Cohen C E, Winston A, Asboe D, Boag F, Mandalia S, Azadian B, Hawkins D A
Department of GU/HIV Medicine, St Stephen's Centre, 2nd Floor, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Sex Transm Infect. 2005 Jun;81(3):217-9. doi: 10.1136/sti.2004.012187.
BACKGROUND/OBJECTIVES: The burden of new syphilis diagnoses in London has mainly been in men who have sex with men (MSM), many of whom are co-infected with HIV. Our HIV unit introduced regular serological screening for syphilis during routine follow up care to detect patients who may be at risk of asymptomatic infection. We assessed if this remained an effective and necessary strategy in the second year since introduction.
All HIV outpatients with newly positive syphilis serology between 1 May 2002 and 30 April 2003 were identified using a prospectively collected database. Only patients who were asymptomatic at the time of screening were included (cohort B). They were compared to patients in the exact preceding year (cohort A).
2655 patients had at least one CD4 count measured in the period (surrogate marker for patients having routine follow up bloods), of whom 2389 (90%) had syphilis serology performed. 40 individuals were found to have early asymptomatic infection (two were re-infections), compared to 26 patients in cohort A. These 40 patients represented 36% of all patients with infectious syphilis treated within our department and 56% of those who were HIV positive. The event rate in cohort B was 7.3 per 1000 patient years (CI 5.2 to 9.9) compared to 2.8 (CI 1.8 to 4.0) in cohort A.
Routine screening is effective and has detected increasing numbers of HIV outpatients with early asymptomatic syphilis. Our department will continue this strategy for all HIV patients during their follow up care. We recommend that other units adopt similar initiatives that assist with regional control of the UK syphilis epidemic.
背景/目的：伦敦新增梅毒诊断病例的负担主要集中在男男性行为者（MSM）身上，其中许多人同时感染了艾滋病毒。我们的艾滋病毒科室在常规随访护理期间引入了梅毒血清学定期筛查，以检测可能存在无症状感染风险的患者。我们评估了在引入该筛查后的第二年，这是否仍然是一项有效且必要的策略。
使用前瞻性收集的数据库，确定了2002年5月1日至2003年4月30日期间梅毒血清学新呈阳性的所有艾滋病毒门诊患者。仅纳入筛查时无症状的患者（队列B）。将他们与前一年同期的患者（队列A）进行比较。
在此期间，2655名患者至少进行了一次CD4细胞计数测量（作为进行常规随访血液检查患者的替代指标），其中2389名（90%）进行了梅毒血清学检测。发现40人有早期无症状感染（2人是再次感染），而队列A中有26名患者。这40名患者占我们科室治疗的所有感染性梅毒患者的36%，占艾滋病毒阳性患者的56%。队列B的事件发生率为每1000患者年7.3例（可信区间5.2至9.9），而队列A为2.8例（可信区间1.8至4.0）。
常规筛查是有效的，并且已检测出越来越多的艾滋病毒门诊患者患有早期无症状梅毒。我们科室将在所有艾滋病毒患者的随访护理中继续这一策略。我们建议其他科室采取类似举措，以协助英国梅毒疫情的区域控制。
