-up sites might represent areas for public health interventions targeting at-risk individuals.
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Affiliation(s)
- Malini DeSilva
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA
| | | | - Byron Robinson
- Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA
| | - Kim Toevs
- Adolescent Health Promotion and STD/HIV/HCV Programs, Multnomah County Health Department, Portland, Oregon, USA
| | - Robyn Neblett-Fanfair
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
| | - Emiko Petrosky
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
| | - Susan Hariri
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
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30
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Black V, Williams BG, Maseko V, Radebe F, Rees HV, Lewis DA. Field evaluation of Standard Diagnostics' Bioline HIV/ Syphilis Duo test among female sex workers in Johannesburg, South Africa. Sex Transm Infect 2016; 92:495-498. [PMID: 27154184 DOI: 10.1136/sextrans-2015-052474] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/10/2016] [Accepted: 04/16/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Point-of-care tests provide immediate results with the opportunity for same-day interventions with improved public health outcomes. A dual HIV/syphilis test enables early treatment of both diseases. METHODS We conducted a field evaluation of the Standard Diagnostics' SD Bioline HIV/Syphilis Duo test (SD Bioline) among female sex workers. SD Bioline was conducted on finger-prick blood according to manufacturer's instructions and compared with (i) Genscreen HIV1/2 (third generation) and Vironostika Ag/Ab (fourth generation) assays for HIV, and (ii) Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) assays for syphilis. A negative TPPA test was considered negative, a TPPA-confirmed RPR titre ≤1:4 as past infection and a TPPA-confirmed RPR titre ≥1:8 as active syphilis. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Of 263 women recruited, 14 (5.3%) declined an HIV test. Among the remaining 249 women, 187 (75.1%) were HIV positive, 51 (20.5%) had syphilis antibodies with seven (2.8%) active infections. For HIV, the sensitivity and specificity were 98.9% (95% CI 95.8% to 99.8%) and 100% (95% CI 92.7% to 100%). For syphilis, the sensitivity and specificity were 66.7% (95% CI 52.0% to 78.9%) and 98.0% (95% CI 94.5% to 99.3%). Sera with high TPPA titres were more likely to test positive. CONCLUSIONS In field conditions, while the SD Bioline test has high sensitivity and specificity for HIV and high specificity for syphilis, the test has lower sensitivity for syphilis than reported from laboratory evaluations. As the dual test detects only two thirds of syphilis cases, it should only be used in areas with weak screening programmes.
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Affiliation(s)
- Vivian Black
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian G Williams
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Venessa Maseko
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Frans Radebe
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Helen V Rees
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - David A Lewis
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
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31
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Petersen J, Gibin M, Sile B, Simms I. Identifying and interpreting spatiotemporal variation in diagnoses of infectious syphilis among men, England: 2009 to 2013. Sex Transm Infect 2016; 92:380-6. [PMID: 27147614 DOI: 10.1136/sextrans-2015-052306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 04/09/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Spatial clusters and variations in the trajectory of local epidemics were explored in relation to sexual orientation, demographic factors, stage of syphilis infection and HIV serostatus. METHODS Kulldorff's scan statistics (SaTScan) was used to distinguish endemic and temporary clusters using a two-stage analysis. RESULTS Endemic areas were found in London, Manchester, Brighton and Blackpool. Up to 40% of diagnoses were found within an 11 km radius of central London. Of men diagnosed with syphilis in London, 80% were men who have sex with men (MSM). Annual incidence in London increased from 24 cases (95% CI 23 to 26) per 100 000 male population in 2009 to 36 cases (95% CI 34 to38) in 2013. In comparison with clusters, endemic areas were characterised by a significantly higher (p<0.05) proportion of MSM (83% compared with 73%), increased HIV positivity (41% vs 15%), age 35 to 44 years (34% vs 23%), a lower proportion of patients born in the UK (50% vs 79%) and a lower proportion of primary stage infection (40% vs 47%). Space-time clusters outside endemic areas occurred in urban and rural areas and diagnoses fluctuated below 10 per month. Exponential increases in diagnoses resembling point source outbreaks were seen at two locations. CONCLUSION Control of syphilis in endemic areas has proved elusive and clusters present unique intervention opportunities. Investigating the diversity of local epidemics provides information that can be used to predict outbreak structure, plan and evaluate sexual health services and guide public health investigation, hypothesis generation and research.
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Affiliation(s)
- Jakob Petersen
- National Travel Health Network & Centre, UCLH NHS Foundation Trust, London, UK
| | - Maurizio Gibin
- GIScience Association Italy, Mombaroccio, Pesaro und Urbino, Italy
| | - Bersabeh Sile
- HIV & STI Department, Health Protection Services, Public Health England, London, UK
| | - Ian Simms
- HIV & STI Department, Health Protection Services, Public Health England, London, UK
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32
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Thomas DR, Williams CJ, Andrady U, Anderson V, Humphreys S, Midgley CM, Fina L, Craine N, Porter-Jones G, Wilde A, Whiteside C. Outbreak of syphilis in men who have sex with men living in rural North Wales (UK) associated with the use of social media. Sex Transm Infect 2016; 92:359-64. [PMID: 27147613 DOI: 10.1136/sextrans-2015-052323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/05/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe an outbreak of infectious syphilis in rural North Wales and the control measures implemented. METHODS Following reports of an increase of syphilis in North Wales, a multidisciplinary Outbreak Control Team (OCT) was established. A multilevel prevention and control response was initiated, including: active case surveillance, partner notification and treatment, sexual network analysis, awareness raising with professionals and affected communities, point-of-care syphilis testing at a sauna and a health promotion campaign targeting users of men who have sex with men (MSM) social network mobile phone applications (apps). RESULTS Four cases of infectious syphilis were diagnosed in clinics in North Wales per 100 000 population in 2013 compared with a mean of one case per 100 000 in the preceding decade. Diagnosed cases peaked in January 2014, declining in the first half of 2014. Initial cases were clustered in the westerly rural counties of North Wales and were predominantly white men, self-reporting as MSM (median age: 34 years, range: 17-61). Point-of-care testing at a sauna did not identity further new infections, suggesting that the cluster was relatively focused and had probably been detected early. The use of apps to find sexual partners was a feature of the network affected. A health promotion campaign, initiated by the OCT, targeting men using MSM apps reached 92% of the 755 men messaged. CONCLUSIONS The outbreak was successfully controlled. However, it is difficult to determine which of the interventions implemented were most effective. Future outbreaks should be used as an opportunity to evaluate interventions using apps.
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Affiliation(s)
- Daniel Rh Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK
| | | | - Ushan Andrady
- Department of Genitourinary Medicine, Betsi Cadwaldr University Health Board, Bangor, Wales, UK
| | - Valerie Anderson
- Department of Genitourinary Medicine, Betsi Cadwaldr University Health Board, Bangor, Wales, UK
| | | | - Claire M Midgley
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK
| | - Laia Fina
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK
| | - Noel Craine
- North Wales Health Protection Team, Public Health Wales, Mold, Wales, UK
| | - Gary Porter-Jones
- North Wales Health Protection Team, Public Health Wales, Mold, Wales, UK
| | - Alison Wilde
- Terrence Higgins Trust Cymru, Cardiff, Wales, UK
| | - Chris Whiteside
- North Wales Health Protection Team, Public Health Wales, Mold, Wales, UK
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Tuddenham S, Ghanem KG. Ocular syphilis: opportunities to address important unanswered questions. Sex Transm Infect 2016; 92:563-565. [PMID: 27116973 DOI: 10.1136/sextrans-2016-052570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/24/2016] [Accepted: 04/02/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tsuboi M, Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, Oka S, Gatanaga H. Prognosis of ocular syphilis in patients infected with HIV in the antiretroviral therapy era. Sex Transm Infect 2016; 92:605-610. [PMID: 27044266 DOI: 10.1136/sextrans-2016-052568] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/04/2016] [Accepted: 03/11/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the clinical course and prognosis of ocular syphilis in patients infected with HIV-1 in the antiretroviral therapy (ART) era. METHODS We conducted a single-centre retrospective chart review of ocular syphilis in patients infected with HIV-1 diagnosed between August 1997 and July 2015. The prognosis of best-corrected visual acuity (BCVA) was analysed. RESULTS The study subjects were 30 eyes of 20 men who had sex with men (MSM) (median age, 41). Loss of vision and posterior uveitis were the most common ocular clinical features (43%) and location of inflammation at presentation (50%), respectively. The median baseline BCVA was 0.4 (IQR 0.2-1.2), including three eyes with hand motion. BCVA≤0.4 at diagnosis was significantly associated with posterior uveitis or panuveitis (p=0.044). Seventy-five per cent were treated with intravenous benzylpenicillin and 53% were diagnosed with neurosyphilis. After treatment (median follow-up: 21 months), BCVA improved in 89% of the eyes, including all eyes with hand motion, to a median BCVA of 1.2 (IQR 0.8-1.2). Kaplan-Meier analysis showed that >28 days of ocular symptoms before diagnosis was the only factor associated with poor prognosis of BCVA. Three patients (15%) developed recurrence after treatment. CONCLUSIONS The prognosis of BCVA in HIV-infected patients with ocular syphilis in the ART era was favourable after proper treatment. Having >28 days of ocular symptoms before diagnosis was associated with poor prognosis. Changes in visual acuity in HIV-infected MSM should prompt an immediate assessment for ocular syphilis as delays in diagnosis and therapy can lead to irreversible visual loss.
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Affiliation(s)
- Motoyuki Tsuboi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shigeko Yashiro
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomichi Katai
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.,Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.,Center for AIDS Research, Kumamoto University, Kumamoto, Japan
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Bristow CC, Larson E, Anderson LJ, Klausner JD. Cost-effectiveness of HIV and syphilis antenatal screening: a modelling study. Sex Transm Infect 2016; 92:340-6. [PMID: 26920867 DOI: 10.1136/sextrans-2015-052367] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/23/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The WHO called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonised approach for the improvement of health outcomes for mothers and children. Testing early in pregnancy, treating seropositive pregnant women and preventing syphilis reinfection can prevent MTCT of HIV and syphilis. We assessed the health and economic outcomes of a dual testing strategy in a simulated cohort of 100 000 antenatal care patients in Malawi. METHODS We compared four screening algorithms: (1) HIV rapid test only, (2) dual HIV and syphilis rapid tests, (3) single rapid tests for HIV and syphilis and (4) HIV rapid and syphilis laboratory tests. We calculated the expected number of adverse pregnancy outcomes, the expected costs and the expected newborn disability-adjusted life years (DALYs) for each screening algorithm. The estimated costs and DALYs for each screening algorithm were assessed from a societal perspective using Markov progression models. Additionally, we conducted a Monte Carlo multiway sensitivity analysis, allowing for ranges of inputs. RESULTS Our cohort decision model predicted the lowest number of adverse pregnancy outcomes in the dual HIV and syphilis rapid test strategy. Additionally, from the societal perspective, the costs of prevention and care using a dual HIV and syphilis rapid testing strategy was both the least costly ($226.92 per pregnancy) and resulted in the fewest DALYs (116 639) per 100 000 pregnancies. In the Monte Carlo simulation the dual HIV and syphilis algorithm was always cost saving and almost always reduced DALYs compared with HIV testing alone. CONCLUSIONS The results of the cost-effectiveness analysis showed that a dual HIV and syphilis test was cost saving compared with all other screening strategies. Updating existing prevention of mother-to-child HIV transmission programmes in Malawi and similar countries to include dual rapid testing for HIV and syphilis is likely to be advantageous.
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Affiliation(s)
- Claire C Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Elysia Larson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Laura J Anderson
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey D Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Bristow CC, Leon SR, Huang E, Brown BJ, Ramos LB, Vargas SK, Flores JA, Caceres CF, Klausner JD. Field evaluation of a dual rapid diagnostic test for HIV infection and syphilis in Lima, Peru. Sex Transm Infect 2015; 92:182-5. [PMID: 26670914 DOI: 10.1136/sextrans-2015-052326] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/14/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Screening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidity, mortality and transmission associated with undiagnosed and untreated infections. Rapid point-of-care tests that can detect multiple infections with a single fingerprick whole blood specimen using a single device are gaining popularity. We evaluated the field performance of a rapid dual HIV and syphilis test in people at high risk of HIV and syphilis infections. METHODS Participants included men who have sex with men and transgender women recruited in Lima, Peru. Reference standard testing for detection of HIV and syphilis infections, conducted using blood samples from venipuncture, included Treponema pallidum particle agglutination and fourth-generation HIV enzyme immunoassay for which positive results had a confirmation HIV Western blot test. For the evaluation test, SD BIOLINE HIV/Syphilis Duo test (Standard Diagnostics, Korea), a fingerprick blood specimen was used. Sensitivity and specificity were calculated and the exact binomial method was used to determine 95% CIs. RESULTS A total of 415 participants were recruited for the study. The dual test sensitivity for detection of T. pallidum infection was 89.2% (95% CI 83.5% to 93.5%) and specificity 98.8% (95% CI 96.5% to 99.8%). For detection of HIV infection, the sensitivity of the dual test was 99.1% (95% CI 94.8% to 100%) and specificity 99.4% (95% CI 97.7% to 99.9%). CONCLUSIONS This high performing dual test should be considered for the use in clinical settings to increase uptake of simultaneous testing of HIV and syphilis and accelerate time to treatment for those who need it.
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Affiliation(s)
- Claire C Bristow
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Emily Huang
- Division of Infectious Diseases: Global Health, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Brandon J Brown
- Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Lourdes B Ramos
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan A Flores
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases: Global Health, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Chadwick JA, MacNab A, Sarma J, Ray S, Kadir I, Muldoon EG. Secondary syphilis presenting with aortitis and coronary ostial occlusion. Sex Transm Infect 2015; 92:108-9. [PMID: 26670911 DOI: 10.1136/sextrans-2015-052247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/07/2015] [Indexed: 11/03/2022] Open
Abstract
Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection.
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Affiliation(s)
- John A Chadwick
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Anita MacNab
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Simon Ray
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Isaac Kadir
- Department of Cardiothoracic Surgery, University Hospital of South Manchester, UK
| | - Eavan G Muldoon
- Department of Infectious Diseases, University Hospital of South Manchester, UK The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Towns JM, Leslie DE, Denham I, Azzato F, Fairley CK, Chen M. Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study. Sex Transm Infect 2015; 92:110-5. [PMID: 26378262 DOI: 10.1136/sextrans-2015-052219] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/31/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chancres, the hallmark of primary syphilis, are classically described as single, painless ulcers at the site of Treponema pallidum inoculation. We aimed to determine the frequency of painful or multiple anogenital lesions of primary syphilis among men, whether there was concurrent herpes simplex virus (HSV) infection and whether HIV status altered clinical presentations. METHODS This study was conducted among men with T. pallidum PCR-positive lesions, attending a clinic in Melbourne, Australia, between 2009 and 2014. Lesions were also tested with HSV PCR, and syphilis serology undertaken. RESULTS 183 men with T. pallidum PCR-positive primary anogenital lesions were included. 89% were men who have sex with men, and 10.9% were heterosexual. 38 men (20.8%) were HIV positive. Anal lesions were more common in HIV-positive men (34.2%) than in HIV-negative men (11.6%). Primary lesions were frequently painful (49.2%) or multiple (37.7%), and infrequently associated with HSV (2.7%). Of 37 men with both painful and multiple primary lesions, only 8% had concurrent HSV. Presentation was not significantly altered by HIV status. CONCLUSIONS Primary syphilis lesions are often painful and/or multiple in the absence of herpes coinfection, and may be clinically misdiagnosed.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia Central Clinical School, Monash University, Melbourne, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia Central Clinical School, Monash University, Melbourne, Australia
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Nuñez-Forero L, Moyano-Ariza L, Gaitán-Duarte H, Ángel-Müller E, Ruiz-Parra A, González P, Rodríguez A, Tolosa JE. Diagnostic accuracy of rapid tests for sexually transmitted infections in symptomatic women. Sex Transm Infect 2015; 92:24-8. [PMID: 26136508 DOI: 10.1136/sextrans-2014-051891] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 06/13/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of tests developed for use at the point of care for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in women having symptoms of lower urinary tract infection. METHODS Cross-sectional study involving sexually active 14-49-year-old women with lower urinary tract infection symptoms consulting during 2010 at a private health clinic and at two public hospitals in Bogotá, Colombia. Pregnant women, those with a previous hysterectomy or those who received antibiotics during the previous 7 days were excluded. Sequential sampling was used; sample size: 1500 women. The ACON NG and CT duo test combo and the ACON individual test plates for NG and separately for CT were used. The QuickVue Chlamydia rapid test (RT) was also used. All of them were compared with nucleic acid amplification methods. The SD Bioline 3.0 and ACON test for syphilis were evaluated and compared with serological tests. Sensitivity and specificity were estimated. RESULTS CT RTs had a sensitivity that ranged between 22.7% and 37.7% and specificity between 99.3% and 100%. Sensitivity for NG with ACON Duo was 12.5% and specificity 99.8%. Tests for syphilis had a sensitivity of 91.6-100% and a specificity of 99.7-97.8%. CONCLUSIONS The RTs studied are not useful for screening for NG at the point of care. In case of CT a recommendation about their use in routine care should be supported by a cost-effectiveness analysis. In screening populations at high risk of sexually transmitted infections or pregnant women, the RTs for syphilis should be used.
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Affiliation(s)
| | | | - Hernando Gaitán-Duarte
- Department of Obstetrics and Gynaecology, Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Edith Ángel-Müller
- Department of Obstetrics and Gynaecology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ariel Ruiz-Parra
- Department of Obstetrics and Gynaecology, Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Andrea Rodríguez
- Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge E Tolosa
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA FUNDARED-MATERNA, Bogotá, Colombia
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Affiliation(s)
- Alaa Attawan
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Irene M Pepper
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Simon J Hickman
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
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Tucker JD, Gelpi A, Bangsberg DR, Grewe ME, Necochea R. The disruptive influence of syphilis cures within specialist venereal systems: implications for HIV cure preparedness. Sex Transm Infect 2015; 91:2-3. [PMID: 25609463 DOI: 10.1136/sextrans-2014-051777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Joseph D Tucker
- International Diagnostics Centre, London, UK Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adriane Gelpi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David R Bangsberg
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Harvard School of Public Health, Boston, Massachusetts, USA
| | - Mary E Grewe
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raul Necochea
- Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Affiliation(s)
- Adriane Gelpi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA International Diagnostics Centre, London, UK
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Affiliation(s)
- Adriane Gelpi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA International Diagnostics Centre, London, UK
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Affiliation(s)
- Adriane Gelpi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam Gilbertson
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA International Diagnostics Centre, London, UK
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Tuite A, Fisman D. Go big or go home: impact of screening coverage on syphilis infection dynamics. Sex Transm Infect 2015; 92:49-54. [PMID: 25954016 DOI: 10.1136/sextrans-2014-052001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/21/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Syphilis outbreaks in urban men who have sex with men (MSM) are an ongoing public health challenge in many high-income countries, despite intensification of efforts to screen and treat at-risk individuals. We sought to understand how population-level coverage of asymptomatic screening impacts the ability to control syphilis transmission. METHODS We developed a risk-structured deterministic compartmental mathematical model of syphilis transmission in a population of sexually active MSM. We assumed a baseline level of treatment of syphilis cases due to seeking medical care in all scenarios. We evaluated the impact of sustained annual population-wide screening coverage ranging from 0% to 90% on syphilis incidence over the short term (20 years) and at endemic equilibrium. RESULTS The relationship between screening coverage and equilibrium syphilis incidence displayed an inverted U-shape relationship, with peak equilibrium incidence occurring with 20-30% annual screening coverage. Annual screening of 62% of the population was required for local elimination (incidence <1 case per 100 000 population). Results were qualitatively similar in the face of differing programmatic, behavioural and natural history assumptions, although the screening thresholds for local elimination differed. With 6-monthly or 3-monthly screening, the population coverage required to achieve local elimination was reduced to 39% or 23%, respectively. CONCLUSIONS Although screening has the potential to control syphilis outbreaks, suboptimal coverage may paradoxically lead to a higher equilibrium infection incidence than that observed in the absence of intervention. Suboptimal screening programme design should be considered as a possible contributor to unsuccessful syphilis control programmes in the context of the current epidemic.
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Affiliation(s)
- Ashleigh Tuite
- Institute of Medical Science and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Fisman
- Institute of Medical Science and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Rowley D, Swięcki P, Firlag-Burkacka E, Sabin C, Kümmerle T, Surah S, Sadlier C, O'Dea S, Horban A, Fätkenheuer G, Mulcahy F. Clinical and epidemiological characteristics of patients with early syphilis from three academic centres in Poland, Germany and Ireland: initial findings from the POETS study. Sex Transm Infect 2015; 91:389-94. [PMID: 25742696 DOI: 10.1136/sextrans-2014-051844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/01/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Syphilis recognition in HIV-positive patients has important implications. Initial data from this study, established in June 2012 to better understand the natural history of syphilis and treatment response, examine the characteristics of patients including sexual behaviour, rates of concurrent sexually transmitted infections (STI) and type of treatment given. METHODS Patients were recruited from Ireland, Poland and Germany. Data gathered included demographics, method of syphilis acquisition, stage of syphilis infection, HIV status, nadir and current CD4 counts and HIV viral suppression rates. Data were then subanalysed into HIV-positive and HIV-negative groups. RESULTS Of 175 patients recruited, 68% were HIV-positive and 86.3% were men who have sex with men. Most HIV-positive patients presented with secondary syphilis (55.7% vs 13.2%) (p=0.0001) while the majority of HIV-negative patients had primary syphilis noted at the time of recruitment (47.2% vs18.9%, p=0.0002). Approximately half of all patients had a HIV RNA viral load <40 copies/mL (55%). Previous syphilis infection occurred more frequently in HIV-positive than HIV-negative patients (p=0.0001). Concurrent STIs at the time of syphilis diagnosis were found in 26.8%, of whom 31 (25.4%) were HIV-positive (p=0.64). HIV-positive patients received doxycycline more frequently than their HIV-negative counterparts (33.6% vs 1.9%, p=0.0001) while HIV-negative patients were treated with long-acting penicillin in 88.7% of cases vs 58% of HIV-positive patients (p=0.0002). CONCLUSIONS A 40% rate of unsuppressed viraemia, high levels of STIs and varying treatment regimens represent a public health risk for Europe, suggesting the model of sexual healthcare delivery in HIV-positive patients requires further evaluation.
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Affiliation(s)
- D Rowley
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - P Swięcki
- The Hospital for Infectious Diseases, Warsaw, Poland
| | | | - C Sabin
- University College London, Royal Free Campus, Rowland Hill street, London, United Kingdom
| | - T Kümmerle
- Klinik I für Innere Medizin, Klinische Infektiologie, Uniklinik, Köln, Germany
| | - S Surah
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - C Sadlier
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - S O'Dea
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - A Horban
- The Hospital for Infectious Diseases, Warsaw, Poland
| | - G Fätkenheuer
- Klinik I für Innere Medizin, Klinische Infektiologie, Uniklinik, Köln, Germany German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - F Mulcahy
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
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47
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Affiliation(s)
- Adam Gilbertson
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Adriane Gelpi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- International Diagnostics Centre, London, UK
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48
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Affiliation(s)
- Adriane Gelpi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- International Diagnostics Centre, London, UK
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49
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Affiliation(s)
- Mary E Grewe
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA International Diagnostics Centre, London, UK
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50
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Hochberg CH, Schneider JA, Dandona R, Lakshmi V, Kumar GA, Sudha T, Akbar M, Ahmed GMM, Ramgopal SP, Armbruster B, Alary M, Dandona L. Population and dyadic-based seroincidence of herpes simplex virus-2 and syphilis in southern India. Sex Transm Infect 2015; 91:375-82. [PMID: 25605970 PMCID: PMC4518737 DOI: 10.1136/sextrans-2014-051708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/24/2014] [Indexed: 11/11/2022] Open
Abstract
Objectives Herpes simplex virus-2 (HSV-2) and syphilis are associated with increased risk of HIV, highlighting the importance of understanding their transmission dynamics. In India, most studies of HSV-2 and syphilis incidence are in high-risk populations and may not accurately reflect infectious activity. In this study, we aim to define HSV-2/syphilis incidence and risk factors in a population sample. Methods We conducted a longitudinal population-based survey in Andhra Pradesh, India, in two rounds: 2004–2005 and 2010–2011. Sociodemographic and behavioural data were collected, and dried blood spots tested for HSV-2 and Treponema pallidum IgG. After calculating sexually transmitted infection (STI) incidence, associated factors were assessed using modified Poisson regression and within-couple transmission rates modelled using seroconcordance/discordance data. Results 12 617 adults participated at baseline with 8494 at follow-up. Incidence of HSV-2 and syphilis per 1000 person-years was 25.6 (95% CI 24.1 to 27.2) and 3.00 (95% CI 2.52 to 3.54). Incidence of HSV-2 was higher in women vs men (31.1 vs 20.2) and in rural vs urban residents (31.1 vs 19.0) (p<0.05 for both). STI seroincidence increased in a step-wise fashion with age and was associated with spousal seropositivity for both sexes (incidence rate ratio (IRR) 2.59 to 6.78). Within couples the rate of transmission per 1000 couple-years from men to women vs women to men was higher for HSV-2 (193.3 vs 119.0) compared with syphilis (27.6 vs 198.8), p<0.05 for both. Conclusions HSV-2 has higher incidence among subpopulations such as women, rural residents and older-aged individuals, suggesting a need for more generalised STI prevention approaches among populations traditionally considered low risk.
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Affiliation(s)
- Chad H Hochberg
- Pritzker School of Medicine, University of Chicago Chicago, Illinois, USA
| | - John A Schneider
- Department of Medicine and Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | | | - Vemu Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Talasila Sudha
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | | | - Michel Alary
- Département de médecine sociale et préventive, URESP, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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