Offer syphilis testing to at-risk groups
A rise in the incidence of syphilis among men who have sex with men was noted in Walsall in 2002. Further case finding was instigated to help limit the spread of the infection. Outreach work was commenced in social venues targeting men who have sex with men and women sex workers.
Screening for syphilis was started in public houses and saunas frequented by men who have sex with men. A self-reported survey tool was used to explore sexual risk taking behaviour among men who have sex with men at the beginning of the outreach activity.
Of the 163 men who completed the questionnaires, 76% identified themselves as gay and 87% described their ethnic origin as white. Almost half (46%) reported knowing they were HIV negative and seven (4%) reported they were HIV positive. Of those who were unsure, 37% assumed they were negative. Fifty-three per cent assumed that the last man they had sex with was HIV negative, while 42% did not think about it and 4% believed him to be positive.
Over the 12 months of outreach work, 51 cases of early syphilis were recorded, of whom four were referred from the outreach activity. Of the 51 syphilis cases, 11 were women, of whom two were detected at antenatal screening. Of the 40 men, 28 had acquired the infection heterosexually, and 12 through homosexual contact.
Although there was a decline in the incidence of syphilis in men who have sex with men after outreach screening, the incidence in heterosexuals increased. There was no apparent link between syphilis cases in heterosexual patients and men who have sex with men.
This study highlights the growing problem of syphilis infection among a relatively stable population in a small town and demonstrates high levels of sexual risk taking in men who have sex with men.
Syphilis infection facilitates HIV infection, so it is always worth checking HIV status in anyone diagnosed with syphilis, especially covering the ‘window period' of three months.
This study is also a timely reminder that syphilis has become more common over the past decade, with outbreaks in London, Brighton, Manchester and Bristol. Some of these outbreaks were not exclusive to men who have sex with men.
GUM and antenatal clinic attendees are already screened for syphilis routinely. We must not forget to offer syphilis testing to people who feel they have been at risk of contracting HIV or another STI, in particular men who have sex with men.
Arumainayagam J, Pallan MJ, Buckley E et al. Syphilis outbreak in Walsall, UK: lessons for control and prevention Int J STD AIDS 2007;18:55-7Reviewer
Dr Richard Ma
GP principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London