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Timeline of key events in the syphilis epidemic from 1940 to the present. MSM, men who have sex with men; CDC, Centers for Disease Control and Prevention.
Source publication
Syphilis has existed for millenni, but its epidemiology was only recently linked to men who have sex with men (MSM) after the introduction of penicillin in the 1940s; the syphilis epidemic became concentrated within the MSM community in subsequent decades. The HIV/AIDS epidemic in the 1980s led to a surge of new syphilis cases and revealed the pote...
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Citations
... Throughout the 1990s, the incidence of syphilis had declined to the point of near elimination, in tandem with advances in awareness and treatment of the HIV epidemic. But since the early 2000s, there has been an ongoing rise in the incidence of syphilis, which disproportionately affects men who have sex with men (MSM), who make up 82% of men infected with syphilis [6,7]. Clinicians should recognize that the incidence of syphilis has been increasing, especially among MSM, including those without HIV co-infection. ...
Syphilis is an infectious disease caused by the spirochete bacteria Treponema pallidum and is most commonly transmitted via contact of mucous membranes with infectious lesions during sexual intercourse. It is called the "great mimicker" due to its ability to infect a wide variety of organs and, as a result, produce a multitude of symptoms. Neurosyphilis, an infection of the central nervous system, can occur at any stage of infection. Cases of early neurosyphilis may not present with any prior history of syphilis infection or classical symptoms of primary or secondary infection. Homosexual men are disproportionately affected by the increasing rate of transmission.In this case, a 43-year-old man was diagnosed with neurosyphilis, initially presenting with bilateral papilledema concerning for idiopathic intracranial hypertension. A detailed social history revealed that the individual was sexually active with a male partner. Despite nonreactive results from the rapid plasma reagin and CSF Venereal Disease Research Laboratory tests, further serum workup yielded positive results for treponemal antibodies. Evidence of facial nerve involvement was also found on MRI. These findings were consistent with a diagnosis of ocular syphilis with syphilitic meningitis involving cranial nerve VII. This case demonstrates the importance of clinical suspicion for syphilis when indicated by social history, even when screening tests are negative, due to the potential for false negatives and highly variable clinical presentation.
... By addressing syphilis in this population, we can work toward reducing the overall burden of this preventable infection [24]. The CDC now has a new recommendation that can dramatically reduce the rates of certain STIs in MSM, bisexual men, and transgender women. ...
After reaching historic lows decades ago, rates of sexually transmitted infections (STIs) have surged since 2020. Health officials claim that the pandemic was responsible for igniting this rise, citing a halt in testing, treatment, and surveillance of STIs as isolation began, and resources were reallocated to address coronavirus disease 2019 (COVID-19) issues. Others cite the overall shift in lawmaking since the early 2000s that has scaled back interventions geared toward controlling STI spread. Regardless of the root cause, this surge demands immediate attention due to the severe damage that these infections can cause, including infertility and pelvic inflammatory disease. In this paper, we examine this issue medically, socially, ethically, and from a public health perspective. The symptoms, treatments, complications, and testing strategies for syphilis, gonorrhea, and chlamydia are analyzed while highlighting at-risk groups and discussing mitigation strategies. The social implications of this current crisis are then explored, reviewing what approaches have been made for this issue so far. Next, we ground this issue in the harm reduction theory to advocate for the ethics of our proposed interventions. We conclude with recommendations at the individual, community, and federal levels to help reverse the surge in STIs and prevent further harm.
... Given the cross-sectional study design of the PHIA surveys, our analysis could not distinguish if syphilis infection predated circumcision. Globally, syphilis infection has predominantly been acquired among men who have sex with men (MSM), however, the PHIA surveys did not measure MSM behavior and therefore we cannot make any inferences about syphilis infection and male circumcision among MSM [26,27]. ...
Voluntary medical male circumcision (VMMC) has primarily been promoted for HIV prevention. Evidence also supports that male circumcision offers protection against other sexually transmitted infections. This analysis assessed the effect of circumcision on syphilis, hepatitis B virus (HBV) infection and HIV. Data from the 2015 to 2019 Population-based HIV Impact Assessments (PHIAs) surveys from Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were used for the analysis. The PHIA surveys are cross-sectional, nationally representative household surveys that include biomarking testing for HIV, syphilis and HBV infection. This is a secondary data analysis using publicly available PHIA data. Univariate and multivariable logistic regression models were created using pooled PHIA data across the five countries to assess the effect of male circumcision on HIV, active and ever syphilis, and HBV infection among sexually active males aged 15–59 years. Circumcised men had lower odds of syphilis infection, ever or active infection, and HIV, compared to uncircumcised men, after adjusting for covariates (active syphilis infection = 0.67 adjusted odds ratio (aOR), 95% confidence interval (CI), 0.52–0.87, ever having had a syphilis infection = 0.85 aOR, 95% CI, 0.73–0.98, and HIV = 0.53 aOR, 95% CI, 0.47–0.61). No difference between circumcised and uncircumcised men was identified for HBV infection ( P = 0.75). Circumcised men have a reduced likelihood for syphilis and HIV compared to uncircumcised men. However, we found no statistically significant difference between circumcised and uncircumcised men for HBV infection.
... Data from Public Health England shows that men who have sex with men (MSM) are the largest group diagnosed with syphilis, comprising 75% of all diagnoses (the majority of whom have an unknown or negative HIV status) [1]. Other risk factors for syphilis include positive HIV status, drug abuse, multiple simultaneous partners and unprotected sexual intercourse [11]. In the UK, there is no screening programme for syphilis beyond antenatal testing to prevent maternal transmission. ...
The rise of syphilis transmission rates over the past two decades has been one of public health's great puzzles. In the UK, the situation has reached epidemic levels, with a 126% increase between 2013 and 2018 [1]. We present a case report of optic neuropathy and choroiditis secondary to primary syphilis. This is an unusual first presentation and not an established pattern of syphilitic ocular manifestation. The diagnosis was established by a full infective screen allowing for timely and appropriate treatment.
... 13 Higher incidence of syphilis in men could be attributed to the increased practice of men having sex with men and/or practice of men going to health care providers to be tested for HIV. 16 The mean values for hematological parameters such as neutrophil (57.4%±12.0), hemoglobin ( Syphilis remains a concerned re-emerged disease worldwide, as it causes considerable morbidity. ...
Background:
Venereal syphilis is a sexually transmitted disease, involving pathological activities mediating tissue destruction by extensive tissue necrosis. As such, the goal amongst researchers has been set to the identification of effective laboratory biomarkers that can reflect the broad spectrum of disease and ultimately aid in timely diagnosis and effective treatment of syphilis. This research aimed to study the applications of hematological biomarkers associated with syphilitic patients visiting a tertiary care hospital.
Methods:
A retrospective cross-sectional study was conducted in the syphilitic patients attending KIST Medical College and Teaching Hospital, Lalitpur, Nepal. A total of 25 syphilitic patients and 41 non-syphilitic participants were included. The rapid plasma reagin test and Treponema pallidum hemagglutination assay were used for the screening and confirmation of syphilis respectively. The hematological investigation was performed using a hematology analyzer. Statistical Package for Social Science version 17.0 was used for data analysis. A P value <0.05 was considered significant.
Results:
Syphilitic patients showed significantly elevated levels of lymphocytes (39.8±11.5) (p=0.025), monocyte (1.9±0.8) (p=0.002), mean corpuscular volume (MCV) (92.6±12.9) (p=0.005), and mean corpuscular hemoglobin (MCH) (31.9±4.6) (p=0.008) and lowered levels of red blood cell (RBC) (4.2±0.3) (p=0.005) and platelets (237.2±628.6) (p=0.048) as compared to the lymphocytes (32.9±11.9), monocyte (0.6±1.2), MCV (83.9±8.8), MCH (34.3±1.5), RBC (4.6±0.7), and platelets (280.9±113.3) of the non-syphilitic participants.
Conclusions:
The results showed that the elevated levels of lymphocyte, monocyte, MCV, and MCH and lowered levels of RBC and platelets are highly specific hematological biomarkers for the diagnosis of patients with syphilis.
... Bacterial sexually transmitted infections (STIs) were increasing substantially worldwide pre-COVID- 19. Gay, bisexual and other men who have sex with men (GBM) shared a disproportionate burden of STIs in urban centres across North America, including Canada [1][2][3][4]. Current Canadian clinical guidelines recommend sexually active GBM receive bacterial STI tests at minimum once per year or every three months if at ongoing risk (e.g., new or multiple sexual partners, anonymous or casual sexual partners, having unprotected sex, or use of substances before or during sexual encounters) [5]. Implementation of these guidelines apply the 'test and treat' prevention and control principles to mitigate adverse health outcomes at the individual level and reduce transmission at the population level. ...
Background
Innovation is needed to produce sustained improvements in bacterial sexually transmitted infections (STI) testing given suboptimal access and uptake among sexually active gay, bisexual or other men who have sex with men (GBM). Yet, the STI testing processes and technologies that best address local testing barriers among GBM in Toronto is unknown. We aimed to explore men’s perspectives regarding STI testing services for GBM to identify and prioritize new STI testing interventions in Toronto, Ontario, Canada.
Methods
We conducted four focus groups with twenty-seven GBM in 2017: two with cisgender men living with HIV, one with cisgender HIV-negative men, and one with transgender men. Twenty-seven men participated in the focus groups with 40% 18–30 years of age, 48% self-identifying as white, and the remainder self-identifying as Middle Eastern, Latino/Hispanic, Asian/Pacific Islander, South Asian, First Nations, African/Caribbean/Black, or mixed race. 59% of participants self-identified as living with HIV. Participants were asked about their STI testing experiences in Toronto, barriers and facilitators to testing, and ideal STI testing process. Focus groups were audio recorded, transcribed verbatim, and analyzed using thematic analysis.
Results
Core concepts included how clinical context, bacterial STI testing delivery, and interactions with healthcare providers can create barriers and recommendations for ways to improve. Regarding clinical context, participants desired more clinics with accessible locations/hours; streamlined testing that minimized use of waiting rooms and wait times; and improved clinic ambience. Bacterial STI testing delivery recommendations included standardization to ensure consistency in sexual history intake, tests offered, follow-up and public health reporting between clinics. Men also recommended reducing the multistep process testing by offering components such as lab requisitions and results online. Participants also recommended interactions with healthcare providers be professional and non-judgmental, offer compassionate and competent care with destigmatizing and lesbian, gay, bisexual and trans (LGBT) affirming communication.
Conclusion
Concrete and practical solutions for improving existing sexual health services and facilitating optimal STI testing include streamlining testing options and providing patient-centred, LGBT-affirming care to enable optimal STI testing.
... Syphilis is a sexually transmitted infection (STI) caused by the gram negative spirochete, Treponema pallidum, which has been linked to increased sexual transmission of HIV [1] and disproportionately affects men who have sex with men (MSM) [2]. Tsuboi et al [3] conducted a global systematic review and meta-analysis of the prevalence of syphilis among MSM over the period 2000-2020 and found the global pooled prevalence was unacceptably high at 7.5%, and ranged from 1.9% in Australia and New Zealand to 10.6% in Latin America and the Caribbean [3]. ...
Background
Syphilis among men who have sex with men (MSM) living with HIV is of public health concern, thus the objective of the study is to determine the correlates of prevalent syphilis infection in this population so that urgent interventions could be instituted.
Methods
A cross-sectional study was conducted during the period September 2020-June 2021
among MSM who attended a large HIV Clinic in Trinidad. A questionnaire was administered to obtain socio-demographic data and correlates of prevalent syphilis and patients were screened for syphilis using the traditional algorithm. Descriptive and bivariate analyses were conducted and multivariable logistic regression factors was used to assess factors significantly associated with a syphilis diagnosis.
Results
Two hundred and sixty four MSM were enrolled; age range 18–64 years, median age 33
years and 89 (34.4%) were actively bisexual. The prevalence of syphilis was 28% (74/264)
and 89.2% (66/74) of these infections were asymptomatic. Multivariable logistic regression analysis showed that those patients who participated in sex with anonymous partners (OR 2.09; 95% CI, 1.03–4.26), those with a previous diagnosis of syphilis (OR 5.16; 95% CI,1.03–25.83) and those who used marijuana in the last 12 months (OR 2.13; 95% CI, 1.14–3.96) were more likely to be diagnosed with syphilis.
Conclusion
There is a high prevalence of asymptomatic syphilis among MSM living with HIV in Trinidad. Repeat episodes of syphilis and anonymous sex may play a role in the transmission
... Syphilis is a major public health issue worldwide, with detection rates of 72.9 cases/100 000 individuals in Brazil [1] and 39.5 cases/100 000 in the United States in 2019 [2]. Syphilis has resurged in recent years, with a higher occurrence among men who have sex with men and people living with HIV/AIDS [3,4]. ...
Objective
Our objective was to describe and compare the occurrence of neurological outcomes and neurosyphilis in people living with HIV with incident syphilis and no neurological symptoms who underwent early screening for asymptomatic neurosyphilis (ANS) or regular clinical management without a lumbar puncture.
Methods
This was a retrospective cohort study in a single referral centre of Sao Paulo, Brazil. Patients with incident syphilis diagnosed between January 2000 and August 2016 and meeting the adapted criteria for ANS investigation suggested by Marra et al. (CD4⁺ T‐cell counts ≤350 cells/mm³ and/or venereal disease research laboratory test results ≥1:16) were identified. Those with no neurological symptoms and immediately referred for lumbar puncture were categorized as group 1, and those not referred for cerebrospinal fluid collection were categorized as group 2. We compared the occurrence of neurological symptoms and neurosyphilis diagnoses between the groups using incidence rates and Kaplan–Meier curves.
Results
We included 425 participants with a median follow‐up of 6 years. The incidence rate of neurological symptoms was 36.5/1000 person‐years in group 1 and 40.6/1000 person‐years in group 2 (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI] 0.57–1.39; p = 0.62). The incidence rate of neurosyphilis was 15.0 cases/1000 person‐years in group 1 and 6.7 cases/1000 person‐years in group 2 (IRR 2.26; 95% CI 0.93–5.68; p = 0.05).
Conclusions
We found no statistically significant differences between groups in the incidence rates of neurological symptoms and neurosyphilis. Our findings support the current guidelines, which suggest a less invasive approach regarding ANS investigation among people living with HIV with incident syphilis.
... Syphilis and HIV have significant interactions. The presence of asymptomatic syphilitic gummas cause mucosal disruptions facilitating the transmission of HIV [8]. Syphilis also causes a transient increase in HIV viral load and a transient decrease in CD4 count which further increase HIV transmission [9]. ...
An isolated cranial nerve VI palsy is a rare initial manifestation of undiagnosed neurosyphilis. A 33-year-old male presented with a one month history of progressive headache and diplopia. Neurologic examination only revealed an isolated abducens palsy on the left. Cranial imaging was unremarkable. Examination of his cerebrospinal fluid revealed lymphocytic predominant leukocytosis and elevated protein. Microbiologic work-up were all negative. Further work-up revealed the patient to be serum Rapid Plasma Reagin and Enzyme Immunoassay reactive. Enzyme-linked immunosorbent assay for Human Immunodeficiency Virus also tested positive. His cerebrospinal fluid was then sent for Rapid Plasma Reagin to confirm the diagnosis of neurosyphilis. He completed 14 days of intravenous penicillin and was eventually discharged with partial resolution of the abducens palsy. We describe the second case of neurosyphilis presenting only with an isolated cranial nerve VI involvement. On further review, ours was the first case documented on an individual who had an undiagnosed Human Immunodeficiency Virus infection. There are various differentials for an isolated cranial neuritis but infectious causes, particularly neurosyphilis, should be considered among young individuals with known risk factors despite their apparently benign medical history.
... This may be due to the fact that participants who seek sexual partners through non-internet route have more sexual partners and unprotected sexual behaviors [26]. Meanwhile, we also found that MSM who had STD history in the past year were more likely to be infected with syphilis, which was consistent with other study [27]. Unlike previous studies on syphilis infection prediction models, which only identified the associated risk factors, our study quantified and validated those risk factors, which can accurately predict the risk of syphilis. ...
Background
The purpose of this study was to develop and validate a simple-to-use nomogram for the prediction of syphilis infection among men who have sex with men (MSM) in Guangdong Province.
Methods
A serial cross-sectional data of 2184 MSM from 2017 to 2019 was used to develop and validate the nomogram risk assessment model. The eligible MSM were randomly assigned to the training and validation dataset. Factors included in the nomogram were determined by multivariate logistic regression analysis based on the training dataset. The receiver operating characteristic (ROC) curves was used to assess its predictive accuracy and discriminative ability.
Results
A total of 2184 MSM were recruited in this study. The prevalence of syphilis was 18.1% (396/2184). Multivariate logistic analysis found that age, the main venue used to find sexual partners, condom use in the past 6 months, commercial sex in the past 6 months, infection with sexually transmitted diseases (STD) in the past year were associated with syphilis infection using the training dataset. All these factors were included in the nomogram model that was well calibrated. The C-index was 0.80 (95% CI 0.76–0.84) in the training dataset, and 0.79 (95% CI 0.75–0.84) in the validation dataset.
Conclusions
A simple-to-use nomogram for predicting the risk of syphilis has been developed and validated among MSM in Guangdong Province. The proposed nomogram shows good assessment performance.
