Abstract
Syphilis remains a disease of public health importance, with considerable health effects if not treated. Concurrent infection with syphilis and untreated HIV facilitates HIV transmission. The incidence of syphilis in Europe has been increasing, particularly among men who have sex with men (MSM) and in MSM with HIV. However, there is heterogeneity among countries in the case definition used for syphilis and in reported syphilis notification rates. In Ireland, we have undertaken a number of refinements of the national syphilis surveillance system since 2014, including refinement of the laboratory thresholds for notification (rapid plasma reagin 1:16 and/or positive IgM). This article outlines the steps taken and some of the challenges we faced. Our current case definition now accurately reflects the epidemiology of syphilis in Ireland and our current surveillance provides timely information for action, while not reducing the sensitivity of the system too much. For countries where surveillance is driven mainly by laboratory reporting and where obtaining clinical details is challenging, these thresholds for notification may be a pragmatic solution.
Highlights
Despite availability of sensitive diagnostic tests and effective treatment, syphilis remains a serious health problem, both for individuals and for public health [1]
To examine the effect of the changes to the case definitions used in Ireland, an evaluation of the sensitivity, completeness and timeliness of the syphilis surveillance system was undertaken in 2018
Sensitivity was considered to be the ability of the surveillance system to detect a health event; at the level of case reporting, sensitivity refers to the proportion of cases of a disease detected by the system [14]
Summary
Despite availability of sensitive diagnostic tests and effective treatment, syphilis remains a serious health problem, both for individuals and for public health [1]. Infection may progress and lead to serious, potentially long-term, health consequences. There are several stages of syphilis infection: Primary syphilis usually involves one lesion that occurs at the site of infection. These lesions are painless and may be in sites that are not visible, may be unnoticed or not recognised. Secondary syphilis occurs 4–8 weeks after primary syphilis; it involves a systemic infection with bacteraemia, symptoms include a widespread rash and wart-like lesions called condylomata lata [2]. While syphilis can be treated with antibiotic therapy, no immunity develops following infection and successful treatment and re-infection can occur with subsequent exposure [3]
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