Enhanced surveillance of infectious syphilis in New Zealand sexual health clinics

Abstract

Following a rise in cases of infectious syphilis in New Zealand, national enhanced surveillance at sexual health clinics was initiated. All public sexual health clinics reported monthly on the number of cases seen, and completed a coded questionnaire on each case. Monthly reports to routine surveillance were compared and discrepancies reconciled. During 2011, 72 cases of infectious syphilis were reported. The majority (83%) were among men who have sex with men who were mainly infected in New Zealand and had an ethnic profile similar to all New Zealanders. Most heterosexual infections occurred overseas, among people of non-European non-Maori ethnicity. About half the cases had symptoms on presentation. Overall, 18% of men who have sex with men were HIV positive. Resurgent syphilis in New Zealand disproportionally affects men who have sex with men, amongst whom HIV is prevalent. Men who have sex with men should be aware of the risks and symptoms of syphilis and encouraged to have regular sexual health checks including serology testing. Control of syphilis should be included in the strategy to check HIV spread. Syphilis serology should continue to be part of routine immigration and antenatal screening, and where clinically indicated. Enhanced surveillance was easily initiated for an uncommon condition seen at sexual health clinics, and provided valuable information.

Keywords

bacterial disease epidemiology surveillance New Zealand men who have sex with men

Get full access to this article

View all access options for this article.

References

Singh

Romanowski

. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev 1999; 12: 187–209.

Golden

Marra

Holmes

. Update on syphilis. JAMA 2003; 290: 1510–1514.

Fenton

Lowndes

. Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex Transm Infect 2004; 80: 255–263.

Axelsen

Smith

Koch-Hansen

. Syphilis cases increasing in Denmark, 2000-01. Euro Surveil 2002; 6: 29–29.

Van de Laar

van Veen

Götz

. Continued transmission of syphilis in Rotterdam, the Netherlands. Euro Surveill 2003; 7: 25–25.

Marcus

Bremer

Hamouda

. Syphilis surveillance and trends of the syphilis. Euro Surveill 2004; 9: 11–14.

Simms

Fenton

Ashton

. The re-emergence of syphilis in the United Kingdom: the new epidemic phases. Sex Transm Dis 2005; 32: 220–220.

Pritchard

Hoile

. Paris syphilis screening campaign extended to selected French towns and cities. Euro Surveill 2002; 6: 48–48.

Fenton

Breban

Vardavas

. Infectious syphilis in high-income settings in the 21st century. Lancet Infect Dis 2008; 8: 244–253.

10.

Fenton

Imrie

. Increasing rates of sexually transmitted diseases in homosexual men in Western Europe and the United States: why? Infect Dis Clin North Am 2005; 19: 311–311.

11.

Botham

Ressler

Bourne

. Epidemic infectious syphilis in inner Sydney-strengthening enhanced surveillance. Aust N Z J Public Health 2006; 30: 529–533.

12.

Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease among men who have sex with men: King County, Washington, 1997–1999. MWR Morb Mortal Wkly Rep 1999; 48: 773–777.

13.

Righarts

Simms

Wallace

. Syphilis surveillance and epidemiology in the United Kingdom. Euro Surveil 2004; 9: 21–25.

14.

Hopkins

Lyons

Coleman

. Resurgence in infectious syphilis in Ireland: an epidemiological study. Sex Transm Dis 2004; 31: 317–317.

15.

The Institute of Environmental Science and Research Ltd. Sexually transmitted infections in New Zealand: Annual Surveillance Report 2011 Porirua, New Zealand.

16.

Azariah

. Is syphilis resurgent in New Zealand in the 21st century? A case series of infectious syphilis presenting to Auckland sexual health service. NZ Med J 2005; 118: U1349–U1349.

17.

Azariah

Perkins

Austin

. Increase in incidence of infectious syphilis in Auckland, New Zealand: results from an enhanced surveillance survey. Sex Health 2008; 5: 303–304.

18.

Cunningham

MacDonald

McLean

. An outbreak of infectious syphilis in Wellington, New Zealand. NZ Med J 2007; 120: U2680–U2680.

19.

Azariah

. An audit of patients treated for syphilis at Auckland sexual health service. NZ Med J 2010; 123: 55–64.

20.

StataCorp. 2009. Stata Statistical Software: Release 11. College Station TSL.

21.

Statistics New Zealand. 2006 Census Data, http://www.stats.govt.nz/Census/2006CensusHomePage.aspx (2006, accessed 22 August 2012).

22.

McAllister

Dickson

Sharples

. Unlinked anonymous HIV prevalence among New Zealand sexual health clinic attenders: 2005-2006. Int J STD AIDS 2008; 19: 752–757.

23.

Jebbari

Simms

Conti

. Variations in the epidemiology of primary, secondary and early latent syphilis, England and Wales: 1999 to 2008. Sex Transm Infect 2011; 87: 191–198.

24.

Saxton

PJW

Dickson

Griffiths

. Actual and undiagnosed HIV prevalence in a community sample of men who have sex with men in Auckland, New Zealand. BMC Public Health 2012; 12: 92–92.

25.

Dougan

Evans

Elford

. Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Sex Transm Dis 2007; 34: 783–783.

26.

Dodds

Nardone

Mercey

. Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study. BMJ 2000; 320: 1510–1511.

27.

Rompalo

Joesoef

O'Donnell

. Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Sex Transm Dis 2001; 28: 158–158.

28.

Zetola

Klausner

. Syphilis and HIV infection: an update. Clin Infect Dis 2007; 44: 1222–1228.

29.

Saxton P, Dickson N, Hughes T, et al. GAPSS 2008: findings from the Gay Auckland Periodic Sex Survey: Te Rangahau Tane Ai Tane: New Zealand AIDS Foundation; 2010.

30.

Adams

McCreanor

Braun

. Doctoring New Zealand’s gay men. NZ Med J 2008; 121: 11–20.

31.

Branger

van der Meer

van Ketel

. High incidence of asymptomatic syphilis in HIV-infected MSM justifies routine screening. Sex Transm Dis 2009; 36: 84–84.

32.

Asboe

Aitken

Boffito

. British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011. HIV Med 2012; 13: 1–44.

33.

Wilson DP, Gray R, Drummond FM, et al. Modelling optimal syphilis screening programs for men who have sex with men. Paper presented at Australasian Sexual Health Conference 2008, September 15–17, Perth, Australia, 157 [poster 64].