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Syphilis: Eine stille Epidemie erwacht wieder

von NFI Redaktion

An article recently published in the Indian Dermatology Online Journal discusses the epidemiological and clinical profile of Indian patients seeking treatment for syphilis at a tertiary care center. The findings suggest that while effective treatment options for syphilis exist and the disease is preventable, there has been a global increase in cases over the past decade. Effective prevention and treatment are needed to ensure that untreated cases do not lead to adverse health consequences with impacts on public health.


Syphilis: A silent epidemic reawakens






Studie: Syphilis: Ist sie mit einem Paukenschlag zurück? Bildquelle: Kateryna Kon / Shutterstock

Study Overview

This study followed a cross-sectional observational design to evaluate the epidemiological and clinical profile of individuals with syphilis treated at a sexually transmitted infection (STI) specialty clinic between 2019 and 2021. Patients of all age and gender groups were included if clinically diagnosed with syphilis, including latent, primary, secondary, tertiary, and congenital cases.

At the clinic, staff collected complete patient histories and conducted general physical, systemic, and mucocutaneous examinations. Clinical photos were taken, and screening for Rapid Plasma Reagin (RPR), Treponema pallidum Hemagglutination Assay (TPHA), and human immunodeficiency virus (HIV) was carried out.

Syphilis diagnosis was established based on serology, clinical features, and medical history. For those showing no clinical signs and symptoms but having positive serology during screening, a diagnosis of latent syphilis was made. Investigations were also conducted in cases where a patient was suspected of having a mixed sexually transmitted disease.

Results

A total of 1,330 people visited the clinic, of which 200 (144 men and 56 women) received a diagnosis of syphilis. The average age of patients was 30.9 years, with most falling in the 21-30 age range.

Male patients were predominantly laborers or truck drivers, while nearly 90% of female patients were housewives. Based on the modified Kuppuswamy socioeconomic scale, most belonged to upper and lower classes.

Regarding marital status, 63% were married, including 53 women and 73 men; over 40% of females showed positive RPR serology and were before childbirth. Around 20% of male respondents reported being either bisexual or homosexual.

Half of the respondents reported previous premarital or extramarital contacts, and 36% reported having sexual contact with paid sex workers. Almost 30% engaged in polygamous relationships, and nearly 85% reported engaging in unprotected sexual intercourse.

Approximately 25% of patients had primary syphilis, 44.5% had secondary syphilis, 30.5% had latent syphilis, and only 0.5% had congenital syphilis (a two-day-old girl without clinical manifestation). Tertiary syphilis was not observed in the study. Chancres were found on the tongue and glans, while 43 patients exhibited rashes at various body sites. In addition to syphilis, 25 individuals also had genital herpes, 7 had molluscum contagiosum in the genital area, 10 had chancres, and 6 simultaneously had genital warts. Screening revealed 5 women and 28 men were HIV-positive, and all 200 patients had positive RPR titers.

Conclusions

Despite the widespread availability of effective treatment options, the prevalence rate of syphilis remains high, with a resurgence of cases in India and several other countries. Comparisons with previous studies indicate an increasing trend in syphilis cases.

The predominantly male patient group may be attributed to engaging in riskier behaviors and being more inclined to seek treatment early. Conversely, women are constrained by cultural and social stigmatization and tend to be more asymptomatic. An early onset of sexual activity could be a risk factor for sexually transmitted diseases if not accompanied by safe practices.

Although other studies have found strong associations between sexually transmitted diseases and lower education, limiting the ability and understanding for self-care, the majority of patients in this study were literate.

Drivers and day laborers who migrate in search of work appear to be a high-risk group due to prolonged separation from their partners, leading to risky sexual behavior. The findings also highlight the need to specifically target commercial sex workers to promote safe behavior and reduce the increasing burden of sexually transmitted diseases.

Infection and re-infection rates can also be high among men who have sex with men living with HIV. This group can be targeted with interventions to reduce the stigma of their conditions, bring them closer to health services, and improve their quality of life.

There is an urgent need to contain the spread of sexually transmitted diseases through rapid diagnostic kits, sexual education, and awareness of safe sex. High-risk groups can be addressed cost-effectively. Most importantly, addressing the stigma of sexually transmitted diseases is crucial to ensure prevention and effective treatment.

Journal Reference:

  • Syphilis: Ist sie mit einem Knall zurück? Kamat, S., Vaghasia, A., J, D., Kansara, KG, Shah, BJ Indian Dermatology Online Journal (2024). DOI: 10.4103/idoj.idoj_187_23, journals.lww.com

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