New state data show that cases of syphilis continue to rise among homosexual and bisexual men in the United States, with men from the South, with the highest rates, according to a presentation at the 2016 STD prevention conference in the week spent in Atlanta. A related study found that half of gay and bisexual men in 20 cities in the United States were screened for syphilis screening during the past year, with 11% of positive tests.
Alex de Voux at the Centers for Disease Control and Prevention (CDC) and colleagues estimated estimates of primary syphilis and secondary syphilis rates among men who have sex with men (MSM).
Syphilis rates have increased in the US in recent years. During 2014 over 63.000 new cases of syphilis were reported, including 20.000 cases of primary and secondary syphilis, with more than 80% of the latter occurring among MSM according to the CDC. They reported that cases of syphilis increased 15% between 2013 and 2014 and other 19% from 2014 to 2015, Voux Dr said.
Syphilis primary or initial infection, is marked by a only cancer (to learn more about another STD with a similar manifestation, click on cancer Mole)
or lesions in the genital or anal area, where bacteria Treponema pallidum enter the body. These wounds are usually painless, heal on their own and can not be noticed ever. If left untreated the infection progresses to the secondary stage, characterized by a rash on the skin and mucous membranes, including the palms and soles of the feet, sometimes accompanied by fever, swollen lymph nodes, fatigue and other symptoms of flu.
These symptoms also disappear without treatment, but the bacteria remain in the body and progress of untreated infection to the latent stage, which can last for years without symptoms. A minority of infected people go on to develop late-stage syphilis, which may involve damage to the heart, eyes (ocular syphilis), nervous system (neurosyphilis) and other organs.
Pregnant women with syphilis can pass it to their babies (congenital syphilis).
The Voux Dr team bases its estimates on data from case reports of syphilis in 2015 of notifiable diseases in the national system, together with the estimates of 2014, the number of adult gay men and bi per state. State estimates of syphilis among homosexual men were not previously possible because state-by-state estimates of this population were not available, they noted. There was a lack of common denominator that was provided by recent estimates of the number of MSM in each state of researchers at Emory University.
The CDC researchers calculated rates for the 44 states that reported the sex of the partners; at least 70% of men diagnosed with primary and secondary syphilis during 2015 - which accounted for 84% of all such cases - comparing rates among men with any male partners against these reports of relationships between female partners only.
Across the country there were 17.887 cases of primary and secondary syphilis among all men and 2030 cases among women in these 44 states in 2015. Among men, case numbers were 12.118 for MSM and 2866 for heterosexual men and 2903 for men with unknown partner sex.
Alaska had the lowest primary and secondary syphilis rate among MSM (73,1 per 100.000), while North Carolina had the highest rate (748.3 per 100.000). Three other states in the Southeast also had among the highest rates in the nation: Mississippi (658.9 by 100.000), Louisiana (601.8 by 100.000) and South Carolina (536,9 by 100.000).
Overall, almost half of men (49%) surveyed in 2014 said they had been tested for syphilis in recent months 12 above 38% in 2008 and 40% in 2011.
Rates of syphilis testing on 2014 were similar between racial / ethnic groups, at 50% for black men and 48% for whites and Latinos. Men who had seen a doctor last year were more likely to have a diagnosis of syphilis than those who were not screened (54 vs. 25%), and those with insurance were also more likely than those without (51 vs. 42%) .
Gay men and bi men at higher risk were more likely to be tested for syphilis, including HIV-positive men (vs. 68 45% of HIV negative) and men with more than 10 sexual partners during the previous 12 months (65 vs 45% among those with fewer partners).
Among sexually active men who were selecionados, the proportion who tested positive for syphilis was 11% in 2014 from 9% in 2008 and 8% in 2011. Although blacks were only slightly more likely to be tested, they had a substantially higher rate of diagnosis of syphilis (14%) than whites (8%) or Latino (11%) in 2014.
HIV-positive men were almost three times more likely to have syphilis than HIV-negative men (21 vs. 8%) and men with more than 10 sexual partners were about twice as likely to contract syphilis as those with fewer partners (17 vs. 9 %).
The largest increases in syphilis diagnoses were seen among black MSM (9% increase in 2008 to 14% in 2014), HIV-positive men (15 to 21%), men with 10 or more sexual partners (11 to 17%) and young people (from 6 to 10%).
"Despite the recommendation for at least annual screening among sexually active MSM, less than half of MSM reported recent syphilis testing on 2014," the researchers concluded in their summary. "While the test among MSM has increased, more work is needed, especially due to increases in syphilis diagnosis among those selected from 2008 to 2014."
Finally, Anna Cope and Sarah Oliver, both the CDC, presented new data on ocular syphilis, a rare event, but serious.
Although syphilis rates have increased across the country from 2000, ocular syphilis clusters were only reported from 2014, Dr Oliver pointed out. Between December 2014 and 2015 March 1 dozen cases of ocular syphilis were reported in San Francisco and Seattle, and subsequent discovery identified more than 200 20 cases States reported in recent 2 years, according to the CDC.
Dr Oliver and colleagues sought to systematically identify cases of ocular syphilis in North Carolina, determine associated risk factors, and compare cases of syphilis with and without ocular manifestations.
Among 4234 syphilis patients identified during 2014-2015, a total of 63 (1,5%) had ocular syphilis. There 20 2014 and 43 cases where 2015 - 115% increased ocular syphilis, although total syphilis cases increased only 35%.
"The association between advanced age, low CD4 count and prevalence of ocular syphilis suggests that immune status may play a role in the development of ocular syphilis and highlights the importance of HIV testing in all patients with syphilis, especially those with ocular syphilis, "The researchers concluded.
These findings support the CDC's recommendation that clinicians should consider testing for HIV, if you see a patient with ocular syphilis, issued earlier this year after the outbreaks in San Francisco and Seattle. Taken together, these studies underscore the importance of screening for syphilis and follow-up care for gay and bisexual men, as well as a rapid diagnosis and complete antibiotic treatment can prevent long-term health complications and break the chain of transmission of the disease that is the basic principle for the eradication of any infectious disease.
de Voux A et al. Rates of Primary and secondary syphilis by state Among men who have fri with men - United States, 2015. 2016 STD Conference, Atlanta, abstract 4B1, 2016. View abstract.
Wejnert C et al. Syphilis screening and diagnosis Among men who have fri with men, 2008-2014, 20 US cities. 2016 STD Conference, Atlanta, abstract 4B4, 2016. View abstract.
Oliver S Increase in ocular syphilis - North Carolina, 2014-2015. 2016 STD Conference, Atlanta, abstract 4B2, 2016. View abstract.
Cope A et al. Ocular syphilis and HIV coinfection: an opportunity to identify previously undetected HIV. 2016 STD Conference, Atlanta, abstract 3F1, 2016. View abstract.