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Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance AbstractBackground: The resurgence of infectious syphilis in men who have sex with men (MSM) has been documented worldwide; however, HIV coinfection and syphilis reinfections in MSM in inner Sydney have not been published.

Objectives: To determine acceptance, completion rates and immunogenicity of the standard vaccination schedule for hepatitis A (HAV) and B (HBV) in persons subject to homelessness. Methods: A convenience sample of clients (n=201) attending a medical clinic for homeless and disadvantaged persons in Sydney was enrolled. Serological screening for HAV and HBV was undertaken. An appropriate vaccination program was instituted. Post‐vaccination serology determined serological response. Results: Although many clients had serological evidence of past infection, at least 138 (69%) clients had the potential to benefit from vaccination. For hepatitis A and B vaccinations, completion rates were 73% (73 of 100 clients) and 75% (69 of 92 clients), respectively; after vaccination, protective antibody was found in 98.2% (56 of 57) and 72% (36 of 50) of clients, respectively. Conclusion: A successful vaccination program can be mounted with a vulnerable population. We consider a clinic with a well‐established history of acceptance and utilisation by the target group; a low staff turnover and regular clientele; inclusion of vaccination as part of routine client care; and counselling (part of pre‐ and post‐serological testing) essential components in achieving good vaccination completion rates.

Objective: To report the results of a 2001‐04 enhanced syphilis surveillance program in south‐eastern Sydney and a subset of cases from the Sydney Sexual Health Centre (SSHC). Methods: For all laboratory syphilis notifications, a questionnaire was sent to the referring doctor requesting demographic data, clinical information about disease classification and the presence of symptoms. Sex of partner/s and HIV status were collected from a subset of cases seen at SSHC. Results: During 2001‐04, 1,275 syphilis notifications were received and 1,112 (87%) were able to be classified as 361 (28%) cases of infectious syphilis, 221 (17%) non‐infectious syphilis and 530 (42%) treated syphilis. From mid 2002, an increase in the number of infectious syphilis notifications was noted. Of the 361 cases of infectious syphilis, most were in men (348, 97%). From a subset of 47 cases of infectious syphilis from SSHC, 43 (91%) were in gay men and nine (21%) had concurrent HIV infection. Conclusions: Inner Sydney has recently experienced a rapid increase in infectious syphilis affecting a defined population: men, aged 30–39, English speaking and Australian born. These results support recent reports of outbreaks among men who have sex with men, but without routine collection of additional risk factors control programs may be misguided. Implications: In light of the review of the NSW Public Health Act 1991, it is recommended that reducing barriers to the collection of HIV status and sex of sexual partners in de‐identified syphilis notifications be explored as a matter of urgency.

In February, 2008, the South Eastern Sydney Illawarra Public Health Unit investigated an outbreak of cryptosporidiosis within the south east region of Sydney, Australia. Thirty-one cases with laboratory-confirmed cryptosporidiosis and 97 age- and geographically matched controls selected by random digit dialling were recruited into a case-control study and interviewed for infection risk factors. Cryptosporidiosis was associated with swimming at Facility A (matched odds ratio = 19.4, 95% confidence interval: 3.7–100.8) and exposure to household contacts with diarrhoea (matched odds ratio = 7.7, 95% confidence interval: 1.9–31.4) in multivariable conditional logistic regression models. A protective effect for any animal contact was also found (matched odds ratio = 0.2, 95% confidence interval: 0.1–0.7). Cryptosporidium hominis subtype IbA10G2 was identified in 8 of 11 diagnostic stool samples available for cases. This investigation reaffirms the importance of public swimming pools as potential sources of Cryptosporidium infection and ensuring their compliance with water-quality guidelines. The protective effect of animal contact may be suggestive of past exposure leading to immunity.