SYPHILIS

Lessons from the syphilis outbreak in homosexual men in east London

M Hourihan, H Wheeler, R Houghton and B T Goh

Ambrose King Centre, Barts and the London NHS Trust, Whitechapel, London E1 1BB, UK

Correspondence to:
Correspondence to:
M Hourihan
Ambrose King Centre, Barts and the London NHS Trust, Whitechapel, London E1 1BB, UK; martin.hourihan{at}bartsandthelondon.nhs.uk

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.

Abbreviations: 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

Keywords: syphilis; homosexual men; HIV; oral sex

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• LaFond, R. E., Lukehart, S. A. (2006). Biological Basis for Syphilis. Clin. Microbiol. Rev. 19: 29-49 [Abstract] [Full Text]