Increased incidence of syphilis in men who have sex with men and risk management strategies, Germany, 2015

Abstract

In Germany, the number of reported syphilis cases increased between 11% and 22% per year between 2010 and 2014. We analysed syphilis surveillance data and data of four behavioural surveys on men who have sex with men (MSM) in Germany (2003, 2007, 2010, 2013) to assess if this rise is ongoing and to find possible explanations for it. Syphilis notifications increased in 2015 by 19% to a total of 6,834. This was mainly due to increasing notifications in MSM of all age groups in larger German cities. Data from the behavioural surveys on MSM in Germany showed a simultaneous increase of selective condom use as HIV-status-bases risk management strategy and the number of syphilis cases. MSM diagnosed with HIV reported condomless anal intercourse with non-steady partners more frequent than MSM not diagnosed with HIV or untested for HIV, but the latter also reported higher frequencies of this behaviour in the more recent surveys. Transmission in HIV-positive MSM probably plays an important, but not exclusive role, for the syphilis dynamics in Germany. A risk adapted routine screening for sexually active MSM and potentially innovative approaches to increase early screening and treatment of syphilis such as internet counselling, home sampling, home testing and broadening venue-based (rapid) testing, should be critically evaluated to effectively reduce syphilis infections.

Circulation of Distinct Treponema pallidum Strains in Individuals with Heterosexual Orientation and Men Who Have Sex with Men

“…Increased prevalence of syphilis among MSM has been reported globally (6)(7)(8)(9)(10). This is assumed to be due to increased high-risk sexual behaviors, including unprotected sex, because successful reduction in HIV transmission has been reported in association with preexposure prophylaxis (PrEP) (10,38). A prescription of antiretroviral drugs for PrEP is not officially supported in Japan.…”

“…. The majority of syphilis patients are males, with the majority of cases being attributable to men who have sex with men (MSM) (6)(7)(8)(9)(10).…”

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

“…Of particular importance are local genital tract inflammatory processes that increase HIV shedding in semen rendering an individual more infectious than is apparent from his blood plasma viral load (Kalichman, Diberto, & Eaton, 2008;Pilcher et al, 2006). Thus, increases in condomless anal sex and exposure to STI will ultimately diminish the prevention benefits of HIV treatments (Jansen, Schmidt, Drewes, Bremer, & Marcus, 2016;Katz, Dombrowski, Bell, Kerani, & Golden, 2016;Payne, Lawrence, Soni, Llewellyn, & Dean, 2016;Sood, Wagner, Jaycocks, Drabo, & Vardavas, 2013). …”

To prescribe, or not to prescribe: decision making in HIV‐1 post‐exposure prophylaxis

“…Recently, studies have shown an increase in the rate of unprotected sex [15] and consequently in the spread of sexually transmitted diseases (STDs) [8]. Rising syphilis rates were observed in the city in which we conducted our study (Cologne, Germany: 2014, n = 313; 2015, n = 332; 2016, n = 347; 2017, n = 418) [16].…”