UK syphilis rise: majority of cases in gay men, over half of whom are HIV-positive

Following two decades of stable decline in the United Kingdom, diagnoses of infectious (primary or secondary) syphilis began to increase in 1998, largely driven by a cluster of localised outbreaks across England. In London, diagnoses of infectious syphilis rose from 54 in 1998 to 336 in 2001, largely due to rapid and substantial increases in diagnoses among gay men. These increases have continued unabated. Data collected from genitourinary medicine (GUM) clinics (KC60 dataset) indicate that between 2000 and 2001 diagnoses of infectious syphilis rose by 118%, and a rise of 187% was seen in men who have sex with men. In 2001, 715 new diagnoses of primary and secondary infectious syphilis (613 male, 102 female) were made in GUM clinics. Of the 613 cases seen in males, 57% (352) were seen in men who have sex with men

As the KC60 return provides limited epidemiological data to inform targeted prevention and outbreak control measures, enhanced surveillance programmes for infectious syphilis have been established across outbreak sites in England. The London programme was established back in April 2001 and subsequently extended to the rest of England in June 2002, in partnership with enhanced syphilis surveillance programmes in other outbreak sites.

By December 2002, 770 diagnoses of infectious syphilis had been reported (690 males, 80 females) since the introduction of the London surveillance programme, 81% of whom were men who have sex with men. Over 50% of syphilis cases reported among men who have sex with men in London were among individuals co-infected with HIV.

The public health laboratory service (PHLS)suggests this reflects the concentration of this disease within subgroups with high rates of partner change, the sustained increases in unsafe sex amongst men who have sex with men in London, overlapping transmission networks, and epidemiological synergy between these two diseases.

PHLS advocates that targeted prevention efforts aimed at improving the education, screening, and treatment of HIV-positive men who have sex with men for infectious syphilis continue to form the core of prevention activities in outbreak sites across England.

The re-emergence of syphilis in the UK was first reported extensively in AIDS Treatment Update back in July 2001. You can read the original article here.

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