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Homosexual Practices Lead to Syphilis Resurgence After Being on the Verge of Elimination in the Us

Posted by Admin on Saturday, November 04, 2017 and filed under Research
Topics: Syphilis

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In a report titled "Primary and Secondary Syphilis — United States, 2005–2013," (MMWR, May 9, 2014 / 63(18);402-406) (here), the CDC writes:

After being on the verge of elimination in 2000 in the United States, Syphilis cases have rebounded. Rates of primary and secondary Syphilis continued to increase overall during 2005–2013; although rates stabilized during 2009–2010, rates have increased since 2011. Increases have occurred primarily among men, and particularly among MSM [men who have sex with men], who contributed the vast majority of male primary and secondary Syphilis cases during 2009–2012.

The epidemiology of Syphilis among men, including MSM, has shifted since 2009, with larger increases occurring among Hispanic and white men. Despite this increase, disparities in primary and secondary Syphilis between black men and other racial/ethnic groups remain large. Many barriers to contacting and treating sex partners exist, including delays in reporting cases to the health department, anonymous partners, physicians who rely on patients to notify their partners (2), and the observed tendency of MSM to notify a smaller proportion of their sex partners than do heterosexuals (3).

These analyses indicate that Syphilis prevention measures for MSM of all races/ethnicities need to be strengthened throughout the United States. This could be accomplished by working with private health-care providers because a substantial number of primary and secondary Syphilis cases among MSM are reported by private physicians (1). Further, both private and public providers should be aware of the resurgence in Syphilis and should be able to recognize the signs and symptoms of Syphilis, conduct risk assessments, and screen all sexually active MSM for Syphilis at least annually with Syphilis serologic tests with confirmatory testing where indicated (4). More frequent screening (i.e., at 3–6 month intervals) is recommended for MSM who have multiple or anonymous sex partners. Disclosure of sexual practices remains difficult for some MSM (5); therefore, providers are encouraged to elicit sexual histories of their patients in a culturally appropriate manner, including recognition of sexual orientation, gender identity, and the sex of patients' sex partners. Additional resources and training for accomplishing this are available online.†

The increase in Syphilis among MSM is a major public health concern, particularly because Syphilis and the behaviors associated with acquiring it increase the likelihood of acquiring and transmitting human immunodeficiency virus (HIV) (6). There are reported rates of 50%–70% HIV coinfection among MSM infected with primary and secondary Syphilis (7) and high HIV seroconversion rates following primary and secondary Syphilis infection (8). The resurgence of Syphilis, coupled with its strong link with HIV, underscores the need for programs and providers to 1) urge safer sexual practices (e.g., reduce the number of sex partners, use latex condoms, and have a long-term mutually monogamous relationship with a partner who has negative test results for sexually transmitted diseases); 2) promote Syphilis awareness and screening as well as appropriate screening for gonorrhea, chlamydia, and HIV infection; and 3) notify and treat sex partners.

Despite decreasing rates of primary and secondary Syphilis in the late 1990s in the United States, the resurgence of cases in recent years highlights the fact that challenges remain, and the increases among MSM are particularly concerning. Public health practitioners might want to consider focusing on efforts to strengthen linkages with practicing physicians to improve case identification and reporting, partner-notification programs, and outreach to MSM.

  1. CDC. Sexually transmitted disease surveillance 2012. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/std/stats12/default.htm.

  2. St Lawrence JS, Montano DE, Kasprzyk D, Phillips WR, Armstrong K, Leichliter JS. STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. Am J Public Health 2002;92:1784–8.

  3. Kerani RP, Fleming M, Golden MR. Acceptability and intention to seek medical care after hypothetical receipt of patient-delivered partner therapy or electronic partner notification postcards among men who have sex with men: the partner's perspective. Sex Transm Dis 2013;40:179–85. CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. RR-12).

  4. Bernstein K, Liu KL, Begier E, Koblin B, Karpati A, Murrill C. Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches. Arch Intern Med 2008;168:1458–64.

  5. CDC. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR 2009;58(No. RR-4).

  6. Su JR, Weinstock H. Epidemiology of co-infection with HIV and Syphilis in 34 states, United States—2009. In: proceedings of the 2011 National HIV Prevention Conference, August 13–17, 2011, Atlanta, GA.

  7. Pathela P, Braunstein S, Shepard CS. Population-based HIV incidence among men diagnosed with infectious Syphilis, 2000–2011. In: proceedings of the STI&AIDS World Congress 2013, July 14–17, 2013, Vienna, Austria.

  8. CDC. Community approaches to reducing sexually transmitted diseases. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.

  9. Available at http://www.cdc.gov/std/health-disparities/foa-march-2011.htm. CDC. Improving sexually transmitted disease programs through assessment, assurance, policy development, and prevention strategies (STD AAPPS).

  10. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/std/foa/aapps/default.htm.


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