Lessons from the syphilis outbreak in homosexual men in east London. Issue 6 (30th November 2004)

• Record Type: Journal Article
• Authors: Hourihan, M; Wheeler, H; Houghton, R; Goh, B T
• Is Part Of: Sexually transmitted infections. Volume 80:Issue 6(2004)
• Page Start: 509
• Page End: 511
• Publication Date: 2004-11-30
• Subjects: DGM, dark ground microscopy -- GUD, genital ulcerative disease -- HPA, Health Protection Agency, PS, primary syphilis -- pVL, plasma HIV-RNA viral load -- SS, secondary syphilis -- STI, sexually transmitted infections -- UPAI, unprotected anal intercourse -- UPOI, unprotected oral intercourse; syphilis -- homosexual men -- HIV -- oral sex; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sti.2004.011023
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Objectives: To describe the epidemiology, presentation, and diagnosis of early syphilis in 103 homosexual men in east London. Methods: A retrospective study using data from KC60 returns, the Health Protection Agency (HPA) enhanced surveillance forms and case notes. Results: 40 cases of primary (PS), 40 of secondary (SS) and 23 of early latent syphilis were identified, 33% co-infected with HIV. 41% had concurrent sexually transmitted infections (STIs). Pain featured in 35% of PS and itch in 13% of rashes. Dark ground microscopy (DGM), performed in 44 of the symptomatic cases, was positive in 37 (84%) allowing early management. Initial syphilis serology was negative in 15/40 (37%) cases of PS. 51% and 49% opted for parenteral and oral treatment, respectively. In 53/103 (51%) cases oral sex was the only risk factor. 86% of infections were UK acquired. Only 4% of contacts were seen. Conclusion: This outbreak, reflecting the resurgence of syphilis across the United Kingdom, highlights several important points. Painful chancres and itchy rash are common presentations. DGM is a highly sensitive diagnostic tool. Initial negative serological screening tests are common in PS and sero-surveillance for 3 months is recommended. The high prevalence of concomitant STIs indicates ongoing unprotected sexual intercourse. Oral sex is a significant risk factor and is a distinctly "unsafe" practice. Conventional partner notification is ineffective. Other methods of screening of the at-risk homosexual population are warranted. Continued education is required to reduce STI acquisition in homosexual men.