Clinical factors associated with syphilis concordance in men in sexual partnerships: a cross-sectional couples study

Towns, Janet M; Huffam, Sarah; Chow, Eric P F; Denham, Ian; Zhang, Lei; Ryan, A B; Bellhouse, Clare; Bissessor, Melanie; Bradshaw, Catriona; Phillips, Tiffany R; Graves, Stephen; Fairley, Christopher K.; Chen, Marcus Y

doi:10.1136/sextrans-2017-053297

Cited by 8 publications

(4 citation statements)

References 7 publications

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“…One study developed a simple-to-use nomogram to predict the risk of syphilis, and several other studies described the risk factors for syphilis based on sociodemographic, clinical or behavioural data. [11][12][13][14] The main objective of the current study was to develop a symptoms-based risk score so that individuals would seek help when symptomatic, analogous to similar algorithms for acute HIV infection. Several symptom and behavioural risk scores for acute HIV have been developed and validated successfully.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there are no studies on the development of a symptoms-based risk score for infectious syphilis. One study developed a simple-to-use nomogram to predict the risk of syphilis, and several other studies described the risk factors for syphilis based on sociodemographic, clinical or behavioural data 11–14. The main objective of the current study was to develop a symptoms-based risk score so that individuals would seek help when symptomatic, analogous to similar algorithms for acute HIV infection.…”

Section: Discussionmentioning

confidence: 99%

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Developing a symptoms-based risk score for infectious syphilis among men who have sex with men

et al. 2022

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BackgroundSyphilis incidence is rising among men who have sex with men (MSM). An online tool based on a risk score identifying men with higher risk of infectious syphilis could motivate MSM to seek care. We aimed therefore to develop a symptoms-based risk score for infectious syphilis.MethodsWe included data from all consultations by MSM attending the Amsterdam Centre for Sexual Health in 2018–2019. Infectious syphilis (ie, primary, secondary or early latent syphilis) was diagnosed according to the centre’s routine protocol. Associations between symptoms and infectious syphilis were expressed as odds ratios (OR), with 95% confidence intervals (CI). Based on multivariable logistic regression models, we created risk scores, combining various symptoms. We assessed the area under the curve (AUC) and cut-off based on the Youden Index. We estimated which percentage of MSM should be tested based on a positive risk score and which percentage of infectious syphilis cases would then be missed.ResultsWe included 21,646 consultations with 11,594 unique persons. The median age was 34 years (IQR 27–45), and 14% were HIV positive (93% on antiretroviral treatment). We diagnosed 538 cases of infectious syphilis. Associations with syphilis symptoms/signs were strong and highly significant, for example, OR for a painless penile ulcer was 35.0 (CI 24.9 to 49.2) and OR for non-itching rash 57.8 (CI 36.8 to 90.9). Yet, none of the individual symptoms or signs had an AUC >0.55. The AUC of risk scores combining various symptoms varied from 0.68 to 0.69. For all risk scores using cut-offs based on Youden Index, syphilis screening would be recommended in 6% of MSM, and 59% of infectious syphilis cases would be missed.ConclusionSymptoms-based risk scores for infectious syphilis perform poorly and cannot be recommended to select MSM for syphilis screening. All MSM with relevant sexual exposure should be regularly tested for syphilis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Developing a symptoms-based risk score for infectious syphilis among men who have sex with men

et al. 2022

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“…Globally, few studies have investigated the concordance rate for syphilis infection in couples during pregnancy. Commonly, the concordance rate in men who have sex with men (MSM) is far higher than that among heterosexual couples; for example, 30.2% as reported by the Melbourne Sexual Health Centre [28]. In China, the prevalence of syphilis among MSM married to women was 17.9% [29].…”

Section: Discussionmentioning

confidence: 99%

Differences in maternal characteristics and pregnancy outcomes between syphilitic women with and without partner coinfection

Zhang

Chen

Sun

et al. 2019

BMC Pregnancy Childbirth

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BackgroundPartner infection is a significant factor in preventing mother-to-child syphilis transmission. We compared pregnancy outcomes between syphilis discordant and syphilis concordant couples.MethodsWe conducted a retrospective study among 3076 syphilis-positive women who received syphilis screening together with their partners during pregnancy. Multivariate analysis was used to explore risks for abnormal outcomes in objects correcting for the major covariate factors. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to compare pregnancy outcomes between syphilis concordant and syphilis discordant couples.ResultsOverall, 657 of the 3076 women were diagnosed with gestational syphilis and had a syphilis-positive partner, giving a partner concordance prevalence of 21.36%. Women in concordant couples were more likely to have higher parity, more children, late antenatal care and syphilis screening, a lower proportion of latent syphilis, and elevated serologic titers than women in discordant couples (P < 0.01 for all). Totally, 10.08% of women had adverse pregnancy outcomes. Multivariate analysis showed partners’ syphilis infection (ORadj = 1.44, 95% CI: 1.10–1.89), untreated pregnancy syphilis (ORadj = 1.67, 95% CI: 1.15–2.43), and higher maternal serum titers (> 1:8) (ORadj = 1.53, 95% CI: 1.17–2.00) increased the risks of adverse pregnancy outcomes. Concordance was associated with increased risk for stillbirth (ORadj = 2.86, 95%CI:1.36–6.00), preterm birth (PTB) (ORadj = 1.38,95%CI:1.02–1.87) and low birth weight (LBW) (ORadj = 1.55, 95%CI:1.13–2.11) compared with discordance. Even among treated women, concordance was associated with increased risk for stillbirth (ORadj = 3.26, 95%CI:1.45–7.31) and LBW (ORadj = 1.52, 95%CI:1.08–2.14). Among women with one treatment course, the risks for PTB(ORadj = 1.81, 95%CI:1.14–2.88) and LBW(ORadj = 2.08, 95%CI:1.28–3.38)were also higher among concordant couples than discordant couples. Nevertheless, there were no significant differences between concordant and discordant couples in risks of stillbirth (ORadj = 2.64, 95% CI: 0.98–7.05),PTB (ORadj = 1.15, 95% CI: 0.76–1.74), and LBW(ORadj = 1.21, 95% CI: 0.78–2.02) among women with two treatment courses.ConclusionMale partner coinfection increased the risks for stillbirth, PTB and LBW, particularly when gestational syphilis treatment was suboptimal. However, this risk could be reduced by adequate treatment.

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“…A retrospective clinical study undertaken by Pang et al in Beijing6 summarises clinical manifestations and risk factors for Jarisch-Herxheimer reaction in children treated for congenital syphilis. Finally, Towns et al7 report a cross-sectional study of MSM couples in Melbourne, Australia which explores the relationship between HIV and secondary syphilis.…”

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confidence: 99%

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2018

Sex Transm Infect

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Clinical factors associated with syphilis concordance in men in sexual partnerships: a cross-sectional couples study

Abstract: There was an overall concordance rate of 30%. Higher concordance rates for early syphilis infection between male sexual partners were associated with HIV and secondary syphilis.

Cited by 8 publications

References 7 publications

Developing a symptoms-based risk score for infectious syphilis among men who have sex with men

Developing a symptoms-based risk score for infectious syphilis among men who have sex with men

Differences in maternal characteristics and pregnancy outcomes between syphilitic women with and without partner coinfection

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