Syphilis Control Research Articles

The introduction of syphilis point of care tests in resource limited settings

ABSTRACTIntroduction: Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks’ gestation.Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings.Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.

Prevalence and factors associated with syphilis in a Reference Center.

The implementation of the rapid test (RT) for syphilis increases access of vulnerable populations to early diagnosis and treatment, impacting the outcomes of infection. We aimed to assess the prevalence of and factors associated with syphilis in a Center for Testing and Counseling (CTC). We conducted a cross-sectional study at a Reference Center for sexually transmitted disease (STD) and acquired immune deficiency syndrome in Londrina, Northern Paraná State, Southern Brazil. Data regarding the 5,509 individuals who underwent RT from June 2012 to December 2014 were collected from patient records and the CTC Information System and served as the basis to check associations of syphilis cases (346) and cases without syphilis (5,163). Nine patients' records were not found. OpenEpi was used to perform a prevalence analysis and determine odds ratios to assess the associations between sociodemographic and behavioral variables (independent variables) and cases of syphilis (dependent variable). An alpha value <0.05 was considered statistically significant. The prevalence of syphilis was 6.3%; higher in males (7.5%) than in females (4.3%, p <0.001). Syphilis was associated with an age of 25-34 years, little education, and single marital status. The main associated behavioral factors were men who have sex with men, drug users, STD patients, and those presenting with an STD in the last year. The use of alcohol, marijuana, cocaine, and crack was significantly associated with syphilis. Strategies for prevention and control of syphilis should be intensified, especially in populations identified as most vulnerable.

Access of pregnant women to technologies for the prevention and control of congenital syphilis in Fortaleza-Ceará, Brazil

To evaluate access to technologies for prevention and control of Congenital Syphilis (CS) by pregnant women. Multi-case study that analyzed prenatal care to pregnant women with syphilis, which aimed at identifying the aspects that hinder their access to soft, soft-hard and hard health technologies that may contribute to the prevention of SC. The field research was done from April to September 2011 at four Health Units of two Regional Executive Divisions in Fortaleza City. Data was collected through observation and interviews with the health professionals and coordinators of the different units, the Statistic Medical Attendance Service professionals, health agents and pregnant women. Soft technologies include active search for pregnant women and home visits; light-hard technologies correspond to counseling, and hard technologies to the gathering of biological material for the serological diagnosis of syphilis and the treatment of pregnant woman and their sexual partners. The analysis consisted in contextualizing and interpreting the meanings of the answers obtained considering access as the main focus. Professionals have difficulty dealing with the subjective issues that involve sexually transmitted infections, and the units have problems in organizational aspects, continuity of care delivery and physical structure, which compromise the access of pregnant women to the technologies for prevention and control of CS. Pregnant women with syphilis do not have access to different technologies for prevention and control of CS, a situation that makes early diagnosis of syphilis unfeasible and possibly contributes to poor syphilis indicators in Fortaleza.

Risk factors for syphilis in women: case-control study.

ABSTRACTOBJECTIVE To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals.METHODS This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained.RESULTS The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors.CONCLUSIONS Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability.

Earlier Detection of Latent Syphilis: Every 3 Month Screening with MSM and HIV

BackgroundSince this data was last presented, there has been a continued resurgence of syphilis despite increasing screening efforts, especially neurosyphilis and ocular syphilis. High-risk populations include men who have sex with men (MSM) and those infected with HIV. In 2015, based on data from an older Australian study and a recent Canadian study, the screening recommendation changed from yearly to every 3–6 months. We determined that high-risk patients should be screened even more frequently, at least every 3 months, to identify patients earlier in the disease course and prevent the development of symptomatic syphilis.MethodsA retrospective chart review of the HIV Clinic Care Registry at the Jerry L. Pettis Memorial VA Medical Center (JLP VAMC) was conducted from 2002 to 2016. Patients were classified according the stage of syphilis, epidemiologic characteristics, and HIV control. In 2004, screening with RPR was changed from yearly to every 3 months.ResultsFrom 2002 to 2016, among HIV-infected men, there were 155 cases of syphilis diagnosed in 126 individuals. Of the subset before the intervention in 2004, 62.5% (5) were symptomatic at the time of diagnosis. After increasing the screening to every 3 months, only 41.6% (62) had symptomatic infection. The majority of subjects were MSM (81%) and Caucasian (71%). Sixty-nine percent of patients who developed infection had a history of prior infection. As many as 54.8% of patients had a viral load <50 copies/mL and 57.1% had CD4 counts of over 400. There were 27 cases of neurosyphilis, with 33% having ocular involvement. Among patients with neurosyphilis, 19% had an RPR in 3 months, and 31% had not had an RPR in 6 months. Primary and secondary syphilis incidence rates in San Bernardino compared with San Bernardino in 2015 were 8.4 and 389 per 100,000 respectively.ConclusionThis study showed a significant decrease in the amount of symptomatic syphilis with every 3-month screening compared with yearly screening. This is important for preventing progression to neurosyphilis, especially ocular involvement, given a large proportion of patients develop disease within 3–6 months. To prevent the morbidity associated with symptomatic and neurosyphilis, screening in high-risk populations of MSM, especially with HIV, should be increased to every 3 months.Disclosures All authors: No reported disclosures.

Spatiotemporal clusters of primary and secondary syphilis cases in south China: an observational study

BackgroundAlthough the overall rate of newly reported primary and secondary syphilis cases in Guangdong Province has been decreasing since 2011, incidence in some cities has increased. Location-based intervention is needed for effective resource allocation. We aimed to understand the geographical variations of syphilis epidemiology and detect possible outbreaks and epidemics at county level by spatiotemporal analyses. MethodsIn this observational study, we collected demographics, residential location, syphilis staging and diagnosis date of all reported primary and secondary syphilis cases in patients diagnosed and living in 21 cities, which were further subcategorised into 126 smaller counties, in Guangdong Province, China, from 2014 to mid-2015. Spatial distribution of rate of reported primary and secondary cases (in 1000 people) at county level (smaller than city level) were mapped and analysed. We did spatial cluster analyses (Anselin Local Moran's I and Getis-Ord Gi* [hotspot analysis] in ArcGIS) on an annual and monthly basis to detect clusters at county level. Spatiotemporal clusters were also detected by a discrete Poisson model in SaTScan at county level with a 2% population window and 20% temporal window. Institutional review board approval was obtained from the Guangdong Provincial Center for Skin Diseases and STI Control, China. Findings18 102 newly reported primary and secondary syphilis cases in patients living in Guangdong Province were analysed. At diagnosis, median age was 39 years (IQR 28–54), and 10 383 (57%) were male individuals. 16 of 126 counties were consistently identified in all methods to have a higher rate of reported cases than expected spatiotemporally, which lasted for 1–5 months. At city level, two cities contained more than half of the counties with clusters. They were also the cities that had rising trends in the incidence of syphilis between 2006 and 2014. Another three cities had a declining syphilis rate, but clusters were detected in one to two counties. InterpretationGeographical variation and occasional outbreaks even in places with relatively good epidemic control in cities were observed. Spatiotemporal cluster detection methods can be used to focus provincial syphilis control programmes. FundingNone. NSW was supported by Guangdong Provincial Center for Skin Diseases and STI Control and the South China-UNC STD Research Training Center grant (FIC1D43TW009532-01), SESH R01 (NIAID 1R01AI114310), and the Fogarty International Center.

Syphilis: Re-emergence of an old foe.

Syphilis is caused by infection with Treponema pallidum subsp. pallidum, a not-yet-cultivable spiral-shaped bacterium that is usually transmitted by sexual contact with an infected partner or by an infected pregnant woman to her fetus. There is no vaccine to prevent syphilis. Diagnosis and treatment of infected individuals and their contacts is key to syphilis control programs that also include sex education and promotion of condom use to prevent infection. Untreated syphilis can progress through four stages: primary (chancre, regional lymphadenopathy), secondary (disseminated skin eruptions, generalized lymphadenopathy), latent (decreased re-occurrence of secondary stage manifestations, absence of symptoms), and tertiary (gummas, cardiovascular syphilis and late neurological symptoms). The primary and secondary stages are the most infectious. WHO estimates that each year 11 million new cases of syphilis occur globally among adults aged 15-49 years. Syphilis has re-emerged in several regions including North America, Western Europe, China and Australia. Host-associated factors that drive the re-emergence and spread of syphilis include high-risk sexual activity, migration and travel, and economic and social changes that limit access to health care. Early, uncomplicated syphilis is curable with a single intramuscular injection of benzathine penicillin G (BPG), the first line drug for all stages of syphilis. Emergence of macrolide-resistant T. pallidum has essentially precluded the empirical use of azithromycin as a second-line drug for treatment of syphilis. Virulence attributes of T. pallidum are poorly understood. Genomic and proteomic studies have provided some new information concerning how this spirochete may evade host defense mechanisms to persist for long periods in the host.

Syphilis: An Old Disease With Present-Day Implications.

Syphilis continues to be a burden on the public health system. While men who have sex with men and HIV-infected individuals are the most affected populations, syphilis rates have also increased in reproductive-aged women, resulting in concurrent increases in congenital syphilis. Prompt diagnosis and treatment are requisite components of syphilis control.

Syphilis incidence among men who have sex with men in China: results from a meta-analysis.

The recent upsurge of syphilis infections among men who have sex with men (MSM) is one of the major challenges facing China. However, the overall burden is still not clear. This study aims to summarize the incidence of syphilis among MSM in China by using meta-analysis. We comprehensively searched PubMed-MEDLINE, China National Knowledge Infrastructure and Chinese Wanfang databases. Articles published between December 2009 and March 2015 that met the inclusion criteria were considerably involved in this meta-analysis. Two reviewers performed a quality assessment of the studies and extracted data for estimating the overall syphilis incidence. STATA 12.0 was used to summarize the overall incidence of syphilis. In all, 14 studies from 13 papers were included in this study. Follow-up duration of these studies ranged from six to 36 months, while drop-out rates ranged from 11.9% to 83.6%. The individual incidence rates of the included studies varied from 3.1/100 person-years (95% CI, 0.8–5.3/100 person-years) to 38.5/100 person-years (95% CI, 28.9–48.1/100 person-years), with a pooled incidence of 9.6/100 person-years (95% CI, 7.0–12.2/100 person-years). The subgroup meta-analysis revealed that incidence estimates were 38.5/100 person-years (95% CI, 28.9–48.1/100 person-years), 12.1/100 person-years (95% CI, 7.0–17.2/100 person-years), 11.2/100 person-years (95% CI, 0.7–23.1/100 person-years), 8.9/100 person-years (95% CI, 6.5–11.2/100 person-years), 5.7/100 person-years (95% CI, 3.4–8.0/100 person-years) and 3.1/100 person-years (95% CI, 0.8–5.3/100 person-years) in Northeast, North, Southwest, East, South and Northwest China, respectively. Syphilis incidence among Chinese MSM is high, and this may increase the spread of other sexually transmitted infections, including human immunodeficiency virus. It is essential to integrate syphilis control programs with HIV control programs. This can be achieved by establishing public health response systems to monitor and control the epidemic of syphilis and HIV together in China.

Mother-to-child transmission of syphilis

Mother-to-child transmission (MTCT)is a major route of transmission of syphilis, and may occur at any time during pregnancy. MTCT of syphilis can lead to many adverse pregnancy outcomes, seriously affects maternal and infant health, and has been a severe public health and social problem. The risk of MTCT of syphilis is associated with stage of syphilis in pregnancy, stage of pregnancy, receiving or not receiving treatment, and is especially high in patients with early syphilis. With the growth of incidence of syphilis, the prevention for MTCT of syphilis has been becoming more and more important. Screening for and early treatment of syphilis in pregnancy can effectively block MTCT of syphilis. To learn the epidemiology, route, risk, and associated factors of MTCT of syphilis will undoubtedly facilitate the development of strategies for syphilis prevention and control. Key words: Syphilis; MTCT; Route of transmission; Risk of transmission

A mathematical model of syphilis transmission in an MSM population

Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum, and is a sexually transmitted disease with multiple stages. A model of transmission of syphilis in an MSM population (there has recently been a resurgence of syphilis in such populations) that includes infection stages and treatment is formulated as a system of ordinary differential equations. The control reproduction number is calculated, and it is proved that if this threshold parameter is below one, syphilis dies out; otherwise, if it is greater than one, it is shown that there exists a unique endemic equilibrium and that for certain special cases, this equilibrium is globally asymptotically stable. Using data from the literature on MSM populations, numerical methods are used to determine the variation and robustness of the control reproduction number with respect to the model parameters, and to determine adequate treatment rates for syphilis eradication. By assuming a closed population and no return to susceptibility, an epidemic model is obtained. Final outbreak sizes are numerically determined for various parameter values, and its variation and robustness to parameter value changes is also investigated. Results quantify the importance of early treatment for syphilis control.

The Distribution of Syphilis Among Inpatients in Wenzhou, China: A Hospital Based Study.

BackgroundThe high prevalence of syphilis among inpatients is an important concern in clinical settings. Thus, a better understanding of the serological test would be valuable.ObjectivesWe analyzed the serological test results for syphilis among the inpatients in Wenzhou central hospital, China, to estimate the distribution of syphilis this Chinese population.Patients and MethodsThe blood samples of 81946 inpatients at the hospital from January 2010 to December 2012 were collected and retrospectively analyzed. Syphilis testing was conducted using a Treponema pallidum enzyme-linked immunosorbent assay (TP-ELISA) and a TP particle agglutination (TPPA) assay. A toluidine red unheated serum test (TRUST) was then used to determine the titer of TP antibody in the TP- ELISA-positive samples.ResultsIn total, 1618 of the 81946 inpatients showed positive syphilis serology; the positive rates in 2010, 2011, and 2012 were 2.27%, 1.58%, and 2.11%, respectively. Males had a significantly higher positive rate when compared to females. Surprisingly, the highest positive rate was observed among patients older than 80 years, followed by patients younger than 19 years, while patients aged 20 - 39 years had the lowest positive rate. The TRUST titer of most TP-positive cases was less than 1:8. Patients aged 20 - 39 years showed the highest percentage of TRUST titer values ≥ 1:8, while patients older than 80 years showed the lowest percentage; the differences between these two groups were statistically significant.ConclusionsThe serological characteristics of syphilis varied with gender and age. Syphilis screening and control should be conducted for young patients and pregnant women, but special attention should also be paid to elderly inpatients. The TRUST assay is better used in syphilis screening and for judgment of curative effects, but the diagnosis needs specific methods, such as the TP-ELISA and the TPPA test.

Resultados de sorologia para casos de sífilis em campanha de município no norte do Brasil

The World Health Organization estimates that approximately 12 million new cases of syphilis occur per year in the world. The aim of this study was to evaluate results in a campaign of active search of syphilis cases in the City of Belem, Para State, Brazil, entitled no controle da sifilis (Belem in syphilis control). This campaign was aimed at the population of reproductive age, above 15 years old. Twelve Municipal Health Centers were selected based on the target audience and positive cases of Belem Health Districts. From October 24, 2013 to October 30, 2013, samples for serology were collected and 630 tests were conducted by Rapid Check Syphilis. The results of the campaign showed that the positive serology for syphilis in the sampled population was 6%, corresponding to 40 cases with positive diagnosis. The most prevalent age group was 21-40 years old in females and 31-50 years old in males. The campaign demonstrated efficacy in syphilis diagnosis, improving the principles of health promotion and disease prevention that focus on maternal and fetal mortality. It is recommended that health services participate actively in the diagnostic campaigns offered by health networks, and continually make available the rapid testing to users and treatment for positive cases.

Early Syphilis Among Men Who Have Sex with Men in the US Pacific Northwest, 2008-2013: Clinical Management and Implications for Prevention.

Substantial increases in syphilis during 2008-2013 were reported in the US Pacific Northwest state of Oregon, especially among men who have sex with men (MSM). The authors aimed to characterize the ongoing epidemic and identify possible gaps in clinical management of early syphilis (primary, secondary, and latent syphilis ≤1 year) among MSM in Multnomah County, Oregon to inform public health efforts. Administrative databases were used to examine trends in case characteristics during 2008-2013. Medical records were abstracted for cases occurring in 2013 to assess diagnosis, treatment, and screening practices. Early syphilis among MSM increased from 21 cases in 2008 to 229 in 2013. The majority of cases occurred in HIV-infected patients (range: 55.6%-69.2%) diagnosed with secondary syphilis (range: 36.2%-52.4%). In 2013, 119 (51.9%) cases were diagnosed in public sector medical settings and 110 (48.0%) in private sector settings. Over 80% of HIV-infected patients with syphilis were in HIV care. Although treatment was adequate and timely among all providers, management differed by provider type. Among HIV-infected patients, a larger proportion diagnosed by public HIV providers than private providers were tested for syphilis at least once in the previous 12 months (89.6% vs. 40.0%; p < 0.001). The characteristics of MSM diagnosed with early syphilis in Multnomah County remained largely unchanged during 2008-2013. Syphilis control measures were well established, but early syphilis among MSM continued to increase. The results suggest a need to improve syphilis screening among private clinics, but few gaps in clinical management were identified.

Establishment of a rabbit model of diabetes mellitus in combination with syphilis and analysis of kidney damages

Objective To establish a rabbit model of diabetes mellitus in combination with syphilis for further monitoring the dynamic changes in rabbits' kidneys and investigating the possible pathogenic mechanism. Methods Twenty-four male rabbits were divided into four groups including diabetes group (group DM, n=8), syphilis group (group T, n=5), diabetes mellitus in combination with syphilis group (group H, n=8) and control group (group C, n=3). The rabbit models for groups DM, T and H were respectively established by injecting rabbits with alloxan, Treponema pallidum strains and alloxan in combination with Treponema pallidum strains. Kidney damages in each rabbit were dynamically monitored. Immunohistochemical staining was used to measure the expression of an inflammation related protein, thioredoxin-interacting protein (TXNIP), in kidney tissues of each rabbit. Results The rabbit models for three experimental groups were successfully established. Compared with the rabbits form groups T and DM, the rabbits from group H showed higher levels of blood urea nitrogen (BUN) and creatinine (Cr) since the eighth week after modeling. Compared with the rabbits form group C, those from the three experimental groups showed obvious kidney damages and the most severe damages in kidney tissues were observed in rabbits from group H. Results of the immunohistochemical staining showed that the expression of TXNIP in kidney tissues were enhanced in rabbits from the three experimental groups, especially in those from the group H. Conclusion Diabetes mellitus in combination with syphilis could induce more severe kidney damages in rabbits than those induced by diabetes or syphilis alone. The possible mechanism might relate to the hyper-expression of TXNIP in kidney tissues. Key words: Diabetes mellitus; Syphilis; Rabbit model; Kidney damage; Thioredoxin-interacting protein

Региональные аспекты эпидемиологии и клиники сифилиса у детей

The purpose of this study was clinical and epidemiological analysis of the incidence of syphilis in children and adolescents in the Ryazan region over a 12 year period. In a retrospective study the authors used the data from regional statistical reports, medical records of newborns, the data on infectious diseases of the Federal State Statistics Service. The analysis of the data for all age groups, including children and pregnant women was carried out. It was noted a substantial reduction in the number of reported cases of syphilis, including among adolescents and youth. The proportion of non-residents and rural residents in the total of patients with syphilis is increasing. In the pediatric population, the leading mode of transmission is vertical (53% of all cases). Among children born from pregnant patients with syphilis, there are 78% of the verified congenital syphilis, and only 5% the classical picture of the disease. It was established a substantial reduction of cases of congenital syphilis, the absence of cases of fetal death and postnatal mortality in recent years. However, the retention of latent forms and late detection of syphilis in pregnant women poses a threat of infection and determines the social significance of the problem. Effective control of congenital syphilis is ensured by the collaboration of obstetriciansgynecologists, dermatologists and neonatologists.

Adaptation of the HIV Care Continuum as a Method for Evaluating Syphilis and Gonorrhea Disease Control Activities in Los Angeles County.

Treatment verification and contact elicitation are core approaches used to control the spread of sexually transmitted diseases (STDs). Methodology adapted from the HIV care continuum is presented as an evaluation and communication tool for STD control activities. Sexually transmitted disease surveillance and program data for Los Angeles County in 2013 were used to construct a 2-part continuum to examine syphilis (all stages) and gonorrhea outcomes among index patients and elicited contacts. The Index Case Continuum (Part 1) assesses the proportion of patients who were treated, assigned for interview, interviewed, and provided name and locating information for at least 1 contact. The Elicited Contact Continuum (Part 2) assesses the proportion of contacts who were located, interviewed, and treated. Among 3668 patients with syphilis, 97% (n = 3556) were treated, 72% (n = 2633) were interviewed, and 25% (n = 920) provided name and locating information for at least 1 contact. The corresponding numbers for 12,541 gonorrhea cases were 95% (n = 11,936), 45% (n = 5633), and 16% (1944), respectively. Among the 1392 contacts elicited from syphilis cases, 53% (n = 735) were either interviewed or determined to not need an interview and 43% (n = 595) were treated. The corresponding numbers for the 2323 contacts elicited from gonorrhea cases were 53% (n = 1221) and 46% (n = 1075), respectively. Adaptation of the HIV continuum is a useful tool for evaluating treatment verification and contact elicitation activities. In Los Angeles County, this approach revealed significant drop-offs in the proportion of index cases naming contacts and in the proportion of contacts who are interviewed and treated.

PL02.3 Syphilis elimination in china

This presentation is mainly about the history, present situation and challenges of syphilis prevention and control in China. With the trend of syphilis prevalence in Guangdong province and the challenges, we discuss the important role and the impact of the control of syphilis in Guangdong province to the whole country, as well as a series of work of exploring the best practices for prevention and treatment of syphilis at the present stage, including improving syphilis surveillance system, diagnosis and treatment, developing the demonstration sites for syphilis control policies implementation, spurring innovation practices for expanding HIV/syphilis screen test among high risk groups.

Survey of prevalence of HIV infection, syphilis and HCV infection and related risk behaviors among club drug users in Zhejiang, 2011

To understand the prevalence of HIV infection, syphilis and hepatitis C infection and related risk behaviors among club drug users in Zhejiang province. The drug users were interviewed with questionnaires in 2011 to collect the information about their demographic characteristics, sexual behaviors, drug use behaviors and the utilization of intervention services. Blood samples were collected from them to detect HIV, syphilis and HCV antibodies. A total of 3 253 drug users were surveyed, in which 1 298 were club drug users, accounted for 39.9%. The proportion of club drug users was high in northern and central Zhejiang, in females, in age group≤25 years, in local residents and in those having commercial sexual behaviors during previous 12 months. Of the 1 298 club drug users, 91.2% were methamphetamine users, 0.1% were infected with HIV (95% CI: 0.0%-0.2%), 8.1% suffered from syphilis (95% CI: 6.6%-9.6%), 17.3% were infected with HCV (95% CI: 15.2%-19.4%). Among the interviewed club drug users, 12.7% were aware of AIDS, 9.2% had injecting drug use histories, 29.6% reported having commercial sex during the previous 12 months, only 33.4% received free condom and counsel, 14.0% received HIV test. Multivariate logistic regression analysis indicated that living in central and southern Zhejiang was associated with syphilis prevalence, HCV infection and injecting drug use behavior, being female was associated with syphilis prevalence. Injecting drug use and commercial sex during the previous 12 months were associated with HCV infection, and injecting drug use and commercial sex during the previous 12 months were associated with each other. Among the 1 285 club drug users, males, local residents in Zhejiang and those who never received free condom or counsel were more likely to have commercial sex. The prevalence of syphilis and HCV infection are high and unprotected sexual behaviors are common among the club drug users in Zhejiang, but less intervention services were received by them, suggesting that more attention should be paid to the prevention and control of HIV, HCV infections and syphilis in club drug users by taking effective intervention measures and increasing intervention coverage.

P09.31 Factors associated with syphilis seroreactivity among polydrug users in northeast brazil: a cross-sectional study usingrespondent driven sampling

Introduction The burden of sexually transmitted infections (STIs), such as syphilis, is greatest in median and low-income countries with serious consequences to sexual and reproductive health and increased risk to HIV infection. The prevalence of syphilis among drug users is higher than in the general population. Our aim is to report the rate of syphilis seroreactivity and associated factors among polydrug users (PDUs) in Northeast Brazil. Methods A cross-sectional study recruited 424 PDUs in Northeast Brazil through respondent driven sampling in 2009. Data was collected data using audio computer-assisted self-interview and rapid tests used for syphilis screening. Multivariable logistic regression was used to estimate factors associated with syphilis seroreactivity. Estimates were weighted by the inverse of the participant social network size. Results Mean age was 29.3 years (range: 18–62), 74.0% were males, and 89.8% were non-white. Syphilis seroreactivity was 16.6%. Being female (wOR: 2.14, 95% CI: 1.09–4.20), over 29 years old (wOR: 4.44, 95% CI: 2.41–8.19), exchange sex for money or drugs (wOR: 3.51, 95% CI: 1.84–6.71), “No/low” self-perceived risk of HIV infection (wOR: 5.13, 95% CI: 1.36–19.37), and having nine or less years of education (wOR: 2.92, 95% CI: 1.08–7.88) were associated with syphilis seroreactivity. Conclusion One of the most urgent needs for syphilis prevention and control is the availability of rapid point-of-care diagnostic tests and treatment, including the integration of STIs services into primary health-care and HIV-care/prevention settings. Gender issues, education in health, access to public services, social interventions focusing human rights, and social inequalities need more coverage for most at risk populations. Disclosure of interest statement This study was funded by the Brazilian Ministry of Health/Department of SDT/AIDS and viral hepatitis, with technical advisor from CDC Brazil. The first author is supported by a grant from the Brazilian National Research Council (CNPq) for his PhD studies.