Evolution of the syphilis epidemic among men who have sex with men

Abstract

Syphilis has existed for millenni, but its epidemiology was only recently linked to men who have sex with men (MSM) after the introduction of penicillin in the 1940s; the syphilis epidemic became concentrated within the MSM community in subsequent decades. The HIV/AIDS epidemic in the 1980s led to a surge of new syphilis cases and revealed the potentiation between HIV and syphilis, as evidenced by a shift in the natural history of neurosyphilis. In response, MSM revolutionised their sexual behaviour by implementing community-driven seroadaptive strategies to stem HIV transmission. The Centers for Disease Control in the US called for the elimination of syphilis in the late 1990s since the rates had fallen sharply but this effort was overtaken by a resurgence of global outbreaks among MSM in the 2000s, many of which were linked to methamphetamine use and sexual networking websites. Syphilis remains highly prevalent today, especially among MSM and individuals infected with HIV, and it continues to present a significant public health conundrum. Innovative syphilis prevention strategies are warranted. MSM engaging in high-risk behaviour such as condomless anal receptive intercourse, sex with multiple partners or recreational drug use should be routinely screened for syphilis infection; they should also be counselled about the limits of seroadaptive behaviours and HIV pre-exposure prophylaxis as they relate to syphilis transmission.

Sexually transmissible infection control programs for men who have sex with men – what will they look like in 2020?

“…1 After a dramatic and steady decline through the middle of the 1990s, STIs resurged among men who have sex with men (MSM) and became hyperendemic. [2][3][4] Recent trends suggest that with the advent of pre-exposure prophylaxis (PrEP), increases in STIs among MSM may be accelerating further. [5][6][7] It is evident that current strategies need to be expanded upon, improved and combined with novel approaches.…”

Neurosyphilis in patients with HIV

“…Syphilis, caused by the spirochaete bacterium Treponema pallidum , has seen a resurgence in high-income countries in recent years, particularly among men who have sex with men 1. The widespread availability of penicillin in the USA and other industrialised countries following World War II resulted in the incidence of syphilis falling from 76 per 100 000 population in 1945 to 4 per 100 000 in 1955–1957.…”

“…The widespread availability of penicillin in the USA and other industrialised countries following World War II resulted in the incidence of syphilis falling from 76 per 100 000 population in 1945 to 4 per 100 000 in 1955–1957. After this period, syphilis rates became concentrated within men who have sex with men, and its incidence surged during the 1980s HIV/AIDS epidemic 1. In response to the fear induced by the epidemic, changes in sexual behaviour caused another decline, until recently where rates have again risen rapidly 1 2.…”

Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men

“…Despite the promising decline of syphilis infections in the late 1990s in many developed countries, syphilis reemerged in 2000 and continues to be a public health challenge [1]. In developed countries, syphilis disproportionately affects men who have sex with men (MSM), many of whom are co-infected with Human Immunodeficiency Virus (HIV) [2, 3].…”