Infectious syphilis in women: what’s old is new again?

Abstract

The aim of this study was to examine trends in infectious syphilis epidemiology among women in Winnipeg, Canada. A descriptive study of syphilis among Winnipeg residents between 2003 and 30 June 2015 was undertaken. Adjusted rate ratios (ARR) and 95% confidence intervals (95%CI) from Poisson regression analyses are reported. Characteristics of men and women were compared using logistic regression, with adjusted odds ratios (AOR) reported. Between 2014 and 2015, the rate of syphilis was 1.7/100,000, representing a five-fold increase since 2006-2013. All cases have been heterosexual, 90% 20-39 years of age, and 59% living in Winnipeg's inner core. Approximately 24% were pregnant at diagnosis; no cases of congenital syphilis have been reported. Compared to men, women were more likely to report alcohol use (AOR: 3.8, 95% CI: 1.2-11.9) and co-infection with chlamydia (AOR: 5.0, 95% CI: 1.1-22.9). In conclusion, the rates of infectious syphilis are increasing among women. Prenatal screening and education for inner-core women and the health care providers serving them should be prioritized.

Can enhanced screening of men with a history of prior syphilis infection stem the epidemic in men who have sex with men? A mathematical modelling study

“…Our results are conditional on the epidemiological context under study, and the relative impact of focused screening of MSM with prior syphilis may vary by the rates of reinfection in the region of interest. Relatedly, the syphilis epidemic in Winnipeg has evolved, making significant inroads into heterosexual populations26; further research is needed to understand the impact of focused screening of populations susceptible to reinfection on mixed or parallel syphilis epidemics.…”

Syphilis in heterosexual women: case characteristics and risk factors for recent syphilis infection in Tokyo, Japan, 2017–2018

“…[3][4][5][6] However, more recently, increased notifications among non-MSM populations, particularly women, have been reported. 5,7,8 Japan, for instance, has seen an increase in syphilis notifications since 2013, with a substantial increase among both men who have sex with women (MSW) and women who have sex with men (WSM); between 2013 and 2016, cases increased from 304 to 1671 among MSW and 137 to 1077 among WSM. 9 Several studies have reported risk factors for syphilis among women, such as socioeconomic and education status and sexual behavior.…”

Syphilis Elimination: Lessons Learned Again

“…Local jurisdictions during the syphilis elimination effort frequently faced different phases of STD epidemics across their respective jurisdictions, in much the same way as they do now. 11–14 In some jurisdictions, for example, a target population with high endemic rates of gonorrhea and chlamydia can suddenly find itself in the throes of a spiking outbreak of syphilis. To be effective, a local health department can be called upon to mount a targeted out-break response while at the same time maintaining an ongoing program to address endemic diseases.…”