14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrC1013

BACKGROUND: Recent outbreaks of syphilis among homosexual men in England have raised concerns regarding a resurgence in high-risk sexual behaviours and a deterioration of sexual health in this group. In this paper we examine national surveillance data to determine the potential impact of the outbreaks on HIV transmission.

METHODS: Analysis of national surveillance data of newly diagnosed HIV infections and enhanced clinical and laboratory surveillance of infectious syphilis.

RESULTS: Rates of infectious syphilis in England have more than doubled among men (from 0.4 to 1.0 per 100,000) since 1997, with those aged 35-44 and 25-34 years being worst affected. The most substantial increases were observed between 1999 and 2000, where rates rose by 70% London and 136% in the North West regions, largely attributed to substantial increases in the numbers of diagnoses among homosexual men (92% and 275% respectively). These increases were substantially higher than those observed for other STIs, or in any other region. Enhanced surveillance for infectious syphilis in both regions identified HIV co-infection, high rates of partner change and utilising sex clubs and cruising grounds as the main risk factors for transmission. Although London remains the focus of the HIV epidemic in the UK, the North West region - currently site of the longest on-going outbreak - is the only region where new HIV diagnoses have continued to increase since 1997 (37%, 84 to 115 cases in 2000), and where sex between men remains the dominant route of transmission.

CONCLUSIONS: The resurgence of infectious syphilis, a disease previously close to elimination in England, is worrying. The disproportionate burden of infections occurring among HIV positive homosexual men suggests overlapping spread networks for these infections, with the potential for onward HIV transmission. A range of targeted prevention, screening and diagnostic interventions have been implemented.

Presenting author: Kevin Fenton

1PHLS Communicable Disease Surveillance Centre, HIV/STI Division, PHLS CDSC, London, United Kingdom.

020708
MoOrC1013

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.