Letter to the Editor International Journal of STD & AIDS 2016, Vol. 27(8) 697–698 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462415595323 std.sagepub.com
A significant increase in cases of infectious syphilis in men who have sex with men since November 2013
Dear Editor, Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum and increasing numbers of STIs are reported in men who have sex with men (MSM), including syphilis.1 Brighton and Hove in England has a large population of MSM and a rise in syphilis is of interest, as it is a surrogate for unsafe sexual behaviour and on-going STI and HIV transmission. Therefore, controlling syphilis is of particular importance not only in Brighton but also in other high MSM-prevalent urban areas in the UK. We identified cases of infectious syphilis in MSM per month from February 2013 to June 2014. We defined infectious syphilis from clinical diagnosis, microscopy and serology. The total number of MSM seen in sexual health in this time period was used as a denominator for incidence calculations. 207 new cases of infectious syphilis were diagnosed, the median age was 36 years (19–60 years), 96/207 (46.4%) were HIVþ and 3/207 (1.4%) were reinfections. Incident cases of syphilis increased significantly and sustainably from November 2013: the median incidence of syphilis from February 2013 to October 2013 was 8.6/1000 MSM/month; this increased significantly to 25.9/1000 MSM/month from November 2013 to June 2014 (2 ¼ 67.447; p < 0.0001). There was no significant difference in the proportion of cases co-infected with HIV. We describe a significant and sustained increase in the incidence of syphilis in MSM from November 2013. Similar increases in other STIs have been reported in
MSM and are thought to be due to: increased accessibility of meeting casual sexual partners driven by social media, awareness that being on HIV therapy reduces HIV transmissibility and increased recreational party drug use.2 Although these factors were not directly accounted for in this study, we have likewise seen a dramatic rise in recreational drug use among MSM in Brighton in the time period, which has also been reported nationally in HIV-infected MSM.3 Anecdotally, in our STI outreach work the use of social media for casual sex has increased considerably in MSM. As a public health response, in partnership with Terence Higgins Trust (THT) and the local Public Health team, we are increasing awareness of syphilis among MSM with advertising campaigns including geo-specific educational messages via smartphone applications. Quarterly meetings have been set up with Public Health, THT and epidemiologists to ensure increased surveillance and effectiveness of interventions. Our strategy for controlling syphilis is focusing on increasing patient and primary care awareness as well as increasing outreach testing provided by THT. Primary care has been alerted to the signs and symptoms of syphilis through regular mail-shots and patients have been informed of syphilis infection via local advertising campaigns and alerted to the link with other STIs and HIV. Brighton sexual health service is monitoring cases of infectious syphilis in the city on a monthly basis and reporting data to Public Health England. Our combined interventions have so far in the first quarter of 2015 generated a small but significant decline in the number of cases of infectious syphilis. We recommend that MSM with syphilis require full STI screening, partner notification, support around drug and alcohol use and interventions to reduce HIV and STI transmission.
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International Journal of STD & AIDS 27(8)
References 1. Sexually transmitted infections and Chlamydia screening in England, 2013 Health Protection Report 8(24), www.gov. uk/government/uploads/system/uploads/attachment_data/ file/345181/Volume_8_number_24_hpr2414_AA_stis.pdf (2014, accessed 25 June 2015). 2. Dasalakis DC and Blaser MJ. Another perfect storm: shigella, men who have sex with men, and HIV. Clin Infect Dis 2007; 24: 335–337. 3. Daskalopoulou M, Rodger A, Philips AN, et al. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV 2014; 1: e22–31.
Nicolas Pinto-Sander1, Elaney Youssef1, Marc Tweed2, Gillian Dean1 and Daniel Richardson1 1 Department of HIV and Sexual Health, Royal Sussex County Hospital, Brighton, UK 2 Terence Higgins Trust-South, Brighton, UK Corresponding author: Nicolas Pinto-Sander, Department of HIV and Sexual Health, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK. Email:
[email protected]
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