Syphilis Incidence Rates Research Articles

Epidemiological and clinical aspects of syphilis incidence in the Russian Federation and the Kyrgyz Republic: comparative analysis

The Soviet period of development of domestic dermatovenereology was characterized by scientific achievements and the creation of organizational forms of combating venereal and contagious skin diseases. After the collapse of the USSR, socio-economic changes occurred in the former Soviet republics that affected the medical sphere. In recent years, the integration of dermatovenereologists with representatives of related specialties has increased and cooperation in the exchange of experience between dermatovenereological services of Russia and other countries is actively developing, including in the field of prevention of the spread of STIs. In 2021 and 2022, a significant increase (by 69.7%) in the incidence of syphilis was registered in Russia for the first time compared to 2020, which is due to an increase in this indicator among migrants (from 2801 cases in 2020 to 12748 cases in 2022), of which 30% of syphilis cases were among citizens of Kyrgyzstan. The article presents the results of a retrospective comparative study of syphilis incidence rates among children aged 0 to 14 years, adolescents aged 15 to 17 years, and adults over 18 years in the Russian Federation and the Kyrgyz Republic, and analyzes regulatory documents governing syphilis testing and treatment. Despite significant similarities in approaches to laboratory diagnostics of syphilis, including neurosyphilis, uniform principles of prenatal examination of women and treatment of pregnant women, there are currently a number of significant differences, including shorter courses of therapy and low doses of drugs, shorter periods of clinical and serological monitoring in the Kyrgyz Republic.

Dermatovenereology in the Russian Federation: results of 2023

The article presents information on dynamics of dermatovenerological service resources, indicators of the population of the Russian Federation provision with dermatovenerologists and dermatovenerological beds, main performance rates and results of dermatovenereological medical care providing in outpatient, inpatient and day hospital conditions for the period 2019–2023. The dynamics of sexually transmitted infections (syphilis, gonococcal infection, trichomoniasis, chlamydial infection, anogenital herpetic viral infection and anogenital venereal warts) incidence in the Russian Federation, as well as contribution of foreign citizens to the syphilis incidence rates are analyzed. The dynamics of prevalence and incidence rates of diseases of the skin and subcutaneous tissue in the Russian Federation in 2019–2023, as well as dynamics of prevalence and incidence of atopic dermatitis, psoriasis, contact dermatitis, localized scleroderma, discoid lupus erythematosus among children aged 0–17 years and adults 18 years and older are presented.

A clinical case of early congenital syphilis

Congenital syphilis results from vertical transmission of Treponema pallidum to the fetus from an infected mother who was not treated before 32 weeks of gestation. Thanks to the development of obstetric and gynecological services, incidence rates of congenital syphilis are decreasing annually, even against the background of an increase in cases of acquired syphilis among the adult population. Depending on the time of manifestation, early (onset before 2 years) and late (onset after 2 years) congenital syphilis are distinguished. The clinical picture of both congenital and acquired syphilis has wide variability and requires careful differential diagnosis with other diseases of infectious and non-infectious nature. The relatively rare frequency of occurrence and the polymorphism of clinical manifestations reduce the alertness of clinicians regarding this disease. Diagnosis is not difficult provided that a correct history is taken and direct (identification of the pathogen itself) and indirect (serological reactions) laboratory tests are carried out. However, the erased course with a small number of clinical manifestations may delay the early detection of the disease. Syphilitic infection in both mother and child is traditionally treated with beta-lactam antibiotics. The prognosis for life and health is individual in each case and depends on concomitant conditions. This article presents a clinical case of early congenital syphilis in a child whose mother was not observed in the antenatal clinic during pregnancy and was infected with Treponema pallidum in the II—III trimesters. Attention is focused on the importance of a thorough history taking even in the presence of non-specific symptoms.

Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men : A Randomized Controlled Trial.

Observational studies suggest that voluntary medical male circumcision (VMMC) may lower HIV risk among men who have sex with men (MSM). A randomized controlled trial (RCT) is needed to confirm this. To assess the efficacy of VMMC in preventing incident HIV infection among MSM. An RCT with up to 12 months of follow-up. (Chinese Clinical Trial Registry: ChiCTR2000039436). 8 cities in China. Uncircumcised, HIV-seronegative men aged 18 to 49 years who self-reported predominantly practicing insertive anal intercourse and had 2 or more male sex partners in the past 6 months. VMMC. Rapid testing for HIV was done at baseline and at 3, 6, 9, and 12 months. Behavioral questionnaires and other tests for sexually transmitted infections were done at baseline, 6 months, and 12 months. The primary outcome was HIV seroconversion using an intention-to-treat analysis. The study enrolled 124 men in the intervention group and 123 in the control group, who contributed 120.7 and 123.1 person-years of observation, respectively. There were 0 seroconversions in the intervention group (0 infections [95% CI, 0.0 to 3.1 infections] per 100 person-years) and 5 seroconversions in the control group (4.1 infections [CI, 1.3 to 9.5 infections] per 100 person-years). The HIV hazard ratio was 0.09 (CI, 0.00 to 0.81; P = 0.029), and the HIV incidence was lower in the intervention group (log-rank P = 0.025). The incidence rates of syphilis, herpes simplex virus type 2, and penile human papillomavirus were not statistically significantly different between the 2 groups. There was no evidence of HIV risk compensation. Few HIV seroconversions and limited follow-up period. Among MSM who predominantly practice insertive anal intercourse, VMMC is efficacious in preventing incident HIV infection; MSM should be included in VMMC guidelines. The National Science and Technology Major Project of China.

Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Men who have sex with men (MSM) in British Columbia (BC) are disproportionately affected by infectious syphilis and HIV. In this study, we developed a co-interaction model and evaluated the impact and effectiveness of possible interventions among different MSM subgroups on the syphilis epidemic. We designed a deterministic compartmental model, which stratified MSM by HIV status and HIV pre-exposure prophylaxis (HIV-PrEP) usage into (1) HIV-negative/unaware MSM (HIV-PrEP not recommended, noton HIV-PrEP), (2) HIV-negative/unaware MSM with HIV-PrEP recommended (not on HIV-PrEP), (3)HIV-negative/unaware MSM actively on HIV-PrEP, and (4) MSM diagnosed with HIV. We estimated the effect of scaling up syphilis testing frequency from Status Quo to six-, four-, and three-months, increasing the percentage of MSM using doxycycline prevention (Doxy-P) to 25%, 50%, and 100% of the target level, and a combination of both among subgroups (2)-(4). We also assessed the impact of these interventions on the syphilis incidence rates from 2020 to 2034 in comparison to the Status Quo scenario where no intervention was introduced. Under the Status Quo scenario, with the expansion of the HIV-PrEP program to improve syphilis testing, the syphilis incidence rate was estimated to peak at 16.1 [Credible Interval (CI):14.2-17.9] per 1,000 person-years (PYs) in 2023 and decrease to 6.7 (CI:3.8-10.9) per 1,000 PYs by 2034. The syphilis incidence rate in 2034 was estimated at 0.7 (0.3-1.3) per 1,000 PYs if MSM diagnosed with HIV could be tested every four months, and at 1.5 (0.7-3.0) per 1,000 PYs if HIV-negative/unaware MSM actively on HIV-PrEP could be tested every three months. By achieving 100% of the target coverage of Doxy-P, the syphilis incidence rate was estimated at 1.4 (0.5-3.4) if focusing on MSM diagnosed with HIV, and 2.6 (1.2-5.1) per 1,000 PYs if focusing on HIV-negative/unaware MSM actively on HIV-PrEP. Under the combined interventions, the syphilis incidence rate could be as low as 0.0 (0.0-0.1) and 0.8 (0.3-1.8) per 1,000 PYs, respectively. The HIV-PrEP program in BC plays a crucial role in increasing syphilis testing frequency among high-risk MSM and reducing syphilis transmission among this group. In addition, introducing Doxy-P can be an effective complementary strategy to minimize syphilis incidence, especially among MSM diagnosed with HIV. This work was funded by the Canadian Institutes of Health Research.

Syphilis Diagnosis After a Chlamydia, Gonorrhea, or HIV Diagnosis Among Reproductive-Aged Women in Baltimore, MD.

Syphilis incidence is increasing among reproductive-aged women, and previous sexually transmitted infections (STIs) are a risk factor for subsequent STIs. This study aimed to determine syphilis incidence after a chlamydia, gonorrhea, or HIV diagnosis, and identify characteristics associated with higher syphilis incidence rates among reproductive-aged women in 1 mid-Atlantic city. A retrospective cohort of 85,113 chlamydia, gonorrhea, and HIV diagnoses occurring between 2009 and 2021 and among women aged 13 to 50 years was constructed using public health surveillance data. Cumulative incidence curves were estimated to examine time to early syphilis (i.e., primary, secondary, or early latent) diagnosis, and multivariable analyses determined incidence rate ratios by age (<25 vs. ≥25 years) and number of prior STI diagnoses (0 vs. ≥1) during the study period, stratified by STI. There were 85,113 reportable STI diagnoses and 646 syphilis diagnoses in the cohort. Approximately 1 of 150 chlamydia, 1 of 100 gonorrhea, and 1 of 50 HIV diagnoses were followed by a syphilis diagnosis within 5 years. Cumulative incidence of syphilis differed significantly by STI diagnosis ( P < 0.001). In multivariable analysis, syphilis incidence rates were higher among women diagnosed with ≥1 (vs. 0) prior STI regardless of STI type ( P < 0.05) and among women ≥25 (vs. <25) years old diagnosed with gonorrhea ( P < 0.05). There were significant differences in syphilis incidence by prior STI type, number of STIs, and age. Our data support targeted screening for syphilis among women with a history of STIs, parwomen with ≥1 prior STI diagnosis, and older women diagnosed with gonorrhea.

Challenges in The Management of Ocular Syphilis in Human Immunodeficiency Virus Patient: A Case Report

Background: The incidence rate of syphilis has been increasing in recent years. Ocular syphilis can manifest at any stage of syphilis, either with or without Human Immunodeficiency Virus (HIV) co-infection. Case Illustration: A 52-year-old man presented with a complaint of blurred vision persisting for the past 6 months. Visual examination revealed NLP (no light perception) in the right eye and 6/30 in the left eye. Syphilis serology testing was positive. Patient were diagnosed with latent syphilis with ocular syphilis, along with stage I HIV infection. Patient were treated with benzathine penicillin also with antiretroviral therapy for the HIV infection. Conclusion: Syphilis and HIV often occur together and can influence each other. Syphilitic ulcers can serve as the port of entry for HIV infection. In HIV-infected individuals with syphilis, the symptoms of syphilis can be varied due to the immunocompromised state. Benzathine penicillin G is a first-line therapy for ocular syphilis.

Epidemiological analysis of congenital syphilis in the State of Paraná, Brazil.

Congenital syphilis is a complex public health issue caused by the transmission of Treponema pallidum. Brazil has high incidence rates, with a distinct transmission pattern surpassing other notifiable diseases. The objective of this study was to examine epidemiological trends, incidence rate, mortality, geographical distribution, prenatal care, and diagnostic determination timing of congenital syphilis in Paraná State. Data from Department of Informatics of the Single Health System were used to analyze the period from 2015 to 2021 in Paraná. Linear regression and t-tests were employed to assess significance. Statistical significance was determined by p<0.05. A total of 5,096 notifications of congenital syphilis were recorded in Paraná over the examined period. The metropolitan region is a notable clustering of cases, following Londrina, Maringá, and Foz do Iguaçu. The age group with the highest cases is found between 20 and 24 years (34.93%). Regarding maternal education, a higher occurrence was noticed in incomplete lower secondary education mothers (22.12%). Regarding ethnic background, 3,792 women were identified as white, which was the majority of this analysis (74.41%). Diagnosed maternal syphilis throughout the prenatal phase during 2015-2018 exhibited a noteworthy increase (p<0.05). Most women received prenatal care (p<0.05), even though a significant number received the diagnosis at the delivery or after it. The average infant mortality rate associated with congenital syphilis in Paraná was 0.03. Paraná State serves as a representative sample of this epidemiological situation, providing significant insights into the intricacies of congenital syphilis incidence. Further comparative investigations including diverse regions within Brazil are necessary.

Mucocutaneous and musculoskeletal manifestation as an early symptomatic congenital syphilis: A rare case

Background: Congenital syphilis (CS) is attributable to the transmission of Treponema pallidum from the mother to the fetus transplacental during gestation. The incidence rate of congenital syphilis is 15 per 100,000 newborns by 2020. Mucocutaneous involvement is present in as many as 70% of infants and may be apparent at birth or develop during the first few weeks of life. Cutaneous findings of early CS classically a vesiculobullous or maculopapular rash on the palms and soles may be associated with desquamation. Skeletal manifestations of congenital syphilis occur in 60%-80% of infants, including osteitis (0.7%), metaphysitis (24%), and periosteal reaction (34%). It is important to be fully informed regarding the early diagnosis and treatment of congenital syphilis to prevent its devastating complications to death. This case report describes clinical features, treatment, and prognosis of congenital syphilis presented with mucocutaneous lesions and musculoskeletal manifestations. Case representation: A one-day-old boy preterm infant, 2145 grams, born spontaneously, presented with ruptured bullous lesions and desquamation on the feet and hands. The laboratory revealed thrombocytopenia, elevated C-reactive protein, elevated bilirubin total (10.9 mg/dL) and direct bilirubin (6.21 mg/dL) at 24 days old, indicating an intrahepatic cholestasis caused by syphilis. Serum VDRL 1:128 and TPHA &gt;1:5120. Long bone radiology showed periostitis involving the humerus, ulna, radius dextra and sinistra, femur dextra and sinistra, a feature of congenital syphilis. The patient was treated with procaine penicillin 107,000 international units intravenous every 24 hours for 10 days. Conclusion: The early recognition of mucocutaneous and musculoskeletal involvement as an early manifestation of CS improved with procaine penicillin intravenous for 10 days.

Seasonality of syphilis in males through the 2011 to 2019 mandatory surveillance period: A cross-sectional study in South Korea.

Although the effects of seasonality on syphilis have been discussed previously, no previous study has evaluated the seasonality of syphilis incidence by sex and age group. We examined the seasonality of syphilis incidence by sex and age group in Korea from 2011 to 2019. The incidence of syphilis was calculated on the basis of Korea Diseases Control and Prevention Agency data, and an autoregressive integrated moving average (ARIMA) model and seasonal and trend decomposition using Loess were used to analyze the seasonality of the incidence in relation to epidemiological factors. The annual age-standardized incidence rates of primary, secondary, and congenital syphilis were 21.1, 8.8, and 64.0 cases/million persons, respectively, from 2011 to 2019. The highest incidence rates for primary and secondary syphilis were observed among those aged 20 to 29, 13 to 19, and 30 to 49 years, but not among the lower age groups. In analyses based on the ARIMA model, all univariate time series showed the highest goodness-of-fit results with ARIMA for primary syphilis (1,1,2), secondary syphilis (1,1,1), and congenital syphilis (0,1,2) (2,0,0) models. This study suggests that the incidence of secondary syphilis shows a summer seasonality for males and the highest incidence rate in the 20 to 29-year age group for both males and females in Korea. Public health action is needed to prevent an increase in syphilis incidence associated with sex, age group, and seasonal patterns.

Prevalência dos indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva

Abstract This article aims to evaluate the performance of preconception health indicators according to sociodemographic characteristics among Brazilian women of reproductive age. We conducted a descriptive epidemiological study using data from 21,645 and 25,228 women, respectively, who responded the 2013 and 2019 national health surveys, and data for the period 2010 to 2020 derived from the national health system’s Department of Informatics (DATASUS). We calculated the prevalence of indicators according to sociodemographic characteristics and statistical significance of differences was measured using Pearson’s chi-squared test. Syphilis and HIV incidence rates were also calculated. There was an increase in the prevalence of access to health service indicators (medical and dental consultations and recent Pap smear). However, there was an increase in the prevalence of hypertension, alcohol use, and obesity. The prevalence of use of contraceptive methods and fertility treatment remained stable. Syphilis incidence increased sevenfold between 2010 and 2020. Black/brown women with a low level of education, higher parity, and living in the North or Northeast performed worse for preconception health indicators. Despite the increase in access to health services, performance on preconception health indicators declined and health inequities continued.

Scaling law characteristics and spatiotemporal multicomponent analysis of syphilis from 2016 to 2022 in Zhejiang Province, China.

Syphilis has caused epidemics for hundreds of years, and the global syphilis situation remains serious. The reported incidence rate of syphilis in Zhejiang Province has ranked first in the province in terms of notifiable infectious diseases for many years and is the highest in China. This study attempts to use the scaling law theory to study the relationship between population size and different types of syphilis epidemics, while also exploring the main driving factors affecting the incidence of syphilis in different regions. Data on syphilis cases and affected populations at the county level were obtained from the China Disease Control and Prevention Information System. The scaling relationship between different stages of syphilis and population size was explained by scaling law. The trend of the incidence from 2016 to 2022 was tested by the joinpoint regression. The index of distance between indices of simulation and observation (DISO) was applied to evaluate the overall performance of joinpoint regression model. Furthermore, a multivariate time series model was employed to identify the main driving components that affected the occurrence of syphilis at the county level. The p value less than 0.05 or confidence interval (CI) does not include 0 represented statistical significance for all the tests. From 2016 to 2022, a total of 204,719 cases of syphilis were reported in Zhejiang Province, including 2 deaths, all of which were congenital syphilis. Latent syphilis accounted for 79.47% of total syphilis cases. The annual percent change (APCs) of all types of syphilis, including primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis, were - 21.70% (p < 0.001, 95% CI: -26.70 to -16.30), -16.80% (p < 0.001, 95% CI: -20.30 to -13.30), -8.70% (p < 0.001, 95% CI: -11.30 to -6.00), -39.00% (p = 0.001, 95% CI: -49.30 to -26.60) and - 7.10% (p = 0.008, 95% CI: -11.20 to -2.80), respectively. The combined scaling exponents of primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis based on the random effects model were 0.95 (95% CI: 0.88 to 1.01), 1.14 (95% CI: 1.12 to 1.16), 0.43 (95% CI: 0.37 to 0.49), 0.0264 (95% CI: -0.0047 to 0.0575) and 0.88 (95% CI: 0.82 to 0.93), respectively. The overall average effect values of the endemic component, spatiotemporal component and autoregressive component for all counties were 0.24, 0.035 and 0.72, respectively. The values of the autoregressive component for most counties were greater than 0.7. The endemic component of the top 10 counties with the highest values was greater than 0.34. Two counties with value of the spatiotemporal component higher than 0.1 were Xihu landscape county and Shengsi county. From 2016 to 2022, the endemic and autoregressive components of each county showed obvious seasonal changes. The scaling exponent had both temporal trend characteristics and significant heterogeneity in the association between each type of syphilis and population size. Primary syphilis and latent syphilis exhibited a linear pattern, secondary syphilis presented a superlinear pattern, and tertiary syphilis exhibited a sublinear pattern. This suggested that further prevention of infection and transmission among high-risk populations and improvement of diagnostic accuracy in underdeveloped areas is needed. The autoregressive components and the endemic components were the main driving factors that affected the occurrence of syphilis. Targeted prevention and control strategies must be developed based on the main driving modes of the epidemic in each county.

Specifics of Epidemiological Anamnesis of Sexually Transmitted Diseases in High-Risk Groups

Introduction: Sexually transmitted infections induce inflammatory diseases of the pelvic organs in women, infertility, infant and maternal mortality, and remain a global health challenge. Current studies are focused on examination and treatment of risk groups, including men who have sex with men, among whom the highest incidence rates of syphilis, gonorrhea, chlamydia, and other socially significant infections are usually registered. Objective: To establish epidemiological features of the incidence of sexually transmitted diseases in men who have sex with men as representatives of a high-risk group. Material and methods: Snowball sampling was used in our questionnaire-based survey that involved 136 men of reproductive age (18 to 49 years). The case study group included 79 men who have sex with men and the control group consisted of 57 heterosexual men. For statistical data analysis, we used Pearson’s chi-squared test and Fisher’s exact test. Results and discussion: The median age of the cases was 32 years and 25.3 % of them noted having bisexual relationships. Compared to the controls, the proportion of men who reported having more than 10 sexual partners over the previous year was statistically higher among the men having sex with other men (63.3 %). 81.0 % of the cases and 57.9 % of the controls reported having casual sexual relations. 50 % of the men who have sex with men had one or more sexually transmitted infections in the medical history, while this percentage was significantly lower in the controls. Conclusion: Men who have sex with men are typical representatives of groups at risk of sexually transmitted diseases due to numerous sexual partners and inherent risky sexual behavior.

Incidence of sexually transmitted infections and association with behavioural factors: Time-to-event analysis of a large pre-exposure prophylaxis (PrEP) cohort.

Our objective was to obtain long-term data on the incidence of sexually transmitted infections (STIs) and their association with behavioural factors after widespread pre-exposure prophylaxis (PrEP) implementation. This was a time-to-event analysis of a national PrEP cohort in Switzerland (SwissPrEPared study). Participants were people without HIV interested in taking PrEP with at least two STI screening visits. Primary outcomes were incidence rate of gonorrhoea, chlamydia, and syphilis. The association between behavioural factors and STI diagnosis was expressed using hazard ratios. We adjusted for testing frequency and calendar year. This analysis included 3907 participants enrolled between April 2019 and April 2022, yielding 3815.7 person-years of follow-up for gonorrhoea (15 134 screenings), 3802.5 for chlamydia (15 141 screenings), and 3858.6 for syphilis (15 001 screenings). The median age was 39 years (interquartile range [IQR] 32-47), 93.8% (n = 3664) identified as men who have sex with men (MSM). The incidence was 22.8 (95% confidence interval [CI] 21.3-24.4) per 100 person-years for gonorrhoea, 26.3 (95% CI 24.7-28.0) for chlamydia, and 4.4 (95% CI 3.8-5.1) for syphilis. Yearly incidence rates decreased between 2019 (all bacterial STIs: 81.6; 95% CI 59.1-109.9) and 2022 (all bacterial STIs: 49.8; 95% CI 44.6-55.3). Participants reporting chemsex substance use were at higher risk of incident STIs, as were those reporting multiple sexual partners. Younger age was associated with a higher risk of gonorrhoea and chlamydia. Incidence rates of bacterial STIs decreased over time. Young MSM, those with multiple partners, and those using chemsex substances were at increased risk of STIs.

Trajectories of PrEP use among men who have sex with men: a pooled analysis of two prospective, observational cohort studies.

Daily and event-driven oral pre-exposure prophylaxis (PrEP) reduce the risk of HIV acquisition. PrEP use can vary over time, yet little is known about the trajectories of PrEP use irrespective of the chosen PrEP regimens among men who have sex with men (MSM). Using data from a mobile, web-based diary application collected daily from 17 August 2015 until 6 May 2018, we analysed PrEP use and sexual behaviour in two large cohorts, AMPrEP (Amsterdam, the Netherlands) and Be-PrEP-ared (Antwerp, Belgium). In both cohorts, participants could choose between daily and event-driven oral PrEP every 3 months. We used group-based trajectory modelling to identify trajectories of PrEP use over time and their determinants. In addition, we estimated the incidence rate of chlamydia, gonorrhoea and syphilis within these trajectories. We included 516 MSM (n = 322 AMPrEP; n = 194 Be-PrEP-ared), of whom 24% chose event-driven PrEP at PrEP initiation. Participants contributed 225,015 days of follow-up (median = 508 days [IQR = 429-511]). Four distinct PrEP use trajectories were identified: ≤2 tablets per week ("low frequency," 12% of the total population), 4 tablets per week ("variable," 17%), "almost daily" (31%) and "always daily" (41%). Compared to participants with "low frequency" PrEP use, participants with "variable" (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.04-4.60) and "almost daily" PrEP use were more often AMPrEP participants (OR = 2.64, 95% CI = 1.27-5.49). "Almost daily" PrEP users were more often employed (OR = 6.76, 95% CI = 2.10-21.75) and were younger compared to participants with "low frequency" PrEP use. In addition, the number of days on which anal sex occurred was lower among participants with "low frequency" PrEP use compared to the other groups (all p<0.001). Compared to "low frequency" PrEP users, the incidence rates of chlamydia and gonorrhoea were higher for participants with "almost daily" and "always daily" PrEP use. We uncovered four distinct PrEP use trajectories, pointing to different patterns of PrEP use in practice beyond the two-regimen dichotomy. These trajectories were related to sexual behaviour and rates of sexually transmitted infection. Tailoring PrEP care according to different PrEP use patterns could be an important strategy to improve efficient PrEP delivery.

IMPACT IN NOTIFIED SYPHILIS DIAGNOSIS DURING THE COVID-19 PANDEMIC IN BRAZIL

Objective This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. Study Design In this descriptive study, data were extracted from a SUS public disease notification database. Results There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. Conclusion The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures. FAPEMIG, CNPq, CAPES. This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. In this descriptive study, data were extracted from a SUS public disease notification database. There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures.

Progression of a large syphilis outbreak in rural North Carolina through space and time: Application of a Bayesian Maximum Entropy graphical user interface.

In 2001, the primary and secondary syphilis incidence rate in rural Columbus County, North Carolina was the highest in the nation. To understand the development of syphilis outbreaks in rural areas, we developed and used the Bayesian Maximum Entropy Graphical User Interface (BMEGUI) to map syphilis incidence rates from 1999-2004 in seven adjacent counties in North Carolina. Using BMEGUI, incidence rate maps were constructed for two aggregation scales (ZIP code and census tract) with two approaches (Poisson and simple kriging). The BME maps revealed the outbreak was initially localized in Robeson County and possibly connected to more urban endemic cases in adjacent Cumberland County. The outbreak spread to rural Columbus County in a leapfrog pattern with the subsequent development of a visible low incidence spatial corridor linking Roberson County with the rural areas of Columbus County. Though the data are from the early 2000s, they remain pertinent, as the combination of spatial data with the extensive sexual network analyses, particularly in rural areas gives thorough insights which have not been replicated in the past two decades. These observations support an important role for the connection of micropolitan areas with neighboring rural areas in the spread of syphilis. Public health interventions focusing on urban and micropolitan areas may effectively limit syphilis indirectly in nearby rural areas.

Trend ranog sifilisa u Beogradu u periodu od 2001. do 2020. godine

Introduction/Aim: In the period 2010-2019, in the countries of the European Union, the incidence of syphilis increased by 209.8% in men and in women there was a slight increase. The increase of incidence was particularly noted in the population of men who have sex with men (MSM). The aim of this study was to determine the trend of early syphilis in Belgrade in the period 2001-2020. Methods: For the analysis of the epidemiological situation of syphilis in the area of Belgrade in the period 2001-2020, data from reports on infectious diseases, medical documentation, annual reports on the work related to the prevention, suppression and elimination of infectious diseases and the results of epidemiological and laboratory tests were used. Data on the number of inhabitants regarding gender and age for Belgrade were taken from the 2011 census, while estimates were used for the years between censuses. Based on the obtained data, raw, age-specific and incidence rates by gender were calculated for syphilis. In order to analyze the trends in incidence rates of syphilis for the period 2001-2020, as well as for the period 2011-2020, joinpoint regression analysis was used. Results: In the period 2001-2020, a total of 938 cases of syphilis were registered, while the highest incidence rate was registered in 2018 (8.1/100,000), and the lowest in 2008 (0.5/100,000). In the period 2001-2008, the incidence rate of syphilis decreased by 1.1% per year (p &gt; 0.05), while in the period 2009-2020, there was a significant increase of 24.3% per year. In the population of men, a significant increase in the incidence rate by 20.7% per year was registered in the period 2011-2020, while in the population of women, this increase was 0.9% per year, and it was not significant. In the period 2011-2020, the highest incidence rates were in men aged 30-39 years, and in women aged 20-29 years. In all age groups, the incidence rate was higher in men than in women, while the average ratio of affected men and women was 11.9. Conclusion: Syphilis is still a common sexually transmitted infection in Belgrade, and therefore, early diagnosis and therapy are needed, especially among the members of vulnerable groups for sexually transmitted infections, in order to prevent the spread of this disease and the emergence of complications. Since it is common among women in the reproductive period, antenatal screening for this infection can be recommended to all pregnant women, and especially to those at increased epidemiological risk.

Trend analysis in syphilis detection rates in pregnant women and in the incidence rate of congenital syphilis in the state of Ceará from 2015 to 2021

RESUMO Objetivo: Analisar a tendência na taxa de detecção de sífilis em gestantes (SG) e na taxa de incidência de sífilis congênita (SC) no estado do Ceará. Métodos: Estudo ecológico que utilizou a técnica da série temporal interrompida para analisar os dados mensais de casos de SG e SC obtidos no Departamento de Informática do Sistema Único de Saúde (DATASUS) no período de janeiro de 2015 a julho de 2021. Utilizaram-se o teste de Kernel e a estimativa de Lincoln-Petersen para analisar a significância estatística. Resultados: Em 2015, estimou-se uma taxa de detecção mensal de SG de 5,4 e de incidência de SC de 8,2 por 1 mil nascidos vivos (NV). A implantação da portaria que alterou os critérios de definição de caso de SG e de SC implicou no aumento de 4,9 na taxa de detecção de SG (p&lt;0,0001; IC95% 3,33; 6,61) e na queda de 0,1 na taxa de incidência de SC (p&lt;0,001; IC95% -0,2; -0,1). A pandemia de COVID-19 não impactou na taxa de detecção mensal de SG (p=0,558; IC95% 5,92; 3,22), nem na sua tendência (p=0,7397; IC95% 0,28; 0,3), mas houve aumento de 0,19 na de SC (p&lt;0,001; IC95% 0,1; -0,31). Conclusões: Entre os anos de 2015 e junho de 2021, a tendência na taxa de detecção de SG e na taxa de incidência da SC sofreu impacto das mudanças nos critérios de definição de caso desses agravos propostas pelo Ministério da Saúde e da pandemia de COVID-19.

Análise da tendência nas taxas de detecção de sífilis em gestantes e de incidência de sífilis congênita no Ceará no período de 2015 a 2021

ABSTRACT Objective: To analyze the trend in the detection rate of Syphilis in Pregnant Women (SP) and in the incidence rate of Congenital Syphilis (CS) in the state of Ceará. Methods: This is an ecological study that used the technique of interrupted time series to analyze monthly data on cases of SP and CS obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from January 2015 to July 2021. The Kernel test and the Lincoln-Petersen estimate were used to analyze the statistical significance. Results: In 2015, a monthly detection rate of SP was estimated at 5.4 and a CS incidence rate of 8.2 per one thousand live births (LB). The implementation of the ordinance that changed the criteria for defining cases of SP and CS resulted in an increase of 4.9 (p&lt;0.0001; 95%CI; 3.33; 6.61) in the detection rate of SP and a decrease of 0.1 on the incidence of CS (p&lt;0.001; 95%CI -0.2; -0.1). The COVID-19 pandemic did not impact the monthly detection rate of SP (p=0.558; 95%CI 5.92; 3.22), nor its trend (p=0.7397; 95%CI 0.28; 0.3), but there was an increase of 0.19 in CS (p&lt;0.001; 95%CI 0.1; -0.31). Conclusion: Between 2015 and June 2021, the trend in the detection rate of SP and in the incidence rate of CS was impacted by changes in the criteria for defining cases of these diseases proposed by the Brazilian Ministry of Health and the COVID-19 pandemic.