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Eurosurveillance, Volume 7, Issue 31, 31 July 2003
Articles

Citation style for this article: Crawley-Boevey E, Simms I. Rise in heterosexually transmitted cases of syphilis in south London, England. Euro Surveill. 2003;7(31):pii=2268. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2268

Rise in heterosexually transmitted cases of syphilis in south London, England

Emma Crawley-Boevey (ecrawley@sghms.ac.uk), specialist registrar in public health, Health Protection Agency, London, on behalf of the South London Syphilis Incident Team, and Ian Simms (ian.simms@hpa.org.uk), Health Protection Agency Communicable Disease Surveillance Centre, London, England.

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 industry.

References:
  1. Health Protection Agency. Rise in heterosexual cases of syphilis in south London. Commun Dis Rep CDR Wkly 2003; 13 (31): news. (http://www.phls.co.uk/publications/cdr/index.html)
  2. Nicoll A, Hamers FF. Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? BMJ 2002; 324: 1324-7. (http://bmj.com/cgi/reprint/324/7349/1324.pdf) [accessed 31 July 2003]
  3. Blystad H et al. Syphilis outbreak in Norway and Sweden among men who have sex with men 1998-2002. Eurosurveillance Weekly 2003;7 (24): 12/06/2003. (http://www.eurosurveillance.org/ew/2003/030612.asp)
  4. Lynch A et al. Syphilis outbreak in Northern Ireland. Eurosurveillance Weekly 2003; 7 (24): 12/06/2003. (http://www.eurosurveillance.org/ew/2003/030612.asp)
  5. Paris syphilis screening campaign extended to selected French towns and cities. Eurosurveillance Weekly 2002; 6 (48): 28/11/2003. (http://www.eurosurveillance.org/ew/2002/021128.asp)

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