Repeated Syphilis Episodes in HIV-Infected Men Who Have Sex With Men: A Multicenter Prospective Cohort Study on Risk Factors and the Potential Role of Syphilis Immunity

Roth, Jan A; Franzeck, Fabian; Balakrishna, Suraj; Lautenschlager, Stephan; Thurnheer, Maria Christine; Trellu, Laurence Toutous; Cavassini, Matthias; Vernazza, Pietro; Bernasconi, Enos; Braun, Dominique L; Kouyos, Roger D.; Battegay, Manuel

doi:10.1093/ofid/ofaa019

Cited by 18 publications

(21 citation statements)

References 28 publications

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“…Some studies have shown that a small sub-population of certain core groups and high-volume repeaters contribute to a large proportion of bacterial sexually transmitted infections (STIs). 27,28 Similar findings of repeat episodes of syphilis were seen in the study by Roth el al of a Swiss cohort of MSM living with HIV, 29 and this was attributed to high-risk sexual behavior and the high background rate of syphilis in MSM populations. 29…”

Section: Discussionsupporting

confidence: 70%

Syphilis among men who have sex with men attending a large HIV clinic in Trinidad

Edwards

John²,

Todd³

et al. 2021

Int J STD AIDS

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A chart review study was conducted to determine the prevalence of syphilis and explore the associated risk factors among men who have sex with men (MSM) who attended a large HIV clinic in Trinidad during the period January–December 2019. Patients were routinely screened for syphilis annually, and demographic, clinical, and laboratory data were extracted from the medical records. Descriptive and bivariate analyses were performed, and factors significantly associated with a syphilis diagnosis were assessed using multivariate logistic regression. During the period, 218 MSM were seen, age range 19–67 years, and median age 34.0 years. The prevalence of syphilis was 41.3% (90/218), and 71.1% (64//90) of these infections were asymptomatic. Multivariate analysis using logistic regression showed that MSM living with HIV in the 30–34 years old-age group (OR, 4.32; 95% CI, 1.04–18.02), and those with a previous history of treated syphilis (OR, 10.18; 95% CI, 4.60–22.53) were more likely to be diagnosed with syphilis. The prevalence of syphilis is high among MSM attending the HIV clinic in Trinidad, and most of these infections were asymptomatic; hence, targeted and sustained interventions to reduce syphilis transmission are urgently required. Repeat episodes of syphilis may play a role in the transmission dynamics of syphilis in MSM.

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Section: Discussionsupporting

confidence: 70%

Syphilis among men who have sex with men attending a large HIV clinic in Trinidad

Edwards

John²,

Todd³

et al. 2021

Int J STD AIDS

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“…A similar trend was observed for the incidence rate of syphilis in HIVdiagnosed MSM in the Swiss HIV Cohort Study (SHCS) [5][6][7]. Having oral sex, condomless anal sex, multiple partners, and sex with non-steady partners have been identified as major risk factors of syphilis transmission [7][8][9]. Recent studies show a decrease in condom use for anal sex in MSM with HIV diagnosis [10].…”

Section: Introductionsupporting

confidence: 55%

“…In Switzerland, the number of syphilis diagnoses in MSM tripled between 2006 and 2017 [4]. A similar trend was observed for the incidence rate of syphilis in HIV-diagnosed MSM in the Swiss HIV Cohort Study (SHCS)[5–7]. Having oral sex, condomless anal sex, multiple partners, and sex with non-steady partners have been identified as major risk factors of syphilis transmission[7–9].…”

Section: Introductionmentioning

confidence: 86%

Assessing the drivers of syphilis among men who have sex with men in Switzerland reveals a key impact of testing frequency: A modelling study

Balakrishna

Salazar‐Vizcaya

Schmidt

et al. 2021

Preprint

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BackgroundOver the last decade, syphilis diagnoses among men-who-have-sex-with-men (MSM) have strongly increased in Europe. Understanding the drivers of the ongoing epidemic may aid to curb transmissions.Methods and FindingsWe set up an epidemiological model to assess the drivers of syphilis in MSM in Switzerland between 2006 and 2017. We stratified the model by syphilis stage, HIV-diagnosis, and behavioral factors to account for syphilis infectiousness and risk for transmission. In the main model, we used ‘reported non-steady partners’ (nsP) as the main proxy for sexual risk. We parameterized the model using data from the Swiss HIV Cohort Study, Swiss Voluntary Counselling and Testing center, cross-sectional surveys among the Swiss MSM population, and published syphilis notifications from the Federal Office of Public Health.The main model reproduced the increase in syphilis diagnoses from 168 cases in 2006 to 418 cases in 2017. It estimated that between 2006 and 2017, MSM with HIV diagnosis had 45.9 times the median syphilis incidence of MSM without HIV diagnosis. Defining risk as condomless anal intercourse with nsP decreased model accuracy (sum of squared weighted residuals, 378.8 vs 148.3). Counterfactual scenarios suggested that increasing screening of MSM without HIV diagnosis and with nsP from once every two-years to twice per year may reduce syphilis incidence (at most 12.8% reduction by 2017). Whereas, increasing screening among MSM with HIV diagnosis and with nsP from once per year to twice per year may substantially reduce syphilis incidence over time (at least 63.5% reduction by 2017).ConclusionsThe model suggests that reporting nsP regardless of condom use is suitable for risk stratification when modelling syphilis transmission. More frequent screening of MSM with HIV diagnosis, particularly those with nsP may aid to curb syphilis transmission.

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“…Neuroinvasion by T. pallidum takes place in at least 30% of infected individuals and in up to 80% of cases, the organism is spontaneously cleared by one's immunity [10]. With the increasing incidence of syphilis reinfection [38], and hence increased risk of repeated T. pallidum neuroinvasion, the cumulative effect of repeated intracranial immune activation may promote chronic CNS immune activation and neuronal damage, even if a fully established neurosyphilis is absent. Other possibilities include unmeasured sociodemographic risk factors that associate with both syphilis acquisition and poorer neurocognitive performance.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory impact of concomitant syphilis infection during acute HIV

et al. 2021

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Cognitive impairment has been reported in people living with HIV-1 (PLWH) with prior syphilis, while PLWH who present with incident syphilis have reduced blood CD4 T-lymphocyte and elevated HIV-1 RNA levels. However, the clinical, virological and neurocognitive effects of syphilis during acute HIV-1 (AHI) remain unknown. MethodsPre-antiretroviral therapy laboratory outcomes and neurocognitive performance in a four-test battery in the SEARCH10/RV254 AHI cohort were compared according to syphilis status, determined by serum Treponema pallidum haemagglutination (TPHA), Venereal Disease Research Laboratory (VDRL) and syphilis treatment history. Impaired cognitive performance was defined as having z-scores ≤ À1 in at least two tests or ≤ À2 in at least one test. ResultsOut of 595 AHI participants (97% male, median age of 26 years and estimated duration of HIV-1 infection of 19 days), 119 (20%) had history of syphilis (TPHA-positive), of whom 51 (9%) had untreated syphilis (TPHA-positive/VDRL-positive/without prior treatment). Compared with those without syphilis (TPHA-negative), individuals with untreated syphilis had higher CD8 Tlymphocyte levels but not higher plasma HIV-1 RNA or lower CD4 T-lymphocyte levels. Taking into account estimated duration of HIV-1 infection (P < 0.001), and later Fiebig stages (III-V) (P < 0.001), those with untreated syphilis had higher CD8 T-lymphocyte levels (P = 0.049). Individuals with any syphilis (TPHA-positive), but not untreated syphilis, had higher odds of impaired cognitive performance than those without (P = 0.002). ConclusionsDuring AHI, individuals with any history of syphilis (TPHA-positive) had poorer cognitive performance than those without syphilis. However, syphilis was not associated with worsened HIV disease measures as described in chronic infection.

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Repeated Syphilis Episodes in HIV-Infected Men Who Have Sex With Men: A Multicenter Prospective Cohort Study on Risk Factors and the Potential Role of Syphilis Immunity

Cited by 18 publications

References 28 publications

Syphilis among men who have sex with men attending a large HIV clinic in Trinidad

Syphilis among men who have sex with men attending a large HIV clinic in Trinidad

Assessing the drivers of syphilis among men who have sex with men in Switzerland reveals a key impact of testing frequency: A modelling study

Clinical and laboratory impact of concomitant syphilis infection during acute HIV

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