An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester

Abstract

Background: In the past few years, increased diagnoses of syphilis have been reported in cities around Britain and Europe. Enhanced surveillance of cases began in 1999 to identify the epidemiology of this increase in Greater Manchester. Methods: Information was collected on all cases of syphilis newly diagnosed in genitourinary medicine (GUM) clinics in Greater Manchester between January 1999 and November 2002. The data collected included demographic information and information about other sexually transmitted infections, sexual behaviour, perception of risk of infection, and awareness of syphilis transmission. Results: The majority of cases identified were white homosexual men resident in Greater Manchester. Of the 414 cases diagnosed, 74% had either a primary or secondary stage of syphilis infection and 37% of cases were HIV positive. High numbers of individuals practised unprotected oral sex despite good awareness of the risk of infection with syphilis. There is evidence that the way people are meeting sexual contacts is changing, with increasing numbers meeting most of their partners through the internet. Conclusions: These findings have implications for targeting interventions. The provision of rapid diagnostic and treatment services is likely to be key for the control of syphilis and potentially of subsequent increases in HIV in the region. We initiated a system of "enhanced surveillance" in February 2000, collecting epidemiological information to establish the extent of infection in Greater Manchester and illuminate the patterns of transmission. METHODSWe devised a form for the collection of epidemiological data, including demographic data, diagnosis, and risk factors and distributed it to each of the 11 GUM clinics in Greater Manchester. Health workers completed one form for each case of syphilis by means of an interview or from case notes where this was not possible. The case definition used was all cases of laboratory confirmed infectious syphilis diagnosed in Greater Manchester from 1999 onwards. For cases diagnosed in 1999 and early 2000, as much data as possible were collected retrospectively from case notes. Completed forms were returned to the North West Office of the Communicable Disease Surveillance Centre (CDSC NW) for collation, data entry, and data analysis. RESULTSBetween January 1999 and November 2002, there were 414 cases of syphilis reported to the enhanced surveillance database by GUM clinics in Greater Manchester. Of these cases, 93% (377/405) were male and 81% (330/405) were homosexual. Of those for whom data were available, 93% of cases (354/382) were born in the United Kingdom, and 82% (310/380) were residents of Greater Manchester. There was no particular residential clustering of cases. The majority of cases (90%; 342/381) were white. The next most significant defined ethnic groups of cases were "Black Caribbean" and "Indian" (each 2.1%; 8/381).The epidemic curve demonstrates some seasonal variation in reporting of infection, with the New Year and summer periods appearing to be key...

Laboratory diagnosis of syphilis with automated immunoassays

“…Syphilis is still a public health problem worldwide (1) and recently outbreaks have been reported in several European countries (6)(7)(8).…”

“…Moreover, recent outbreaks have been reported in several cities in Europe and North America among men who have sex with men (MSM) (6)(7)(8). Outbreaks among MSM are associated with a rise in unsafe sexual behavior, perhaps a consequence of improved antiretroviral treatment for HIV in recent surveys; 37-52% of MSM reported multiple risk behaviors (6)(7)(8)(9).…”

“…Outbreaks among MSM are associated with a rise in unsafe sexual behavior, perhaps a consequence of improved antiretroviral treatment for HIV in recent surveys; 37-52% of MSM reported multiple risk behaviors (6)(7)(8)(9).…”

HIV Behavioral Research Online

“…22 Similar results have been reported in the UK, where increasing numbers of men testing positive for syphilis (the majority of whom were coinfected with HIV) reported meeting partners online. 21 In fact, Taylor et al 28 surveyed men in Los Angeles County already diagnosed with syphilis and found that men who met partners online reported more sexual and drug use risk behaviors.…”

“…Men can use the Internet to instantly identify and eventually meet with a large number of anonymous sex partners they might not meet otherwise, increasing their risk for HIV and other STIs. 4,[21][22][23] Unlike public and commercial sex venues, where subtle gestures and nonverbal forms are used to communicate information regarding sexual interests and behaviors desired, [24][25][26] the Internet permits men to communicate explicitly through written text or even through the use of photos or streaming video.…”