Rise in heterosexually transmitted cases of syphilis in south
Over the past 12 months, south London has seen almost three
times as many heterosexual cases of syphilis as were diagnosed in 2001 (25
in 2001, 72 in 2002 and over 40 cases in the first five months of this year)
(1). Cases are occurring among those who have had unprotected oral or vaginal
sex with casual partners or strangers, and people buying or selling sex. Of
73 cases diagnosed between July 2002 and May 2003, 17 cases (23%) had documented
links with the commercial sex industry. Twenty patients (54% of those engaging
in oral sex) reported having unprotected oral sex and 48 patients (69% of
those engaging in vaginal sex) reported having unprotected vaginal sex (Figures
1 and 2).
Figure 1. Protection used by syphilis patients engaging
in oral sex (n=37). Data from enhanced surveillance carried out by South
London Syphilis Incident Team. (See Figure 2 for key).
Figure 2. Protection used by syphilis patients engaging
in vaginal sex (n=70). Data from enhanced surveillance carried out by South
London Syphilis Incident Team.
An incident control team has been set up in south London involving public
health and genitourinary medicine (GUM) healthcare professionals. Current
intervention activities being undertaken to tackle this problem include:
||Enhanced surveillance to monitor the outbreak.
||General health advice to people raising awareness and highlighting
that syphilis can be easily diagnosed with a blood test and effectively
treated with antibiotics. People are also being reminded to practise
safer sex by using condoms.
||People with symptoms, or who consider themselves or their regular
partners to be at risk, are being advised to go to GUM clinics for assessment.
||Specific work targeted at commercial sex workers including outreach
work giving health advice and a fast track referral system in GUM clinics.
||Communication to raise awareness amongst local healthcare professionals
and relevant voluntary agencies.
Other initiatives are planned, including the appointment of a specialist
health advisor and the piloting of a new test to facilitate case finding.
A number of outbreaks of infectious syphilis have occurred in western Europe
over the past seven years (2-5). Each has been geographically localised
within behaviourally vulnerable groups and has typically involved several
hundred cases, although smaller outbreaks have been reported. Most of the
outbreaks have been seen in men who have sex with men, a high proportion
of whom had co-infections with HIV. A high number of cases reported unprotected
oral sex. Cases were mainly seen in nationals of the country of origin,
and were not travel associated. Few cases have been reported in heterosexuals,
and these have predominantly been associated with travel, commercial sex
work and ‘crack’ cocaine use.
This increase in heterosexual syphilis seen in south London is, however,
an important reminder that the rise in syphilis infection has not been confined
to men who have sex with men. Neither has this recent rise been exclusive
to south London, as heterosexual cases have also been reported in other
parts of London, some of which have been linked with the commercial sex