HIV-positive gay/bisexual men are more likely to be diagnosed with secondary syphilis than HIV-negative gay/bisexual men, according to the latest data reported at the Health Protection Agency’s First Scientific Conference.
Syphilis has several stages. In the primary stage, painless sores, called chancres, appear about 2-3 weeks after initial exposure, and can often be missed, especially in the throat or rectum. Secondary syphilis usually occurs between 2 to 8 weeks after the appearance of the original chancre. Since the diagnosis of secondary syphilis is based on blood tests, increased syphilis serology screening at HIV clinics may account for this discrepancy.
However, secondary syphilis is the most contagious stage of the once-rare sexually transmitted disease and is characterised by the spread of Treponema pallidum - the bacteria which causes syphilis - throughout the body. Since it is possible that HIV speeds up the course of syphilis, it can also can be harder to treat in people infected with HIV, and may also result in a more aggressive and unusual disease process, with an increased risk of brain involvement, and unusual symptoms that include skin and mouth ulcers and fever.
The conference report also found that HIV/syphilis co-infected men were more likely to be older (i.e. over 34 years old) and to have used the internet to meet their partners than their HIV-negative counterparts.
Last year saw a 68% increase in syphilis diagnoses made in gay/bisexual men in England, Wales and Northern Ireland. The biggest outbreak of syphilis is occurring in London, where 980 people were diagnosed between April 2001 and May 2003, of which 684 were gay/bisexual men: 59% of these cases occurred in people already infected with HIV. Manchester and Brighton have also seen outbreaks affecting a substantial number of gay/bisexual HIV-positive men.
Although unprotected anal intercourse was responsible for the majority of the 607 syphilis infections in gay/bisexual men seen in the London outbreak, unprotected oral sex (sucking) was implicated in 35% of syphilis acquisition. In an associated finding, oral sex was also implicated in 17% of gonorrhoea in gay/bisexual men in 2002.
Heterosexual transmission of syphilis is also rising. In South London, 73 new cases of syphilis have been reported between July 2002 and May 2003, most due to unprotected oral or vaginal sex with casual partners or strangers, although a substantial minority of people involved were known to be linked to the sex industry.
The Health Protection Agency warns that the syphilis epidemic is far from over. Last year, 1193 diagnoses of syphilis were made in England, Wales and Northern Ireland: the highest number seen since 1984, before the time of widespread awareness of HIV/AIDS in the UK.
Further information on this website
HIV-positive patients should be tested for syphilis every three months says UK study
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Fisting, drug use, syphilis; risk factors for hepatitis C transmission in HIV-positive gay men
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UK syphilis rise: majority of cases in gay men, over half of whom are HIV-positive - news story
Simms I et al. The London syphilis outbreak: a tale of two epidemics p 112 Programme and Abstracts of 1st HPA Annual Scientific Conference, 2003.
Evans B. Oral sex> a pleasure, a threat - both/and or either/or p 132 Programme and Abstracts of 1st HPA Annual Scientific Conference, 2003.
CDR Weekly Provisional national data released for 2002 on sexually transmitted infection July 3, 2003