Dutch Doctors Uncover High Rates of Syphilis in HIV-Positive Men
April 21, 2009
Over the past decade, rates of syphilis have soared in Canada and other high-income countries. Syphilis outbreaks are common and ongoing among men who have sex with men (MSM). In the United States and possibly elsewhere, rates of syphilis among MSM are so high that some researchers refer to it as an epidemic within this community.
Syphilis is the name given to an infection caused by the germ T. pallidum. This disease can be spread in the following ways:
The germs that cause syphilis (called treponemes) can cause sores on the genitals, rectum and mouth. These sores can be an entry point for HIV and other sexually transmitted infections (STIs) to get inside the body. Once inside the body, treponemes can enter the lymphatic system or the bloodstream -- just like HIV. From there, in a matter of hours or a few days, treponemes can quickly spread throughout the body and reach the brain, heart and other vital organ-systems.
Initial symptoms of syphilis, particularly if sores or lesions are inside the genitals or rectum, may go unnoticed, so regular medical checkups and laboratory testing for syphilis and other germs are vital for sexually active people.
Researchers in the Netherlands have been conducting blood tests on more than 1,000 mostly HIV positive MSM, screening them for syphilis. They have found that a substantial proportion had symptom-free syphilis, detected only with blood tests. Based on their results, researchers are calling for more frequent syphilis testing in HIV positive MSM.
Researchers at the Academic Medical Centre at the University of Amsterdam took some steps to try to understand the trends in syphilis:
In their clinic, which had more than 1,000 HIV positive MSM patients, researchers found the following trends:
These findings suggest a massive increase in syphilis cases over the 10 years of the study. Although the researchers are not ready to release data from syphilis testing in more recent years, they did mention that presently blood tests continue to show very high rates of syphilis. What's more, about 31% of syphilis cases were detected only with blood tests because patients did not have symptoms.
The Dutch doctors pinpoint the following circumstances to help explain the surge in syphilis rates:
Not Just in the Netherlands
Researchers at the UCLA Medical Centre in Los Angeles have also found high rates of symptom-free STIs among MSM, a finding that suggests this problem may be occurring in sexual networks worldwide.
What to Do?
Commenting on the Dutch findings, Dr. Jeffery Klausner, the director of STD Prevention and Control at the San Francisco Department of Public Health, issued the following guidance in the February 2009 issue of the journal Sexually Transmitted Diseases:
"I recommend that clinicians obtain a syphilis screening test in HIV-infected patients with every CD4+ T cell count or plasma HIV viral load. In clinical practice, these measures are often done every three or four months."
This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.