You are here

Article Text

Article menu

Download PDFPDF

Letter
Syphilis outbreak in Milan, Italy
Free
  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; m.cusinipoliclinico.mi.it

http://dx.doi.org/10.1136/sti.2003.007526

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    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
    Figure 1

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

    References

    1. ↵
      Pinkerton S, Layde PM. Using sexually transmitted disease incidence as a surrogate marker for HIV incidence in prevention trials: a modelling study. Sex Transm Dis2002;29:298–307.
      OpenUrlCrossRefPubMedWeb of Science
    2. ↵
      Nicoll A, Hamers FF. Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? BMJ2002;324:1324–7.
      OpenUrlFREE Full Text
    3. ↵
      St Louis ME, Wasserheit JN. Elimination of syphilis in the United States. Science1998;281:353–4.
      OpenUrlAbstract/FREE Full Text
    4. ↵
      Weir E, Fishman D. Syphilis: have we dropped the ball? CMAJ2002;167:1267–8.
      OpenUrlFREE Full Text
    5. ↵
      Halsos AM, Edgardh K. An outbreak of syphilis in Oslo. Int J STD AIDS2002;13:370–2.
      OpenUrlAbstract/FREE Full Text
    6. ↵
      Blocker ME, Levine WC, St Louis ME. HIV prevalence in patients with syphilis, United States. Sex Transm Dis2000;27:53–9.
      OpenUrlCrossRefPubMedWeb of Science