Past Syphilis Research Articles

High syphilis prevalence and incidence in people living with HIV and Preexposure Prophylaxis users: A retrospective review in the French Dat'AIDS cohort.

In the past years, we observed a sharp increase of Syphilis, especially among male who have sex with male (MSM), either HIV-infected, or on pre-exposure prophylaxis (PrEP). Our aim was to assess syphilis prevalence and incidence among people living with HIV (PLWH) and PrEP users. PLWH were included from 2010 to 2020 and PrEP users from 2016 to 2020 from the Dat'AIDS French cohort. We calculated syphilis prevalence and incidences for first infections, re-infections, and iterative infections (> 2 times). T-Tests, Wilcoxon tests and Chi2 test were used for descriptive analysis and multivariate logistic regression models were used to estimate Odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with syphilis. Among the 8 583 PLWH, prevalence of subject with past or present syphilis was 19.9%. These subjects were more likely MSM or transgender and aged over 35 years, but prevalence was lower in AIDS subjects. Same pattern was seen for incident infection and re-infection. Incidence was 3.8 per 100 person-years for infection and 6.5 per 100 person-years for re-infection. Among 1 680 PrEP users, syphilis prevalence was 25.8%, with an estimated 7.2% frequency of active syphilis. Risk of syphilis infection was higher in male and increased with age. Incidence was 11.2 per 100 person-years for infection and 11.1 per 100 person-years for re-infection. Syphilis prevalence and incidence were high, especially in older MSM with controlled HIV infection and PrEP users, enhancing the need to improve syphilis screening and behavioral risk reduction counseling among high-risk subjects.

Lessons learnt from syphilis-infected blood donors: a timely reminder of missed opportunities

ObjectiveDue to the increased number of syphilis infections diagnosed in the UK and beyond, we reviewed our data on blood donors infected with syphilis in the UK and Ireland between...

Predicting the diagnosis of HIV and sexually transmitted infections among men who have sex with men using machine learning approaches

ObjectivesWe aimed to develop machine learning models and evaluate their performance in predicting HIV and sexually transmitted infections (STIs) diagnosis based on a cohort of Australian men who have sex with men (MSM). MethodsWe collected clinical records of 21,273 Australian MSM during 2011–2017. We compared accuracies for predicting HIV and STIs (syphilis, gonorrhoea, chlamydia) diagnosis using four machine learning approaches against a multivariable logistic regression (MLR) model. ResultsMachine learning approaches consistently outperformed MLR. Gradient boosting machine (GBM) achieved the highest area under the receiver operator characteristic curve for HIV (76.3%) and STIs (syphilis, 85.8%; gonorrhoea, 75.5%; chlamydia, 68.0%), followed by extreme gradient boosting (71.1%, 82.2%, 70.3%, 66.4%), random forest (72.0%, 81.9%, 67.2%, 64.3%), deep learning (75.8%, 81.0%, 67.5%, 65.4%) and MLR (69.8%, 80.1%, 67.2%, 63.2%). GBM models demonstrated the ten greatest predictors collectively explained 62.7-73.6% of variations in predicting HIV/STIs. STIs symptoms, past syphilis infection, age, time living in Australia, frequency of condom use with casual male sexual partners during receptive anal sex and the number of casual male sexual partners in the past 12 months were most commonly identified predictors. ConclusionsMachine learning approaches are advantageous over multivariable logistic regression models in predicting HIV/STIs diagnosis.

Syphilis in heterosexual women: case characteristics and risk factors for recent syphilis infection in Tokyo, Japan, 2017-2018.

In response to an increase in heterosexual syphilis notifications in Tokyo, we conducted a questionnaire-based case-control study among women aged ≥20 years and sexually active in the past six months who sought a syphilis test in Tokyo during 2017-2018. Cases were women diagnosed as recent syphilis infection based on serological tests. Controls were serologically non-reactive or those with only a past syphilis infection. We described cases and assessed for risk factors of recent syphilis using logistic regression. A total of 524 women (60 cases, 464 controls) were enrolled. Notably, among cases, 10 (16.7%) were students, 3 (5.0%) had a history of syphilis, and 14 (23.3%) had a single sex partner in the past six months. Female sex worker (FSW) status was strongly associated with syphilis (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.96-5.90). In multivariable analysis, recent syphilis was associated with inconsistent condom use for vaginal/anal sex among FSWs (adjusted OR [aOR] = 3.42; 95%CI = 0.92-12.70) and among non-FSWs, with younger age (aOR = 0.36; 95%CI = 0.19-0.70; increase per category from 20-24, 25-29 to ≥30 years) and ≤high school education (aOR = 5.24; 95%CI = 1.95-14.10). A notable proportion of cases were those with first time infection and those with only a single partner. Moreover, risk factors differed between FSWs and non-FSWs, and a multi-pronged approach to prevent syphilis is required.

Syphilis infection among people who use and inject drugs in Cambodia: a cross-sectional study using the respondent-driven sampling method.

This cross-sectional study explored the prevalence and correlates of syphilis infection among people who use and inject drugs (PWUD/PWID) in Cambodia. Data were collected in 2017 from 1,677 PWUD/PWID living in the capital city of Phnom Penh and 11 other major provinces using the respondent-driven sampling method. The SD Bioline HIV/Syphilis Duo test was used to determine human immunodeficiency virus (HIV) and current or past syphilis infection. A multivariable logistic regression analysis was conducted to identify risk factors associated with current or past syphilis infection. The prevalence of current or past syphilis infection was 3.8% (95% confidence interval = 2.4-4.6). After adjustment, current or past syphilis infection remained positively associated with being female, living on the streets, having an average monthly income of US$100-299, having transactional sex in the past three months, and having been to a rehabilitation centre in the past 12 months. Current or past syphilis infection was negatively associated with having attained at least high school level of formal education. The findings indicate vulnerability to syphilis infection among PWUD/PWID in Cambodia, particularly among subpopulations who are more marginalized. Syphilis prevention and control programmes should be systematically integrated into HIV and sexually transmitted infection policy and services in the country.

Predicting the Diagnosis of HIV and Sexually Transmitted Infections Among Men Who Have Sex with Men Using Different Machine Learning Approaches

Background: We aimed to develop models and evaluate their performance of machine learning approaches in predicting the diagnosis of HIV and sexually transmitted infections (STIs) based on a large retrospective cohort of Australian men who have sex with men (MSM). Methods: We collected demographic, clinical, behavioural and laboratory information from the clinic records of 21273 MSM who attended Melbourne Sexual Health Centre (MSHC), Australia between 2011-2017. We limited the analysis of three STIs (syphilis, gonorrhoea, chlamydia) to the period of January 2015 to December 2017. We compared the accuracy for predicting the diagnosis of HIV and three STIs using four machine learning approaches against a multivariable logistic regression (MLR) model. Findings: HIV was diagnosed in 436/18505 MSM (436 diagnoses/58121 consultations), syphilis in 741/13820 MSM (810 diagnoses/38490 consultations), gonorrhoea in 3258/10802 MSM (4382 diagnoses/25011 consultations), and chlamydia in 2836/7708 MSM (3918 diagnoses/13926 consultations). Machine learning approaches more accurately predicted each infection than MLR. Gradient boosting machine (GBM) was the most accurate and achieved the highest area under the receiver operator characteristic curve for HIV (76·3%) and STIs (syphilis, 85·8%; gonorrhoea, 75·5%; chlamydia, 68·0%), followed by extreme gradient boosting (71·1%, 82·2%, 70·3%, 66·4%), random forest (72·0%, 81·9%, 67·2%, 64·3%), deep learning (75·8%, 81·0%, 67·5%, 65·4%), and MLR (69·8%, 80·1%, 67·2%, 63·2%). The trained GBM models demonstrated that the ten greatest predictors collectively explained 62·7-73·6% of variations in predicting the diagnosis of HIV/STIs. Among which, STIs symptoms, past syphilis infection, age, time living in Australia, frequency of condom use with casual male sexual partners during receptive anal sex and the number of casual male sexual partners in the past 12 months were predictors most commonly identified by the models. Interpretation: Machine learning approaches are advantageous over multivariable logistic regression models in predicting the diagnosis of HIV/STIs. Funding Statement: Australian NHMRC Leadership Investigator Grant (GNT1172900) Declaration of Interests: LZ is supported by the National Natural Science Foundation of China (8191101420); Thousand Talents Plan Professorship for Young Scholars (3111500001); Xi'an Jiaotong University Young Talent Support Program; Xi’an Jiaotong University Basic Research and Profession Grant (xtr022019003). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). EPFC is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873). XZ is supported by National Science and Technology Major Project of China (2018ZX10721102); The key Project of Philosophy and Social Sciences Research in Jiangsu Education Department of China (2018SJZDI123); Nantong Municipal Bureau of Science and Technology, China (MS12018001, HS2016002 ). All other authors declare no competing interests. Ethics Approval Statement: The datasets were completely de-identified and not re-identifiable. Ethical approval was granted by the Alfred Hospital Ethics Committee, Australia (project number: 124/18).

Syphilis Testing among Men Who Have Had Rectal Gonorrhea and Chlamydia Tests, United States

The Centers for Disease Control and Prevention (CDC) recommends syphilis screening at least annually for sexually active men who have sex with men (MSM). The objective of this study is to assess the frequency of MSM testing for syphilis and how syphilis test results compared with results of rectal gonorrhea and chlamydia tests. In collaboration with a large US commercial laboratory, we identified men aged 15–60 years who had rectal chlamydia or gonorrhea tests during 09/01/2013–09/30/2015 as presumed MSM. We classified MSM as having current or past syphilis if during the study period they had (1) either a reactive qualitative non-treponemal test or at least a 1:1 quantitative non-treponemal test, and (2) they had a reactive treponemal test. Of 52,771 MSM, 14.3% had no syphilis testing, 4.8% had only treponemal testing (37.8% were reactive), 63.2% had only non-treponemal testing (2.0% were reactive), and 17.7% had both non-treponemal and treponemal testing (86.6% had current or past syphilis). Of those MSM who had reactive qualitative non-treponemal tests, at least 90% had no quantitative non-treponemal tests. Current or past syphilis was more common among MSM with positive rectal gonorrhea or chlamydia tests (24.1%) than MSM with negative rectal gonorrhea and chlamydia tests (13.0%, p < 0.005). Of MSM with any syphilis testing during 09/01/2013–09/30/2014, 64.8% also had annual repeat testing. Syphilis testing in general and repeat syphilis testing were frequent but suboptimal among MSM. It is important to continually monitor syphilis for MSM, especially for those MSM who had rectal chlamydia or gonorrhea infection.

Cytokine expression in Treponema pallidum infection

BackgroundCurrent syphilis tests cannot distinguish between active and past syphilis among patients with serofast rapid plasma reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis.MethodsWe collected quarterly serum samples from participants at risk for incident syphilis in a prospective cohort study of men and male-to-female transgender women. We defined incident syphilis as a new RPR titer ≥ 1:8 or a fourfold increase from a prior RPR titer and a positive Treponema pallidum particle agglutination assay. We measured cytokine expression using a 63-multiplex bead-based Luminex assay (eBiosciences/Affymetrix, San Diego, California, USA). We used tertile bins and Chi square tests to identify differences in proportions of cytokines between samples from patients with active and treated syphilis. We constructed a network of cytokine profiles from those findings. We used R software (R version 3.4.1, R, Vienna, Austria) to fit models.ResultsWe identified 20 pairs of cytokines (out of 1953 possible pairs) that differed between active and treated syphilis. From those, we identified three cytokine networks of interest: an Eotaxin–Rantes–Leptin network, a Mig-IL1ra-Trail-CD40L network, and an IL12p40-IL12p70 network.ConclusionsDifferences in cytokine profiles are present among men and male-to-female transgender women with active and treated syphilis. Cytokine assays may be a potentially useful tool for identifying active syphilis among patients with serologic syphilis reactivity.

HIV seroprevalence, self-reported STIs and associated risk factors among men who have sex with men: a cross-sectional study in Rwanda, 2015

ObjectivesIn many populations, men who have sex with men (MSM) are at a high risk of HIV infection. This study aimed to estimate the burden of HIV, other STIs and...

700: Diagnostic accuracy of Abbott ARCHITECT Syphilis TP chemiluminescent immunoassay in pregnant women

An alternative to a traditional syphilis diagnostic algorithm, the reverse sequence algorithm (treponemal antibody with reflex to rapid plasma reagin (RPR)) utilizes a screening test such as Abbott ARCHITECT Syphilis TP chemiluminescent immunoassay (CIA) to provide objective, rather than subjective, results. We evaluated the diagnostic accuracy of the CIA screen in pregnant women compared to the traditional RPR prior to clinical implementation of the reverse algorithm at our hospital. Prospectively collected blood samples from routine prenatal RPR tests were collected and frozen. Samples were batch-tested with treponemal-specific CIA (index test). Women with reactive (positive) RPR had particle agglutination assay (TPPA, gold standard) available for analysis; for RPR-/CIA+ samples, TPPA was performed. We calculated sensitivity, specificity, predictive value, and false positive rate of the CIA test in pregnant women and evaluated perinatal outcomes of women with reactive CIA. Of 1,605 specimens, 35(2.1%) were RPR+, including 24(69%) CIA+/TPPA+ and 11(31%) CIA-/TPPA- (false positive RPR) (Figure 1). Of 1,570 RPR- specimens, 14(0.9%) were CIA+, including 13(93%) confirmed TPPA+, and 1(7%) TPPA- (false positive CIA). Diagnostic performance of the CIA (with 95% CI) was: sensitivity 100%(90.5-100%), specificity 99.9%(99.6 -100%), positive predictive value 97.4% (86.2-99.9%), and false positive rate 0.06%(0.002-0.4%)(Table 1). Among 37 CIA+/TPPA+ women, 11(30%) had previously treated syphilis, 19(51%) had active infection, and 7(19%) had RPR- status which did not require treatment or investigation by the local health department. There was no difference in age, parity, or race/ethnicity among women with RPR+/CIA+/TPPA+ versus RPR-/CIA+/TPPA+ results. One stillbirth occurred in a woman with early, active RPR+/CIA+/TPPA+ syphilis identified at delivery; no adverse perinatal outcomes occurred among women with RPR-/CIA+/TPPA+ results. Compared with the traditional RPR screening test, the treponemal-specific CIA accurately diagnoses current or past syphilis in pregnancy. While women with RPR+/CIA+/TPPA+ and RPR-/CIA+/TPPA+ results had similar demographic characteristics, the clinical significance of RPR-nonreactive status in pregnancy is unclear: adverse perinatal outcomes were limited to women with untreated, RPR+/CIA+/TPPA+ results in our study.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Performance Characteristics of the Reverse Syphilis Screening Algorithm in a Population With a Moderately High Prevalence of Syphilis.

With the recent introduction of automated treponemal tests, a new reverse syphilis algorithm has been proposed and now used by many clinical laboratories. We analyzed the impact of instituting the reverse screening syphilis algorithm in a laboratory that serves a geographic area with a moderately high prevalence of syphilis infection. Serum samples sent for syphilis testing were tested using a treponemal enzyme immunoassay (EIA) as the screening assay. EIA reactive samples were tested by rapid plasma reagin (RPR) and titered to end point if reactive. RPR nonreactive samples were analyzed by the Treponema pallidum particle agglutination test (TP-PA). Pertinent medical records were reviewed for false-reactive screens and samples with evidence of past syphilis infection. Among 10,060 patients tested, 502 (5%) were reactive on the initial EIA screen. The RPR was reactive in 150 (1.5%). TP-PA testing determined that 103 (1.0%) were falsely reactive on initial EIA screen. The reverse screening algorithm, however, identified 242 (2.4%) with evidence of latent, secondary, or past syphilis, 21 of whom had no or unknown prior treatment with antibiotics. Despite a 1.0% false-reactive rate, the reverse syphilis algorithm detected 21 patients with possible latent syphilis that may have gone undetected by traditional syphilis screening.

Asymptomatic anal sexually transmitted infections in HIV-positive men attending anal cancer screening.

HIV-positive men who have sex with men (HIV+MSM) have an increased risk for anal dysplasia and for sexually transmitted infections (STIs). We determined the positivity rates of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), Mycoplasma genitalium (MG) and syphilis in HIV+MSM participating in an anal cancer screening programme. In total, 852 intra-anal swabs were collected from 503 HIV+MSM between 2012 and 2014. Anal cytology and polymerase chain reaction assays for human papillomavirus (HPV), CT, NG and MG detection were performed. The syphilis status was determined serologically. Risk factors for STIs were explored by multiple logistic regression analysis. In total 20·7% (104 of 503) of the patients had an STI other than HPV within the study period. The most common was CT, found in 10·9%, followed by NG (8·9%) and MG (4·2%). Early syphilis was detected in 4·6% and past syphilis in 44·5% of the HIV+MSM. Eighteen patients (3·6%) had more than one STI episode, and 90·6% of the 127 cases of STIs were asymptomatic. Age, anal HPV infection, abnormal anal cytology and previous syphilis were risk factors for STI. Anal STIs are frequent and mostly asymptomatic in HIV+MSM participating in anal cancer screening. STI screening should be incorporated into anal cancer screening programmes for HIV+MSM.

Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database.

IntroductionOutbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries.MethodsPatients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis.ResultsWe included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88–6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69–7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706–0.997) were significantly associated with syphilis seroconversion.ConclusionsWe observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.

Prevalence and associated factors of HIV infection among men who have sex with men in Hefei, China, 2013-2014: a cross-sectional study.

The objective of this study was to investigate the prevalence and influencing factors of HIV infection among men who have sex with men (MSM) in Hefei, China. A total of 578 MSM were recruited, with a mean age of 28.13 ± 6.91; 70.7% were under 30. The awareness rate was 95.4% (560/587) in the cross-sectional study. Of all the respondents, 73 (12.44%) were seropositive for HIV and 56 (9.54%) for syphilis. Multivariate analysis showed that self-reported sexually transmitted infections (STIs) (AOR = 8.02, 95% CI: 2.58-24.98, P < 0.001), received HIV testing in the past year (AOR = 0.33, 95% CI: 0.19-0.60, P < 0.001) and syphilis (AOR = 3.40, 95% CI: 1.69- 6.85, P = 0.001) were independently associated with HIV infection. It is necessary for post-test counselling to address risk among those who engage in sexual risk behaviours. More efforts are needed to enhance HIV/STI testing and treatment services in China.

O15.3 Evaluation of an Immunochromatographic Point-Of-Care Test For the Simultaneous Detection of Nontreponemal and Treponemal Antibodies in Patients with Syphilis

BackgroundWe described the evaluation of the DPP Syphilis Screen and Confirm Assay, a point-of-care test (POC) for the simultaneous detection of nontreponemal and treponemal antibodies for the serological diagnosis of patients with syphilis.MethodsA total of 248 samples from patients with active syphilis (173), past syphilis (15) and from individuals considered as no infected byTreponema pallidum(60) were studied with the DPP Syphilis Screen and Confirm, Rapid Plasma Reagin (RPR), and fluorescent treponemal antibody absorption (FTA-Abs) tests. In addition patients with active syphilis cases (36) primary, (39) secondary, and (98) latent, were evaluated. The DPP Syphilis Screen and Confirm device consists of a plastic cassette with a recombinantT. pallidumand a synthetic nontreponemal test line antigens and a procedural control line.ResultsThe sensitivity of the DPP Syphilis Screen and Confirm, nontreponemal and treponemal tests was 97.6% and 96.8% while the specificity was 94.7% and 93.1% respectively, when compared to the predicates RPR and FTA-abs tests. The treponemal and nontreponemal clinical sensitivity of primaries was 100% (36/36), for both and for secondary syphilis was also 100% (39/39), for both test and predicates. For patients with latent syphilis the sensitivity was 97.96% (96/98) for the treponemal test and 98.98% (97/98) for the nontreponemal test while for the predicates FTA-ABS and RPR was 100% (98/98) and 98.98% (97/98), respectively. With patients without syphilis the specificity of the DPP Syphilis Screen and Confirm test was 91.66% (55/60) for the treponemal line and 96.66% (58/60) for the nontreponemal line.ConclusionThese results indicates that the DPP Syphilis Screen and Confirm POC test could be a useful tool for the serological diagnosis of syphilis, including resource-poor settings where there is a need to provide counselling and treatment on site and thus prevent the further spread of the disease.

Neurocognitive impairment in HIV-infected individuals with previous syphilis

Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.

Blissful Ignorance When Managing Pregnant Women With Syphilis and Nonreactive Nontreponemal Tests?

Blissful Ignorance When Managing Pregnant Women With Syphilis and Nonreactive Nontreponemal Tests?

Prevalence and Factors Associated with Hepatitis B Immunization and Infection among Men Who Have Sex with Men in Beijing, China

BackgroundAmong the Chinese population of 1.3 billion, there are an estimated 93 million carriers of hepatitis B virus (HBV). Men who have sex with men (MSM) are at increased risk for HBV infection; however, the prevalence of HBV immunization and infection among Chinese MSM remains undetermined.MethodsA cross-sectional survey of 1,114 eligible participants was conducted in Beijing, China. Multiple methods were used to recruit study participants. Demographic information and potential correlated factors were collected by questionnaire. Additionally, blood specimens were collected and tested for sexually transmitted infections and serologic markers of hepatitis B immunization and infection.ResultsLaboratory data were available for 1,111 participants (99.7%), the prevalence of hepatitis B immunization was 38.9%, and 26.5% had serologic markers of HBV infection. Multivariate analyses indicated that higher education level, smaller number of male sex partners in the past 12 months, reported diagnosis of sexually transmitted disease (STD), and history of blood donation were independently associated with HBV immunization. Absence of steady male sex partner(s) in the past 12 months, and reported diagnosis of STD were shown to be independently associated with HBV infection. MSM positive for HBV infection were more likely to have past or current syphilis infection.ConclusionsLow prevalence of HBV immunization and high prevalence of HBV infection among Chinese MSM and a correlation between sexual risk factors and hepatitis B infection indicate that comprehensive preventative measures for HBV among MSM, including blood donor and HIV-STD clinic vaccination programs as well as targeted health education campaigns should be developed in China.

Hepatitis C Virus Infections in the Swiss HIV Cohort Study: A Rapidly Evolving Epidemic

Hepatitis C virus (HCV) infection has a growing impact on morbidity and mortality in patients infected with human immunodeficiency virus (HIV). We assessed trends in HCV incidence in the different HIV transmission groups in the Swiss HIV Cohort Study (SHCS). HCV infection incidence was assessed from 1998, when routine serial HCV screening was introduced in the SHCS, until 2011. All HCV-seronegative patients with at least 1 follow-up serology were included. Incidence rates (IRs) of HCV infections were compared between men who have sex with men (MSM), injection drug users (IDU), and heterosexuals (HET). HCV incidence was assessed in 3333 MSM, 123 IDU, and 3078 HET with a negative HCV serology at baseline. Over 23 707 person-years (py) for MSM, 733 py for IDU, and 20 752 py for HET, 101 (3%), 41 (33%), and 25 (1%) of patients seroconverted, respectively. The IR of HCV infections in MSM increased from 0.23 (95% credible interval [CrI], .08-.54) per 100 py in 1998 to 4.09 (95% CrI, 2.57-6.18) in 2011. The IR decreased in IDU and remained <1 per 100 py in HET. In MSM, history of inconsistent condom use (adjusted hazard ratio [HR], 2.09; 95% CI, 1.33-3.29) and past syphilis (adjusted HR, 2.11; 95% confidence interval [CI], 1.39-3.20) predicted HCV seroconversion. In the SHCS, HCV infection incidence decreased in IDU, remained stable in HET, and increased 18-fold in MSM in the last 13 years. These observations underscore the need for improved HCV surveillance and prevention among HIV-infected MSM.

Changing Epidemiology of Sexually Transmitted Infections: Call for New Strategies Against the Increase in Chlamydia Infection in Sweden

This descriptive analysis of sexually transmitted infections (STIs) is based on data regulated by the Swedish Communicable Disease Act and consists of free testing and treatment, partner tracing and notification. Today, chlamydia is the only STI that affects the general population in Sweden. In the past gonorrhoea and syphilis had an appreciable effect on the general population. However, in the 1990s both of these diseases became rare. HIV has almost exclusively been restricted to three subpopulations (men who have sex with men, injecting drug users and people from HIV endemic countries). The Swedish strategy employed to reduce gonorrhoea and syphilis has been highly successful as demonstrated by a substantial decrease in the incidence of gonorrhoea and syphilis in the mid-1990s. A recent slight increase in syphilis and HIV might be due to the introduction of highly active antiviral therapy (HAART) that may have promoted promiscuous behaviour. The present chlamydia strategy, which focuses on opportunistic screening, partner tracing and condom use, has failed despite being one of the world's most all comprehensive plans. The number of chlamydia cases more than doubled after 1998, and in 2007, the number was the highest ever recorded in Sweden. This noticeable increase in chlamydia cases has important implications and suggests that greater attention should be given to transmission dynamics, including the effects of screening programmes and acquired immunity. Complication and clearance rates after asymptomatic chlamydia infection need to be established, but the most important goal is to encourage behavioural changes in terms of fewer episodes of unprotected sexual intercourse and fewer sexual partners.