Sustained increase in infectious syphilis notifications in Victoria

Guy, Rebecca; Leslie, David; Simpson, Kleete; Hatch, Beth; Leydon, Jennie; Hellard, Margaret; Kelly, Heath

doi:10.5694/j.1326-5377.2005.tb07004.x

Cited by 19 publications

(13 citation statements)

References 4 publications

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“…After the marked decline in syphilis infection rates in the 1980s with the HIV/AIDS epidemic raising safe‐sex awareness, the recent increase is thought to be primarily due to higher risk sexual behaviour, particularly among men who have sex with men 1,2 . In Melbourne, Australia, notification of infectious syphilis increased more than fivefold from 1995 to 2004, 3 and in Sydney it almost doubled between 2000 and 2004 4 . Localized syphilis outbreaks have been reported among homosexual men, particularly if HIV‐positive 3 .…”

Section: Introductionmentioning

confidence: 99%

Syphilitic retinitis and uveitis in HIV‐positive adults

Hughes

Guzowski

Simunovic

et al. 2010

Clinical Exper Ophthalmology

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Section: Introductionmentioning

confidence: 99%

Syphilitic retinitis and uveitis in HIV‐positive adults

Hughes

Guzowski

Simunovic

et al. 2010

Clinical Exper Ophthalmology

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“…In the last decade, rates of syphilis infections have increased among MSM in Europe, America and Australia [6]–[8]. MSM with HIV infection are disproportionately affected by syphilis.…”

Section: Introductionmentioning

confidence: 99%

“…MSM with HIV infection are disproportionately affected by syphilis. Enhanced surveillance in the same countries show that between 50% and 60% of infectious syphilis notifications in MSM are among men with HIV infection [6]–[8]. Community-based cohort studies in Australia have shown that the incidence of syphilis in MSM with HIV infection is five-times higher than the incidence in MSM without HIV (2.5 vs 0.5 per 100 person years) [9].…”

Section: Introductionmentioning

confidence: 99%

Opt-Out and Opt-In Testing Increases Syphilis Screening of HIV-Positive Men Who Have Sex with Men in Australia

et al. 2013

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BackgroundSince 2005, Australian clinicians were advised to undertake quarterly syphilis testing for all sexually active HIV-positive men who have sex with men (MSM). We describe differences in syphilis testing frequency among HIV-positive MSM by clinic testing policies since this recommendation.MethodsThree general practices, two sexual health clinics and two hospital HIV outpatient clinics provided data on HIV viral load and syphilis testing from 2006–2010. Men having ≥1 viral load test per year were included; >95% were MSM. We used Chi-2 tests to assess changes in syphilis testing frequency over time, and differences by clinic testing policy (opt-out, opt-in and risk-based).ResultsThe proportion of men having HIV viral loads with same-day syphilis tests increased from 37% in 2006 to 63% in 2007 (p<0.01) and 68–69% thereafter. In 2010, same-day syphilis testing was highest in four clinics with opt-out strategies (87%, range:84–91%) compared with one clinic with opt-in (74%, p = 0.121) and two clinics with risk-based strategies (22%, range:20–24%, p<0.01). The proportion of men having ≥3 syphilis tests per year increased from 15% in 2006 to 36% in 2007 (p<0.01) and 36–38% thereafter. In 2010, the proportion of men having ≥3 syphilis tests in a year was highest in clinics with opt-out strategies (48%, range:35–59%), compared with opt-in (39%, p = 0.121) and risk-based strategies (8.4%, range:5.4–12%, p<0.01).ConclusionOver five years the proportion of HIV-positive men undergoing syphilis testing at recommended frequencies more than doubled, and was 5–6 times higher in clinics with opt-out and opt-in strategies compared with risk-based policies.

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“…Although only ~10% of Australian MSM have HIV infection they contribute around half of all cases of infectious syphilis among MSM [3,4]. Community-based cohort studies have shown that the incidence of syphilis in MSM with HIV infection is 5–10 times higher than in MSM without HIV [5].…”

Section: Introductionmentioning

confidence: 99%

A longitudinal evaluation of Treponema pallidumPCR testing in early syphilis

Shields¹,

Guy

Jeoffreys

et al. 2012

BMC Infect Dis

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BackgroundSyphilis is a growing public health problem among men who have sex with men (MSM) globally. Rapid and accurate detection of syphilis is vital to ensure patients and their contacts receive timely treatment and reduce ongoing transmission.MethodsWe evaluated a PCR assay for the diagnosis of Treponema pallidum using swabs of suspected early syphilis lesions in longitudinally assessed MSM.ResultsWe tested 260 MSM for T pallidum by PCR on 288 occasions: 77 (26.7%) had early syphilis that was serologically confirmed at baseline or within six weeks, and 211 (73.3%) remained seronegative for syphilis. Of 55 men with primary syphilis, 49 were PCR positive, giving a sensitivity of 89.1% (95% CI: 77.8%-95.9%) and a specificity of 99.1% (95% CI: 96.5%-99.9%). Of 22 men with secondary syphilis, 11 were PCR positive, giving a sensitivity of 50% (95% CI: 28.2%-71.8%) and a specificity of 100% (95% CI: 66.4%-71.8%). Of the 77 syphilis cases, 43 (56%) were HIV positive and the sensitivity and specificity of the PCR test did not vary by HIV status. The PCR test was able to detect up to five (10%) primary infections that were initially seronegative, including one HIV positive man with delayed seroconversion to syphilis (72 to 140 days) and one HIV positive man who did not seroconvert to syphilis over 14 months follow-up. Both men had been treated for syphilis within a week of the PCR test.ConclusionsT pallidum PCR is a potentially powerful tool for the early diagnosis of primary syphilis, particularly where a serological response has yet to develop.

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Sustained increase in infectious syphilis notifications in Victoria

Cited by 19 publications

References 4 publications

Syphilitic retinitis and uveitis in HIV‐positive adults

Syphilitic retinitis and uveitis in HIV‐positive adults

Opt-Out and Opt-In Testing Increases Syphilis Screening of HIV-Positive Men Who Have Sex with Men in Australia

A longitudinal evaluation of Treponema pallidumPCR testing in early syphilis

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