18 Nov 2016

New approaches needed for syphilis prevention

Anonymous sex made easier with apps. Image: Bustle
by Anne Crawford

Two separate Monash University studies have shown that new ways of controlling syphilis among men who have sex with men (MSM) are needed because traditional measures aimed at curbing the rapid spread of the disease have not been effective.



The first study, conducted by researchers in the Central Clinical School and Melbourne Sexual Health Centre, in collaboration with the Partner Notification Officers (PNO) from the Victorian Department of Health and Human Services, investigated the effectiveness of the PNO service.

The service, in which all MSM diagnosed with syphilis were routinely offered a referral to a PNO to help them inform recent sexual partners, was introduced in October 2013 as part of a Department drive to counter the disease. It was modelled on one successfully used in HIV notification.

The officers usually contacted partners via phone, but also used other methods such as internet chat-room sites, phone applications used to meet partners, email, letters, and occasionally face-to-face meetings. Partners notified by the PNO were advised of their risk of syphilis and the need for testing and treatment.

Symptoms of syphilis include rashes, sores, flu-like symptoms and ulcers: at worst it can affect the heart and other organs. The infected person is often unaware of the disease early on. It is readily treated with penicillin.

The centre actively encouraged the 380 MSM diagnosed with syphilis from the start of the program to March 2015 to use the PNO service. But researchers found that only 34 % (128 men) accepted PNO referral and that of the 28% (105 men) contacted by the PNO, 58 reported they had already notified partners themselves.

Eventually only 4% (14 men) provided the PNO with contact details for partners. The PNOs were able to make contact with 25 of these partners – out of a total 2213 partners initially reported by 380 men.

Among those interviewed the most common barrier to notifying partners was the fact that partners were anonymous and there were no contact details for them.

An increasing number of MSM meet sexual partners via the internet through social networking and the use of smartphone apps such as Grindr, which make anonymous sex easier. In Australia, the proportion of gay men who use such applications to seek sexual partners increased from 24% in 2011 to 46% in 2014.

While there was little syphilis in Victoria in the early 2000s, the prevalence of the disease is on the rise. The study reported that the notifications for infectious syphilis in Victoria doubled from 290 cases in 2010 to 629 cases in 2014, but supervising researcher Dr Jason Ong said recent statistics showed a trebling to 946 officially reported cases.

“The study showed that traditional methods are not working and we really need to think outside the box about how men can be supported in contacting their male partners,” Dr Ong said.

The study concluded that patient-initiated strategies were needed to help improve syphilis control. The centre will push its Let Them Know website which informs partners of infected people that they might have been exposed to a sexually transmitted infection in a generic SMS or email. The Drama Down Under website also targets gay men.

The second study reviewing 761 syphilis cases in MSM diagnosed at the Melbourne Sexual Health Centre from 2007 to 2013. It found that the implementation of public health campaigns was not associated with a significantly shorter time from the onset of symptoms to treatment and concluded that alternative strategies, such as more frequent testing of MSM, should be promoted to control the syphilis epidemic in Australia.

References

Tan WS, Chen M, Ivan M, Stone K, Rane V, Fairley CK, Ong JJ. Partner Notification Outcomes for Men Who Have Sex With Men Diagnosed With Syphilis Referred to Partner Notification Officers, Melbourne, Australia. Sexually Transmitted Diseases: November 2016, Volume 43, Issue 11, p 685–689. doi: 10.1097/OLQ.0000000000000512

Chow EP, Dutt K, Fehler G, Denham I, Chen MY, Batrouney C, Peel J, Read TR, Bradshaw CS, Fairley CK. Duration of syphilis symptoms at presentations in men who have sex with men in Australia: are current public health campaigns effective? Epidemiol Infect. 2016 Jan;144(1):113-22. doi: 10.1017/S0950268815001168. Epub 2015 Jun 1.
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