Syphilis and MSM (Men Who Have Sex With Men)
Services for intermediate-probable core group members: For those in the subcategory, program staff should periodically remind those individuals about the importance of frequent syphilis and other STI screening, the location and availability of service providers, the signs and symptoms of syphilis and its complications, and conduct risk assessments. Because many of our recommendations and suggestions have not been tested or evaluated, there will be a need for a variety of pilot studies and detailed examination of program operations Table 3.
Case management for high-probable core group members will require a collaborative process to define the specifics and scope of the services and a step-by-step evaluation to address acceptability and impact on syphilis transmission. Lastly, implementation science research on how to best deliver preexposure or postexposure chemoprophylaxis with doxycycline to maximize impact and minimize adverse effects is urgently needed. The underlying principle supporting the proposed programmatic shift to focus on clinical and occult primary syphilis and the risk of transmission is the acceptance that preventing transmission is a high priority objective of syphilis control.
If so, all operational intervention and service delivery activities should be evaluated relative to that objective. Many activities are effective at preventing syphilis transmission whereas some may have minimal or no impact, but are important to carry out to improve personal health, reduce the individual complications of syphilis, and for other reasons.
Developing a methodology to classify the transmission impact of different interventions at a very detailed level within the broader groups ie, surveillance, case interviews, partner services, counseling, and health education and subsequent monitoring standards are needed to prioritize intervention activities. A challenge for STD program directors wanting to focus more efforts on primary syphilis will be to implement procedures to evaluate low-titer reactive serologies among MSM to identify those with high-probable asymptomatic occult primary syphilis.
Among high-probable occult primary syphilis, the lowest titer seroconversions are most important because they usually occur in the first 7 to 10 days of the primary stage when timely interventions can have the most impact on the duration of syphilis infectiousness D.
Syphilis Now Primarily a Disease of Gay Men | Medpage Today
To help accomplish that, we recommend redirecting resources to evaluate all reported reactive serologic tests and developing databases capturing prior nonreactive test results. Patients tested in STD clinics and in HIV care clinics should have past test results routinely available to disease investigators. Another challenge will be to obtain more information about why so many persons with syphilis are not being diagnosed in the primary stage, and to develop strategies to increase detection of those cases.
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In the current epidemic among MSM, implementing intensive screening programs is an important tool for identifying more MSM with early latent infection, many of whom may have occult primary infections in need of prompt treatment. For all persons at risk of acquiring syphilis, effective patient and clinician health education about the signs and symptoms of clinical primary syphilis and the subtle signs and symptoms of occult primary syphilis are needed to facilitate prompt diagnosis and treatment.
A similar approach was promoted among HIV prevention programs and HIV care providers when it became apparent that acute HIV infection, whether symptomatic or not, was highly infectious, playing a major role in transmission, and often missed by routine antibody testing. Both the individual and community benefit from the detection and immediate treatment of acute HIV infection. We encourage STD programs and community advocates to follow that example and redirect efforts and resources to detect and control acute highly infectious primary syphilis.
However, lowering communitywide syphilis incidence would in turn impact both of those serious preventable outcomes. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.
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Conflict of Interest and source of funds: None declared. Received for publication February 14, , and accepted June 18, Back to Top Article Outline. Figure 1. TABLE 1.
TABLE 2. Figure 2. TABLE 3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance Atlanta: U.
Men who have sex with men and syphilis
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Syphilis Now Primarily a Disease of Gay Men
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Early detection makes all the difference
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