The characterisation of a recent syphilis outbreak in Sheffield, UK, and an evaluation of contact tracing as a method of control

Abstract

Objective: To explore the factors around and the success of contact-tracing in a recent major outbreak of infectious syphilis in Sheffield, and to evaluate the effectiveness of it, our hitherto standard strategy of control. Method: Retrospective chart review Results: Over a period of 18 months, an outbreak of 21 cases was, on closer inspection, the result of several, discrete ''micro'' outbreaks in different groups. Two major patterns emerged, a relatively straightforward and more accessible cluster in heterosexual persons (a ''spread'' network), and more sporadic, ''starburst'' networks in men who have sex with men. Conclusion: Our traditional method of control, contact-tracing, was seen to be most effective in the spread network in heterosexuals. In the face of an apparent outbreak, clinicians should explore the nature and parameters of their local epidemic and engage a mixture of control methods. These may include, but not excusively so, contact-tracing to interrupt transmission by case-finding and by treatment.

Investigation of an HIV transmission cluster centred in South Wales

“…A quarter of those contacted successfully with a known outcome were diagnosed with HIV. This one in four positive rate and a 68% provider referral success rate compares favourably with other studies, adding to the evidence that HIV partner notification can be both acceptable and successful in MSM 5 7…”

Variations in the epidemiology of primary, secondary and early latent syphilis, England and Wales: 1999 to 2008

“…In the early stages of the epidemic, heterosexual outbreaks were generally isolated and linked, for example, to travel abroad 1. More recently, heterosexual infections have been acquired through local sexual networks within the UK, sex work and, in some cases, among students and young people aged less than 20 13 14. In England and Wales, GUM clinics offer free, open access services that are widely advertised, but some of those at risk of infection find accessing services difficult.…”

Partner notification for sexually transmitted infections in the modern world: a practitioner perspective on challenges and opportunities

“…can provide early warning of outbreaks, reveal associated trends in sexual behaviour or mixing patterns and, through analysis of sexual network phase and structure, suggest appropriate control measures 67 For example, network analysis of syphilis cases in Sheffield, UK, revealed that heterosexual cases and contacts were identifiable and interconnected and thus responsive to management through PN, whereas men who have sex with men networks were more sporadic, with many untraceable partners met via the internet or saunas 7. As a result, control efforts were expanded to include internet provider referral via dating sites and outreach screening in a local sauna used by men who have sex with men.…”