Rates Of Infectious Syphilis Research Articles

Higher rates of laboratory-confirmed cases of syphilis in Western Canadian blood donors compared with Eastern Canadian blood donors following a period of societal re-opening.

There is a growing infectious syphilis outbreak in Western Canada. Although blood donors are screened for syphilis risks, some blood donors will still be confirmed test-positive for syphilis. This study compares the characteristics of confirmed test-positive syphilis donations in both Western Canada and Eastern Canada, November 2022-August 2023. Donors were defined as Western or Eastern Canadian. Blood donations were tested for syphilis using the PK-TP assay (Beckman Coulter PK7300 Automated Microplate System). Confirmatory Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) assays were performed by one of two reference laboratories. An RPR titre ≥1:8 was used as a proxy for possible infectious syphilis. Rates of laboratory-confirmed syphilis were higher in Western (n = 43, 13.4/100,000 donations) versus Eastern donors (n = 19, 4.7/100,000 donations; Fisher's exact test, two-sided, p ≤ 0.0001). Most syphilis confirmations were in first-time donors (Western Canada n = 31/43, 72.1%, Eastern Canada 12/19, 63.2%). Although rates of laboratory-confirmed syphilis were higher in Western versus Eastern donors, Western donors did not have higher rates of infectious syphilis. Further studies might assess whether donors with laboratory-confirmed syphilis understood pre-donation screening questions or were completely unaware of a past infection.

Summary of the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) Statement: Recommendations on Screening for Syphilis in Non-Pregnant Adults and Adolescents.

Sustained and significant increases in Canadian rates of infectious syphilis prompted the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) to update the existing screening recommendation for non-pregnant adults and adolescents. These guidelines were developed following the 2014 World Health Organization Handbook. The research question was: "What is the clinical utility of syphilis screening using risk-based versus population-wide approaches for adolescents and adults?" The evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The environmental scan included 11 guidelines on syphilis screening published between 2014 and January 2023. Two systematic reviews were identified and included. In the updated literature search from November 6, 2019, to January 17, 2023, there were no published systematic reviews on the effectiveness of risk-based screening or the comparison of risk-based and interval screening; however, one recent randomized control trial in Canada was published. Evidence for outcomes, patient values and preferences, resources, acceptability, equity, cost and cost effectiveness and feasibility were reviewed. This statement provides two screening recommendations for adults and adolescents. Recommendation 1: NAC-STBBI recommends syphilis screening in all sexually active persons with a new or multiple partners and/or upon request of the individual. They also recommend screening every three to six months in individuals with multiple partners. Recommendation 2: NAC-STBBI recommends that targeted "opt-out" screening programs should be considered as frequently as every three months when serving population groups and/or communities experiencing a high prevalence of syphilis (and other STBBI). Both are strong recommendations with moderate certainty of evidence.

Congenital syphilis re-emergence in Winnipeg, Manitoba.

Infectious syphilis rates have been increasing in Winnipeg, Manitoba among individuals during their childbearing years. Untreated or inadequately treated prenatal infection often results in congenital syphilis, with devastating consequences to fetal health and survival. The objective of this study was to review public health surveillance data regarding congenital syphilis incidence and birthing parent risk factors in Winnipeg from 2018 to 2020. Data extracted from a population-based surveillance database maintained by the Winnipeg Regional Health Authority Public Health investigations for all 2018-2020 probable or confirmed cases of early congenital syphilis or syphilitic stillbirth were reviewed. Rates of congenital syphilis were calculated per 1,000 live births. Descriptive analyses were performed to describe birthing parent age, neighbourhood of residence, intravenous substance use, Child and Family Services involvement, access to prenatal care and obtainment of adequate prenatal treatment. There were eight cases of confirmed/probable congenital syphilis in 2018, 22 cases in 2019 and 30 cases in 2020. Average birthing parent age was 26.5-27.0 years. The majority (66.7%) of birthing parents lived in inner city neighbourhoods with known infectious syphilis outbreaks. Over 50% of birthing parents did not receive any prenatal care, or the care received consisted of inadequate treatment or follow-up. Reinfection among birthing parents who did receive prenatal care was suspected in an additional 23.3% of cases. Congenital syphilis rates in Winnipeg have increased dramatically. Public health and healthcare provider efforts to address the needs of the community are vital for promoting access to safe and effective prenatal care.

Rising syphilis rates in Canada, 2011-2020.

Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020. Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011-2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed. The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15-39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016. Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.

Enabling culturally safe sexual health services in western Sydney: a protocol to improve STI treatment outcomes for Aboriginal young people

BackgroundAboriginal people face challenges on several fronts when it comes to the health and wellbeing of their community, compared to the rest of the Australian population. This is no different in urban areas such as Australia’s largest urban Aboriginal community located in Blacktown, NSW, where sexually transmitted infections (STIs) remain an issue of concern. Across Australia, rates of infectious syphilis, human immunodeficiency virus (HIV), and hepatitis C infection have increased by 400, 260, and 15% respectively while gonorrhoea decreased 12% in the 5-year period from 2013 to 2017. This study explores how to address the barriers that prevent young Aboriginal people under 30 years of age from accessing STI treatment through Government Sexual Health Services.MethodsThis qualitative study will use purposeful sampling to recruit 20 male and 20 female health consumers, 10 Aboriginal elders and 10 sexual health clinicians. This recruitment will be undertaken with the assistance of the local Government Health Services and local Aboriginal organisations. One-on-one semi-structured interviews will be undertaken by someone of the same gender in order to address cultural preferences. Data will be entered into NVivo and thematically analysed.DiscussionThis study will seek to add to the literature that explores why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia. The results of the qualitative research will be disseminated with the assistance of participating local Aboriginal organisations, and the findings will be published through peer-reviewed scientific journals and conference presentations.Trial registrationThe study is approved by the Western Sydney Local Health District Human Research Ethics Committee (HREC/16/WMEAD/449) and the New South Wales Aboriginal Health and Medical Research Council’s Human Research Ethics Committee (1220/16).

Neurosyphilis in a Non-HIV Patient: More than a Psychiatric Concern

Neurosyphilis is a form of tertiary syphilis infection caused by the spirochete bacterium Treponema pallidum. Patients suffering from this illness can present with neurological manifestations such as headaches, seizures, hearing loss, and ataxia. However, the typical presentation of neurosyphilis is the insidious onset of psychiatric symptoms including personality changes. A good history and clinical work-up is essential in the diagnostic process. There has been a recent increase in the incidence of infectious syphilis in Canada (1). However, in other parts of the world including China, infectious syphilis rates have remained high due to limited access to primary care and affordable treatments (2) Here, we present a case of neurosyphilis in a 40 year old Chinese male residing in China who presents with an 18 month history of personality changes as well as neurological and physical manifestations of the infection.

Changing face of the syphilis epidemic in men who have sex with men

There has been renewed interest in the clinical presentation of syphilis since the increasing rates of infectious syphilis in men who have sex with men (MSM) globally.1 Extragenital lesions of...

Infectious and congenital syphilis in Canada, 2010-2015.

Syphilis is the third most commonly reported notifiable sexually transmitted infection (STI) in Canada, following chlamydia and gonorrhea, respectively. Rates of this STI have been rising rapidly in Canada since 2001. To summarize trends observed in syphilis rates for 2010 to 2015 in Canada. Laboratory-confirmed cases of infectious syphilis and early congenital syphilis were reported to the Public Health Agency of Canada by all of the Canadian provinces and territories. National infectious syphilis rates were computed, as were rates per sex, age group and province/territory. Rates of congenital syphilis were also calculated. From 2010 to 2015, the rate of infectious syphilis in Canada increased by 85.6%, from 5.0 to 9.3 cases per 100,000 population. In 2015, a total of 3,321 cases of infectious syphilis were reported, mainly in males (93.7%), among whom the rate was 17.5 cases per 100,000 males versus 1.2 per 100,000 females. The rate also rose faster among males in 2010-2015, a 90.2% increase versus 27.8% among females. Individuals aged 20-39 years had the highest rates. Across the provinces and territories, the highest rates of infectious syphilis were in Nunavut, British Columbia and Manitoba.​: The rate of congenital syphilis decreased from 2010 to 2014 (1.6 to 0.3 cases per 100,000 live births) before increasing to 1.5 cases per 100,000 live births in 2015, which corresponds to six reported cases. Rates of syphilis continue to rise in Canada, especially among young men, and this is consistent with trends in the United States of America and European Union. Based on data from Canada and from these regions, the sexual behaviour of men who have sex with men (MSM) is thought to be a major risk factor for syphilis.

Infectious syphilis in women: what’s old is new again?

The aim of this study was to examine trends in infectious syphilis epidemiology among women in Winnipeg, Canada. A descriptive study of syphilis among Winnipeg residents between 2003 and 30 June 2015 was undertaken. Adjusted rate ratios (ARR) and 95% confidence intervals (95%CI) from Poisson regression analyses are reported. Characteristics of men and women were compared using logistic regression, with adjusted odds ratios (AOR) reported. Between 2014 and 2015, the rate of syphilis was 1.7/100,000, representing a five-fold increase since 2006-2013. All cases have been heterosexual, 90% 20-39 years of age, and 59% living in Winnipeg's inner core. Approximately 24% were pregnant at diagnosis; no cases of congenital syphilis have been reported. Compared to men, women were more likely to report alcohol use (AOR: 3.8, 95% CI: 1.2-11.9) and co-infection with chlamydia (AOR: 5.0, 95% CI: 1.1-22.9). In conclusion, the rates of infectious syphilis are increasing among women. Prenatal screening and education for inner-core women and the health care providers serving them should be prioritized.

P207 Syphilis: significant increase in men who have sex with men (msm) since november 2013

Background High rates of infectious syphilis have been reported in MSM. Locally 1:10 of the population are estimated MSM and high rates of HIV and sexually transmitted infections are seen. Methods We identified cases of infectious syphilis in MSM per month from February-2013 to June-2014 attending sexual health services. Age, ethnicity, HIV status and syphilis re-infection were noted. The total number of MSM seen in sexual health was used as a denominator for incidence calculations and rates were compared using Chi-square and Mann-Whitney test. Results 207 new cases of infectious syphilis were identified over the study period. The median age was 36 years (19–60), 96/207(46.4%) were HIV+ and 3/207(1.4%) had syphilis re-infection. The median incidence of syphilis from February to October 2013 was 8.6/1000 MSM; this increased significantly to 25.9/1000 MSM from November–June 2014 [chi-square 67.447 (p < 0.0001). There was no significant difference in the percentage co-infected with HIV between these time points (February-October = 57%, November-June = 46% [Mann-Whitney = 16.5, p = 0.0581). Conclusion We describe a significant increase in the incidence of infectious syphilis in MSM from November 2013. This rise is likely attributable to changes in sexual behaviour among MSM: increased accessibility to sex driven by social media, increased anonymous and group sex and growing use of party drugs. Locally we are working with the Terrence Higgins Trust and public health teams to increase awareness among MSM and primary care.

Infectious syphilis in Canada: 2003-2012.

In the 1990s, rates of reported cases of infectious syphilis were relatively low and were similar among males and females. In 2001, rates began to increase, particularly among males. To identify trends in reported cases of infectious syphilis in Canada from January 1, 2003 to December 31, 2012. Notifiable disease reports were submitted to the Public Health Agency of Canada by provincial and territorial epidemiological units and data were summarized by age and sex. Rates of reported cases of infectious syphilis increased by 101.0% between 2003 and 2012, from 2.9 to 5.8 per 100,000. Over this time frame, rates increased among males by 128.3% and decreased among females by 40.9%. In males, rates of infectious syphilis were highest among those aged 25 to 29; in females, rates were highest among those aged 20 to 24. In Canada, as in many countries, rates of reported infectious syphilis cases in males have markedly increased over the last 10 years.

Social network investigation of a syphilis outbreak in Ottawa, Ontario.

The incidence of syphilis in Ottawa, Ontario, has risen substantially since 2000 to six cases per 100,000 in 2003, again to nine cases per 100,000 in 2007, and recently rose to 11 cases per 100,000 in 2010. The number of cases reported in the first quarter of 2010 was more than double that in the first quarter of 2009. In May 2010, the Ontario Ministry of Health and Long Term Care requested the assistance of the Field Epidemiology Program to describe the increase in infectious syphilis rates and to identify social network sources and prevention messages. Syphilis surveillance data were routinely collected from January 1, 2009 to July 15, 2010, and social networks were constructed from an enhanced social network questionnaire. Univariate comparisons between the enhanced surveillance group and the remaining cases from 2009 on non-normally distributed data were conducted using Kruskal-Wallis tests and χ(2) tests. The outbreak cases were comprised of 89% men. Seventeen of the 19 most recent cases consented to answer the questionnaire, which revealed infrequent use of condoms, multiple sex partners and sex with a same-sex partner. Information regarding social venues where sex partners were met was plotted together with sexual partnerships, linking 18 cases and 40 contacts, representing 37% of the outbreak population and connecting many of the single individuals and dyads. Uncovering the places sex partners met was an effective proxy measure of high-risk activities shared with infected individuals and demonstrates the potential for focusing on interventions at one named bar and one Internet site to reach a high proportion of the population at risk.

Trends in Age Disparities Between Younger and Middle-Age Adults Among Reported Rates of Chlamydia, Gonorrhea, and Infectious Syphilis Infections in Canada: Findings From 1997 to 2007

The objective was to determine trends in age disparities between reported rates of chlamydia, gonorrhea, and infectious syphilis among younger versus middle-age Canadians. We examined age- and sex-specific reported rates of chlamydia, gonorrhea, and infectious syphilis between 1997 and 2007. Sexually transmitted infection (STI) rates in the younger age group (15-29 years) were compared to the middle-age group (40-59 years) over the 11-year period. We used Poisson regression to examine trends in age-specific (younger:middle-age) rate ratios. Between 1997 and 2007, both the number and rate of reported cases increased for all 3 nationally notifiable STIs. Although chlamydia and gonorrhea rates continued to be higher among younger adults, rates of all 3 STIs increased more dramatically among middle-age adults. Between 1997 and 2007, chlamydia rates increased by 86.8% among adults aged 15 to 29 (P <0.0001) and 165.9% among adults 40- to 59-years-old (P <0.0001). The corresponding increases for gonorrhea were 133.3% (P <0.0001) and 210.2% (P <0.0001) respectively. Infectious syphilis rates increased 5-fold among younger adults compared to an increase of 11-fold among middle-age adults (P <0.0001) since 1997. The reported rate ratios (younger:middle-age) decreased over time for chlamydia (P <0.0001), gonorrhea (P <0.0001), and syphilis (P = 0.005). Males were disproportionately represented among reported chlamydia, gonorrhea, and infectious syphilis cases, constituting 59.8%, 87.6%, and 93.0% of middle-age adult cases, respectively, in 2007. Middle-age adults may be increasingly affected by chlamydia, gonorrhea and infectious syphilis. There is a need for sexual health information targeting Canada's middle-age adults and their health care providers.

Partner notification for HIV and STD in the United States: low coverage for gonorrhea, chlamydial infection, and HIV.

Little is known about the scope of current public health partner-notification (PN) activities in the United States. The goal of the study was to define what PN services U.S. health departments provide in areas with high STD/HIV-related morbidity. The study involved a survey of STD program staff members in U.S. areas with the highest reported rates of infectious syphilis, gonorrhea, chlamydia, and HIV in 1998. Staff members of 60 (77%) of 78 health departments provided data. PN interviews were conducted with 7583 (89%) of 8492 cases of syphilis, 23,097 (17%) of 139,287 cases of gonorrhea, and 26,487 (12%) of 228,210 cases of chlamydia. In areas with mandatory HIV reporting, 4375 (52%) of 8328 persons infected with HIV were interviewed for PN. Except for patients with syphilis, public health PN services affect only a minority of persons with STD or HIV infection in high-morbidity areas of the United States.

A CAREFUL LOOK at VENEREAL DISEASE NURSING

A CHANGE CAME ABOUT in the public health nurse's responsilility for venereal disease control during the 1940's. The rate of venereal disease was high during and right after the war, the population was on the move, and other public health programs required the attention of the nurses. As a result, venereal disease investigators, lay persons trained in investigative and interviewing techniques, were hired. The VDI's, as they were sometimes called, were given some responsibilities in the identification and follow-up of contacts of known cases, responsibilities previously allocated to public health nurses. Their contribution to the control program is well recognized. Although the rates of infectious syphilis are lower than they were in the war years, there is again an upward trend in incidence. There are fewer investigators, and they are found chiefly in the metropolitan areas where the incidence of early infectious syphilis is greatest. In view of this, public health nurses must now take a careful look