Abstract
BackgroundSyphilis is an important sexually transmitted infection (STI) with serious public health consequences. Among men who have sex with men (MSM) in Lima, the prevalence and incidence are extraordinarily high. Current syndromic approaches, however, fail to identify asymptomatic cases, and in settings where large proportions of individuals test positive again after treatment, it is frequently difficult to distinguish treatment failure from re-infection. Thus, new approaches are needed to improve treatment strategies and public health control efforts.Methods/DesignStudy participants will undergo baseline testing for syphilis infection along with a behavioral survey covering demographics, sexual behavior, drug and alcohol abuse and health-care seeking behavior. The cohort will be followed for 18 months at three-month intervals. Blood and earlobe scrapings will also be collected for T. pallidum DNA testing, to create molecular markers for subtyping. We will also perform cytokine testing on collected samples in order to create host immunologic profiles associated with recurrence, re-infection, treatment failure and success.DiscussionAdvances in social epidemiology, molecular typing and characterization of host immune responses will offer promise in developing new understandings of syphilis management. We will share our findings with the Peruvian Ministry of Health and other public health organizations, to identify new approaches of case detection and successful treatment.
Highlights
Syphilis is an important sexually transmitted infection (STI) with serious public health consequences
We will share our findings with the Peruvian Ministry of Health and other public health organizations, to identify new approaches of case detection and successful treatment
Diagnostic, molecular and immunological research, our study offers potential to develop new approaches that may inform strategies for improving current syphilis control strategies (Figure 1)
Summary
We anticipate that the benefits of study participation will outweigh risks, including loss of confidentiality and privacy of clinical information. New understandings obtained from this study will provide indirect benefit to through impact and potential improvement of treatment norms and guidelines. We will make great efforts to identify feasible changes and produce concrete recommendations that can be proposed for revision of the present syphilis management guidelines, in Peru. The information we intend to gather during the proposed study has the potential to provide a more comprehensive and sound understanding of the syphilis epidemic, including prevention, diagnosis, and treatment. SL contributed to study design and project implementation and assisted in manuscript revision. KK contributed to study design, drafted the survey instrument.
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