SYPHILIS

Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding

N L Lambert¹, M Fisher¹, J Imrie², R Watson³, C H Mercer², J V Parry⁴, A Phillips¹, A Iversen⁵, N Perry¹ and G L Dean¹

¹ HIV/GUM Research Department, Residence Block, Brighton General Hospital, Elm Grove, Brighton BN2 3EW, UK
² Centre for Sexual Health and HIV Research, Royal Free and University College Medical School, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK
³ Terrence Higgins Trust South, 61 Ship Street, Brighton BN1 1AE, UK
⁴ Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
⁵ Surrey and Sussex Health Protection Unit, Health Protection Agency, 36–38 Friars Walk, Lewes BN7 2PB, UK

Correspondence to:
Correspondence to:
Dr Gillian Dean
Lawson Unit, Outpatient Building, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK; Gillian.Dean{at}bsuh.nhs.uk

Objectives: To investigate the feasibility and acceptability of implementing community based syphilis screening using different sample collection techniques, and its effectiveness in screening at-risk populations and identifying new syphilis cases.

Methods: Two phases of syphilis screening were conducted in venues frequented by men who have sex with men (MSM). Phase 1 used venepuncture and phase 2 a validated saliva test. Evaluation used quantitative data from testers, venues and the local genitourinary medicine (GUM) clinic, and qualitative data from venue and programme staff.

Results: 1090 MSM were tested over 7 weeks. 62% of testers had not attended a GUM clinic in the past year. 64% of testers reported 2 sexual contacts in the past 90 days and 11% reported 10. Similar diagnosis rates were recorded for phase 1 (1.4%) and phase 2 (1.8%). There was greater uptake of testing with the saliva test in saunas during phase 2.

Conclusions: Syphilis screening in gay venues is feasible and acceptable to at-risk MSM, and reaches a group not routinely accessing GUM services. The low case detection for syphilis suggest this approach, while unlikely to contain outbreaks, may be more useful if combined with screening for other sexually transmitted infections and effective health promotion strategies.

Abbreviations: CBO, community based organisation; GUM, genitourinary medicine; MSM, men who have sex with men; PCT, primary care trust; STI, sexually transmitted infections

Keywords: syphilis; screening; homosexual men; MSM

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