Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis

Eric P.F. Chow, Denton Callander, Christopher K. Fairley, Lei Zhang, Basil J Donovan, Rebecca Guy, David A. Lewis, Margaret Hellard, Phillip Read, Alison Ward, Marcus Y. Chen, ACCESS collaboration

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background. Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Methods. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. Results. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91%; Ptrend <.0001) and HIV-positive MSM (42% to 77%; Ptrend <.0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend <.0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend <.0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend <.0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend =.030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend <.0001), while secondary infections decreased from 45% to 26% (Ptrend =.0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87; P =.005) or frequency (r = -0.93; P =.001). Conclusions. Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.
Original languageEnglish
Pages (from-to)389-395
Number of pages7
JournalClinical Infectious Diseases
Volume65
Issue number3
DOIs
Publication statusPublished - 1 Aug 2017

Keywords

  • men who have sex with men
  • screening
  • syphilis

Cite this

@article{66500ea7d673493cbc144b65b047737c,
title = "Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis",
abstract = "Background. Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Methods. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. Results. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48{\%} to 91{\%}; Ptrend <.0001) and HIV-positive MSM (42{\%} to 77{\%}; Ptrend <.0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend <.0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend <.0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27{\%} to 44{\%} (Ptrend <.0001), while the proportion that were secondary decreased from 24{\%} to 19{\%} (Ptrend =.030). Among HIV-positive MSM, early latent infections increased from 23{\%} to 45{\%} (Ptrend <.0001), while secondary infections decreased from 45{\%} to 26{\%} (Ptrend =.0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87; P =.005) or frequency (r = -0.93; P =.001). Conclusions. Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.",
keywords = "men who have sex with men, screening, syphilis",
author = "Chow, {Eric P.F.} and Denton Callander and Fairley, {Christopher K.} and Lei Zhang and Donovan, {Basil J} and Rebecca Guy and Lewis, {David A.} and Margaret Hellard and Phillip Read and Alison Ward and Chen, {Marcus Y.} and {ACCESS collaboration}",
year = "2017",
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doi = "10.1093/cid/cix326",
language = "English",
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journal = "Clinical Infectious Diseases",
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Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis. / Chow, Eric P.F.; Callander, Denton; Fairley, Christopher K.; Zhang, Lei; Donovan, Basil J; Guy, Rebecca; Lewis, David A.; Hellard, Margaret; Read, Phillip; Ward, Alison; Chen, Marcus Y.; ACCESS collaboration.

In: Clinical Infectious Diseases, Vol. 65, No. 3, 01.08.2017, p. 389-395.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis

AU - Chow, Eric P.F.

AU - Callander, Denton

AU - Fairley, Christopher K.

AU - Zhang, Lei

AU - Donovan, Basil J

AU - Guy, Rebecca

AU - Lewis, David A.

AU - Hellard, Margaret

AU - Read, Phillip

AU - Ward, Alison

AU - Chen, Marcus Y.

AU - ACCESS collaboration

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background. Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Methods. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. Results. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91%; Ptrend <.0001) and HIV-positive MSM (42% to 77%; Ptrend <.0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend <.0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend <.0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend <.0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend =.030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend <.0001), while secondary infections decreased from 45% to 26% (Ptrend =.0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87; P =.005) or frequency (r = -0.93; P =.001). Conclusions. Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.

AB - Background. Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Methods. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. Results. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91%; Ptrend <.0001) and HIV-positive MSM (42% to 77%; Ptrend <.0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend <.0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend <.0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend <.0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend =.030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend <.0001), while secondary infections decreased from 45% to 26% (Ptrend =.0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87; P =.005) or frequency (r = -0.93; P =.001). Conclusions. Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.

KW - men who have sex with men

KW - screening

KW - syphilis

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U2 - 10.1093/cid/cix326

DO - 10.1093/cid/cix326

M3 - Article

VL - 65

SP - 389

EP - 395

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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