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Study highlights high prevalence of syphilis among men who have sex with men

The proportion of MSM with syphilis was highest in settings where HIV prevalence was greater than 5% and in low and -middle income countries.

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A new study highlights the unacceptably high global prevalence of syphilis among men who have sex with men (MSM) and underscores the need to advance stalled progress toward eliminating syphilis as a public health threat by 2030. 

The study – Prevalence of syphilis among men who have sex with men: A global systematic review and meta-analysis from 2000 to 2020 – was done by Motoyuki Tsuboi, MD; Jayne Evans, MSc; Ella P Davies, MBChB; Jane Rowley, PhD; Eline L Korenromp, PhD; Prof Tim Clayton, MSc; et al. It appeared in The Lancet Global Health.

Syphilis, a sexually transmitted infection (STI), is caused by the bacteria Treponema pallidum. Globally, seven million new syphilis infections were reported in 2020, and the World Health Organization (WHO) set targets to reduce incidence of syphilis by 90% by 2030, even if global response has been slow.

The findings from this study show that MSM have high burden of syphilis infection, with significant variation across countries and regions.

The global pooled prevalence of syphilis among men who have sex with men was 7.5% during 2000-2020 (95% CI: 7.0-8.0), as compared to the most recent estimate of syphilis among men in the general population in 2016, 0.5% (95% UI: 0.4-0.6). The proportion of MSM with syphilis was highest in settings where HIV prevalence was greater than 5% and in low and -middle income countries. Sub-analysis showed that pooled prevalence estimates were higher between 2015-2020 compared to the prior five years in half of the global regions assessed and several countries are reporting a high and sustained increase in syphilis infection among MSM.

According to the WHO, syphilis is both preventable and curable with cost-effective and, in certain contexts, cost-saving interventions. Point-of-care tests include blood-based rapid tests that produce results in less than 20 minutes, and products that test syphilis and HIV using a single platform.

But “while there have been modest reductions in congenital syphilis as a result of the scale-up of interventions in antenatal care, such as syphilis screening and treatment for pregnant women, there is (still) an urgent need to galvanize momentum and better serve other priority populations disproportionally impacted by the disease,” the WHO stated.

This is because while treatment with injectable benzathine penicillin is simple to administer and inexpensive, “a major challenge is that populations at higher risk for syphilis… are often not able to access services due to structural barriers, including criminalization, policy and legal barriers, discrimination and violence.”

As such, the WHO recommended for governments to “address these structural barriers as a priority.”

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“This first review of global syphilis prevalence among men who have sex with men highlights the urgent need to improve access to syphilis testing, treatment and prevention services,” said Dr. Meg Doherty, Director of WHO’s Department of Global HIV, Hepatitis and STI Programmes. “Stakeholders must address structural barriers, like discrimination and violence; improve sexuality education, and expand access and delivery of syphilis testing and immediate treatment for all populations at higher risk of infection.”

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