Epidemic infectious syphilis in inner Sydney – strengthening enhanced surveillance

Abstract

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.

Superficial Retinal Precipitates in Patients With Syphilitic Retinitis

“…This unabated resurgence of syphilis among MSM has also been observed throughout Europe, North America, and Australia. [4][5][6][7][8][9][10][11] In addition, the increase of primary and secondary syphilis has shown tremendous variation across racial and ethnical groups in the United States with African-American and Latino groups disproportionately affected. 3 Of note, human immunodeficiency virus (HIV) coinfection is quite common.…”

Transcription of TP0126, Treponema pallidum Putative OmpW Homolog, Is Regulated by the Length of a Homopolymeric Guanosine Repeat

“…Despite being perceived by the general public to be a disease of the past, syphilis continues to be a significant burden for global health, with an estimated prevalence of 36 million cases worldwide and an incidence that exceeds 11 million new cases every year (1). Although most syphilis cases occur in Latin America, sub-Saharan Africa, and Southeast Asia (2), including China (3), a worrying resurgence of syphilis has recently been observed in many developed countries, including the United States, Canada, Australia, and several European nations (4)(5)(6)(7)(8). Congenital syphilis remains a leading cause of stillbirths and perinatal deaths among neonates in developing areas (9,10), and patients with syphilis are at increased risk for transmission and acquisition of HIV (11,12).…”

Re-Emergence of HIV Infection and Syphilis Among Men Who Have Sex with Men

“…The majority of infectious syphilis diagnoses were made in the earlier primary or secondary stages. The enhanced syphilis surveillance program showed infectious syphilis is affecting a defined population in Sidney: men (31:1 male-to-female ratio for 2004), English speaking and Australian born (Botham et al, 2006). The male-to-female ratio for 2004 of 31:1 strongly suggests transmission between men (Botham et al, 2006).…”

“…The enhanced syphilis surveillance program showed infectious syphilis is affecting a defined population in Sidney: men (31:1 male-to-female ratio for 2004), English speaking and Australian born (Botham et al, 2006). The male-to-female ratio for 2004 of 31:1 strongly suggests transmission between men (Botham et al, 2006). The public health response to this epidemic has included work by the Sexually Transmitted Infections in Gay Men Action Group (STIGMA).…”

“…pallidum (Fenton et al, 2008), identified in 1905 by Schaudinn & Hoffmann (Waugh, 2005, as cited in Fenton et al, 2008). The disease is treatable with standard antibiotics (Pao et al, 2002, as cited in Fenton et al, 2008, but in the absence of therapy, gives rise to four sequencial clinical stages commonly known as primary, secondary, latent (divided into early and late stages) and tertiary syphilis (Table 2) (Botham et al, 2006). In the initial stages, the infection is highly transmissible and often presents as ulcerative genital lesions.…”