Introduction From 2010 to 2015, the incidence of infectious syphilis (primary, secondary, and early-latent) has increased 5-fold in British Columbia (BC). In response, the BC Centre for Disease Control (BCCDC) enhanced surveillance for syphilis to characterise sexual/social networks driving the epidemic, and to monitor the risk of HIV transmission. Here we communicate indicators developed from the provincial enhanced surveillance system.
Methods In BC, management of syphilis – including partner notification – is centralised, and coordinated by the BCCDC. In January 2016, a new workflow was implemented to systematically collect and analyse data on HIV co-infection, viral-load and partners. New indicators were developed along a cascade-of-care framework for case and partner care.
Results From January to September 2016, 581 syphilis cases were diagnosed in BC; 491 (84%) were among men who have sex with men (MSM). Of these, 201 (41%) were HIV-positive and 268 (55%) were HIV-negative. Three-quarters of HIV-positive MSM had undetectable viral loads. 149 (74%) of HIV-positive MSM and 137 (51%) of HIV-negative MSM were diagnosed during the early-latent stage. For both groups, 96% of cases were treated within 30 days of syphilis testing. Of the 201 HIV-positive MSM, 141 (70%) discussed partners with public health nurses and together reported 1270 partners (65% anonymous, 35% notifiable) or 9.0 partners/case (range:0–214). Of the 268 HIV-negative MSM, 215 (80%) discussed partners and reported 1806 partners (51% anonymous, 49% notifiable), or 8.4 partners/case (range:1–200).
Conclusion A greater proportion of HIV-positive MSM were diagnosed with syphilis during the asymptomatic early-latent stage, which may be due to routine syphilis screening. However, a lower proportion of HIV-positive MSM with syphilis co-infection were engaged with public health for partner notification, and report a lower proportion of notifiable partners, compared to MSM with syphilis only. Strategies to engage HIV-positive MSM in partner care would strengthen the public health response to syphilis.