Advertisement

Canadian Journal of Public Health

, Volume 99, Issue 5, pp 401–405 | Cite as

Epidemiology of Infectious Syphilis in Ottawa

Recurring Themes Revisited
  • Aviva Leber
  • Paul MacPherson
  • B. Craig Lee
Article

Abstract

Objectives

To describe the epidemiology of an outbreak of infectious syphilis in Ottawa.

Methods

A retrospective chart review of infectious syphilis cases in Ottawa from 2001–2006.

Results

Rates of syphilis have risen more than tenfold. The epidemic was centered in men, with the majority of cases (83.5%) occurring among men who have sex with men (MSM). These individuals differed from the general MSM population residing in Ottawa in their being older, more likely to be HIV positive, and more sexually promiscuous. Inconsistent condom use by MSM engaged in either oral or anal sex was pervasive. Thirty-seven percent of MSM reported sexual encounters with men from Montreal and Toronto. Visceral manifestations of syphilis, including neurosyphilis, were more common in persons co-infected with HIV. As a result, this subgroup was more likely to have received an extended antibiotic treatment regimen. There was a substantial delay between serological diagnosis and treatment. Less than half of treated cases returned for a six-month evaluation.

Conclusions

Multiple sexual partners, unprotected oral sex, and increased age among MSM were the predominant risk factors contributing to this syphilis epidemic. Co-infection with HIV modified the clinical presentation of syphilis, necessitating a more intensive diagnostic and therapeutic approach. The interconnection of urban sexual networks has likely contributed to the dynamics of local syphilis transmission and suggests that effective interventions will require a coordinated national approach.

Key words

Syphilis epidemiology HIV 

Résumé

Objectifs

Décrire l’épidémiologie d’une flambée de syphilis infectieuse à Ottawa.

Méthode

Examen d’un graphique rétrospectif des cas de syphilis infectieuse survenus à Ottawa de 2001 à 2006.

Résultats

Les taux de syphilis ont plus que décuplé. L’épidémie était concentrée dans la population masculine, la majorité des cas (83,5 %) s’étant produits chez des hommes ayant des relations sexuelles avec des hommes (HRSH). Ces sujets différaient de la population générale des HRSH vivant à Ottawa du fait de leur âge (ils étaient plus vieux), de leur probabilité accrue d’être séropositifs pour le VIH et de leur plus grande promiscuité sexuelle. L’irrégularité dans le port du condom par les HRSH pratiquant le sexe oral ou anal était omniprésente. Trente-sept p. cent des HRSH ont déclaré avoir eu des rapports sexuels avec des hommes de Montréal et de Toronto. Les manifestations viscérales de la syphilis, y compris la neurosyphilis, étaient plus courantes chez les sujets co-infectés par le VIH. Par conséquent, ce sous-groupe était plus susceptible d’avoir suivi une antibiothérapie prolongée. Nous avons observé un délai important entre le sérodiagnostic et le traitement. Moins de la moitié des cas traités se sont soumis à une nouvelle évaluation après six mois.

Conclusion

Les partenaires sexuels multiples, les rapports sexuels oraux non protégés et le vieillissement de la population des HRSH étaient les principaux facteurs de risque ayant contribué à l’épidémie de syphilis. La co-infection par le VIH a modifié le tableau clinique de la syphilis et nécessité une approche diagnostique et thérapeutique plus intensive. L’interconnexion des réseaux sexuels des villes a sans doute contribué à la dynamique de la transmission locale de la syphilis, ce qui donne à penser que des interventions efficaces exigent une approche coordonnée à l’échelle nationale.

Mots clés

syphilis épidémiologie VIH 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. The changing epidemiology of syphilis. Sex Transm Dis Suppl 2005;32(10):S4–S10.CrossRefGoogle Scholar
  2. 2.
    Nakashima AK, Allyn K, Rolfs R, Kilmarx P, Greenspan J. Epidemiology of syphilis in the United States, 1941–1993. Sex Transm Dis 1996;23(1):16–23.CrossRefGoogle Scholar
  3. 3.
    Grassly NC, Fraser C, Garnett GP. Host immunity and synchronized epidemics of syphilis across the United States. Nature 2005;433:417–21.CrossRefGoogle Scholar
  4. 4.
    Patrick DM, Rekart ML, Jolly A, Mak S, Tyndall M, Maginley J, et al. Heterosexual outbreak of infectious syphilis: Epidemiological and ethnographic analysis and implications for control. Sex Transm Infect 2002;78(Suppl 1):i164–i169.CrossRefGoogle Scholar
  5. 5.
    Jayaraman GC, Read RR, Singh AA. Characteristics of individuals with male to male and sexually acquired infectious syphilis during an outbreak in Calgary, Alberta, Canada. Sex Transm Dis 2003;30(4):315–19.CrossRefGoogle Scholar
  6. 6.
    Transmission of primary and secondary syphilis by oral sex-Chicago, Illinois, 1998–2002. MMWR 2004;3(41):966–68.Google Scholar
  7. 7.
    Paz-Bailey G, Meyers A, Blank S, Brown J, Rubin S, Braxton J, et al. A case-control study of syphilis among men who have sex with men in NYC-association with HIV infection. Sex Transm Dis 2004;31(10):581–87.CrossRefGoogle Scholar
  8. 8.
    Rietmeijer CA, Patnaik JL, Judson FN, Douglas J. Increases in gonorrhea and sexual risk behaviours among men who have sex with men: A 12-year analysis at the Denver Metro Health Clinic. Sex Transm Dis 2003;30(7):562–67.CrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. Increases in unsafe sex and rectal gonorrhea among men who have sex with men–San Francisco, California, 1994–1997. MMWR 1999;48(3):45–48.Google Scholar
  10. 10.
    Hansen L, Wong T, Perrin M. Gonorrhoea resurgence in Canada. Int J STD AIDS 2003;14(11):727–31.CrossRefGoogle Scholar
  11. 11.
    Dowell ME, Ross PG, Mushar DM, Rompalo A. Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus. Am J Med 1992;93:481–88.CrossRefGoogle Scholar
  12. 12.
    Gourevitch MN, Selwyn PA, Davenny K, Verley J, Rompalo A. Effects of HIV infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. Ann Intern Med 1994;121:94–100.CrossRefGoogle Scholar
  13. 13.
    Lukehart SA, Hook EW 3rd, Baker-Zander SA, Collier AC, Critchlow AC, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: Implications for diagnosis and treatment. Ann Intern Med 1988;109(11):855–62.CrossRefGoogle Scholar
  14. 14.
    Rolfs RT, Joesoef MR, Hendershot E, Rompalo A, Augenbraun M, Chiu M, et al. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. N Engl J Med 1997;337(5):307–14.CrossRefGoogle Scholar
  15. 15.
    Shalaby IA, Dunn JP, Semba RD, Jabs D. Syphilitic uveitis in human immunodeficiency virus-infected patients. Arch Ophthalmol 1997;115:469–73.CrossRefGoogle Scholar
  16. 16.
    Walter T, Lebouche B, Miailhes P, Cotte L, Roure C, Schlienger I, Trepo C. Symptomatic relapse of neurologic syphilis after benzathine penicillin G therapy for primary or secondary syphilis in HIV-infected patients. Clin Infect Dis 2006;43:787–90.CrossRefGoogle Scholar
  17. 17.
    Kasper D, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL. Harrison’s Principles of Internal Medicine, 16th Edition. New York, NY: McGraw Hill, 2005;978–80.Google Scholar
  18. 18.
    Romanowski B, Sutherland R, Fick GH, Mooney D, Love EJ. Serologic response to treatment of infectious syphilis. Ann Intern Med 1991;114(12):1005–9.CrossRefGoogle Scholar
  19. 19.
    Marra CM, Maxwell CL, Smith SL, Lukehart S, Rompalo A, Eaton M, et al. Cerebrospinal fluid abnormalities in patients with syphilis: Association with clinical and laboratory features. J Infect Dis 2004;189:369–76.CrossRefGoogle Scholar
  20. 20.
    Libois A, DeWit S, Poll B, Garcia F, Florence E, DelRio A, et al. HIV and syphilis: When to perform a lumbar puncture. Sex Transm Dis 2007;34(3):141–44.CrossRefGoogle Scholar
  21. 21.
    Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Rep 2006;55:1–94.Google Scholar
  22. 22.
    Edozien AO, Heffelfinger JD, Weinstock HS, Berman S, Clanton S. Congenital syphilis-United States, 2002. MMWR 2004;53:716.Google Scholar
  23. 23.
    Statistics Canada. 2006 Census of Canada. Ottawa, ON: Statistics Canada, 2006.Google Scholar
  24. 24.
    Primary and secondary syphilis-United States, 2003–2004. MMWR 2006;55:269–73.Google Scholar
  25. 25.
    Adam B, Husbands W, Murray J, Maxwell J. Renewing HIV prevention for gay and bisexual men: A research report on safe sex practices among high risk men and men in couples in Toronto. 2003.Google Scholar
  26. 26.
    Internet use and early syphilis infection among men who have sex with men-San Francisco, California, 1999–2003. MMWR 2003;54(50): 1229–32.Google Scholar
  27. 27.
    Douglas JM, Peterman TA, Fenton KA. Syphilis among men who have sex with men: Challenges to syphilis elimination in the United States. Sex Transm Dis Suppl 2005;32(10):S80–S83.CrossRefGoogle Scholar
  28. 28.
    Santé et Services Sociaux de Québec. Portrait des infections transmissibles sexuellement et par le sang (ITSS) au Québec Année 2005 (et Projections 2006). Québec: Gouvernment du Québec, 2006.Google Scholar
  29. 29.
    Niccolai LM, Stephens N, Jenkins H, Richardson W, Muth S, Rothenberg R. Early syphilis among men in Connecticut: Epidemiologic and spatial patterns. Sex Transm Dis 2007;34(3):183–87.CrossRefGoogle Scholar
  30. 30.
    Myers T, Allman D. Ontario Men’s Survey. Toronto, Ontario. HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto, 2004.Google Scholar
  31. 31.
    Peterman TA, Collins DE, Aral SO. Responding to the epidemic of syphilis among men who have sex with men: Introduction to the Special Issue. Sex Transm Dis Suppl 2005;32(10):S1–S3.CrossRefGoogle Scholar
  32. 32.
    Crepaz N, Hart T, Marks G. Highly active anti-retroviral therapy and sexual risk behaviour-a meta-analytic review. JAMA 2004;292(2):224–36.CrossRefGoogle Scholar
  33. 33.
    Stolte IG, Dukers NH, de Wit JB, Fennema JS, Coutinho RA. Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART. Sex Transm Infect 2001;77(3):184–86.CrossRefGoogle Scholar
  34. 34.
    Ghanem KG, Erbelding E, Weiner Z, Rompalo A. Serologic response to syphilis treatment in HIV infected and uninfected patients attending STD Clinics. Sex Transm Infect 2007;83(2):97–101.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  1. 1.Department of MedicineUniversity of OttawaOttawaCanada

Personalised recommendations