Syphilis has re-emerged in response to behavior change, probably driven by changes in the HIV epidemic. The future course of the epidemic is difficult to predict and control remains elusive.

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...

No abstract

No abstract

Objective: To explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19. Design: Observational study. Setting: Liverpool, UK. Participants: 496 784 residents. Intervention: Free LFTs to all people living and working in Liverpool (6th November 2020 to 31st January 2021). Main outcome measures: Residents who received a LFT, residents who had multiple LFTs, and positive test results. Results: 214 525 residents (43%) received a LFT identifying 5557 individuals as positive cases of COVID-19 (1.3%) between 6th November 2020 and 31st January 2021. 89 047 residents had more than one test (18%). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake and repeat testing were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for Mixed ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Spatial regression models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas. Conclusions: Large-scale voluntary asymptomatic community testing saw social, ethnic, and spatial inequalities in an inverse care pattern, but with an added digital exclusion factor. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access.