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Syphilis outbreak in Milan, Italy
  1. M Cusini1,
  2. M Ghislanzoni1,
  3. C Bernardi1,
  4. G Carminati1,
  5. R Zerboni1,
  6. E Alessi1,
  7. B Suligoi2
  1. 1Centro MTS, Istituto di Scienze Dermatologiche, IRCCS Ospedale Maggiore, Milano, Italy
  2. 2Istituto Superiore di Sanità, Roma, Italy
  1. Correspondence to:
 Dr Marco Cusini
 Centro MTS, Istituto di Scienze Dermatologiche, Via Pace 9, 20122 Milano, Italy;

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Infectious syphilis has been considered a sensitive marker of risky sexual behaviour.1 Following a decline of syphilis in Western Europe,2,3 there has been a resurgence of infectious syphilis in many countries, with a number of outbreaks in men who have sex with men (MSM).4,5

The STD centre of milan is the biggest in northern Italy with an average of about 6000 patients per year. All patients are offered screening tests for syphilis using treponemal particle agglutination test (TPPA) and rapid plasma reagin (RPR).

The number of cases of early syphilis (primary, secondary, and early latent asymptomatic with probable infection <12 months previously) has increased from 46 to 211 between 2000 and 2002. Over the same time the number of cases of late syphilis (asymptomatic with probable infection >12 months previously) have remained stable. Most cases of early syphilis in 2001 and 2002 (261/306, 85%) were in MSM. Fig 1 shows the trends.

As in other reports of recent syphilis outbreaks in MSM, a proportion of cases (25.8%) are in men with HIV.6 Of the 74 HIV positive men with early syphilis, 39 (53%) already knew their HIV status. This is an indication that our health promotion messages are not effective with this group at least.

The fear of AIDS has declined in Italy: public campaigns are soft, HAART therapy has changed the appreciation of HIV infection in infected patients, and HIV is no longer considered a fatal condition.

Figure 1

Trend of early syphilis per sexual behaviour 1999, 2000, 2001, and 2002.