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Epidemiology
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Incidence of syphilis among HIV-infected men in Singapore, 2006–2017: temporal trends and associated risk factors
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  • Published on: 27 July 2020
    Opportunities for behavioral intervention post-treatment for syphilis
    • Venkateshwaran Sivaraj, Registrar in Genitourinary Medicine Guy's and St Thomas' NHS Foundation Trust
    • Other Contributors:
      • Olubanke Davies, Consultant in Genitourinary Medicine

    Ang et al [1] discussed rising syphilis incidence among HIV positive men in Singapore. The diagnostic test used for syphilis in this study (RPR) is a non-specific treponemal antibody test. This limitation should be acknowledged while interpreting results. However, it is of good epidemiological value for public health programs for behavioural intervention. An important opportunity for sexual health promotion that can be missed if overlooked is post-treatment follow up for RPR titre monitoring. BASHH guidelines recommend follow up RPR titre post treatment until sero-fast or sustained 4 fold decrease in titre (at 3, 6 and 12 months).
    An audit at our central London clinic showed that 31% of men had a bacterial STI when followed up for RPR monitoring post-treatment for syphilis [2]. Of 32 men (mean age 37 years; range 21- 75 years; 31 MSM), 11 were HIV positive. Six patients attended follow up visits at 3,6, and 12 months post treatment , 9 attended two follow up visits , 6 attended one follow up visit. Ten (31%) had a bacterial STI diagnosis (6 Chlamydia, 6 Gonorrhea, 1 LGV) during follow up. This highlighted the importance of STI screening and sexual health promotion for the MSM cohort during follow up for RPR monitoring in our clinic. Opportunistic screening for STI should be conducted across the globe where resources permit.

    Reference:
    [1] Ang LW, Wong C, Ng O et al. Incidence of syphilis among HIV-infected
    men in Singapore, 2006–2017: temporal tren...

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    Conflict of Interest:
    None declared.