Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
AIDS Patient Care STDS. 2010 Jan;24(1):23-9. doi: 10.1089/apc.2009.0255.
Syphilis outbreaks in the United States have been reported since 2000 with highest rates in the South and many cases among HIV-infected individuals. We evaluated incident syphilis cases and concurrent gonorrhea and chlamydia screening at a southern HIV clinic. A retrospective cohort study included HIV-infected patients with at least one reactive plasma reagin (test for serum reagin antibodies to cardiolipin-cholesterol-lecithin antigen) and primary care visit from July 2004 to June 2007. Primary, secondary, and early latent syphilis cases were identified as incident syphilis and evaluation for gonorrhea and chlamydia within 1 month were described. Logistic regression was performed to determine factors associated with incident syphilis. Among 1544 patients, 40 incident syphilis cases were identified (5 primary, 29 secondary, and 6 early latent). The majority of patients were not virologically suppressed and only 25% had gonorrhea and chlamydia testing. In adjusted analyses, younger age (0.57 per 10 years, 95% confidence interval [CI] 0.41-0.80) and minority race (2.26, 95% CI 1.12-4.59) were associated with incident syphilis. Among 40 incident syphilis cases, only 1 in 4 were further tested for gonorrhea and chlamydia. These low rates are concerning as concurrent sexually transmitted infections (STIs) increase risk for HIV transmission. HIV care provider education with emphasis on STI testing in the setting of incident syphilis is key in prevention.
自 2000 年以来，美国一直有梅毒疫情报告，南部地区的发病率最高，许多病例发生在 HIV 感染者中。我们评估了一家南部 HIV 诊所中新增梅毒病例以及同时进行的淋病和衣原体筛查情况。这项回顾性队列研究纳入了至少有一次反应性血浆反应素（检测血清反应素抗体对心磷脂-胆固醇-卵磷脂抗原的试验）阳性且在 2004 年 7 月至 2007 年 6 月期间接受初级保健就诊的 HIV 感染者。将原发性、二期和早期潜伏性梅毒病例确定为新增梅毒，并描述了在 1 个月内对淋病和衣原体进行评估的情况。采用 logistic 回归分析确定与新增梅毒相关的因素。在 1544 例患者中，发现 40 例新增梅毒病例（5 例原发性、29 例二期和 6 例早期潜伏性）。大多数患者未进行病毒学抑制，只有 25%的患者进行了淋病和衣原体检测。在调整分析中，年龄较小（每 10 岁增加 0.57，95%置信区间[CI]为 0.41-0.80）和少数族裔（2.26，95%CI 为 1.12-4.59）与新增梅毒相关。在 40 例新增梅毒病例中，只有 1/4 进一步进行了淋病和衣原体检测。这些低比率令人担忧，因为同时发生的性传播感染（STI）会增加 HIV 传播的风险。在发生新增梅毒的情况下，对 HIV 护理提供者进行有关 STI 检测的教育是预防的关键。
