Mendez-Lopez Ana, Stuckler David, Marcus Ulrich, Hickson Ford, Noori Teymur, Whittaker Robert N, Jansen Klaus, Diaz Asuncion, Henszel Lukasz, Velter Annie, Semenza Jan C, Schmidt Axel J
Department of Preventive Medicine, Public Health, and Microbiology, School of Medicine, Autonomous University of Madrid, Spain.
Dondena Research Centre, Bocconi University, Italy.
Lancet Reg Health Eur. 2022 Aug 9;22:100483. doi: 10.1016/j.lanepe.2022.100483. eCollection 2022 Nov.
Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence.
Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP).
Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26-2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42-4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32-3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01-1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23-36.41), selling sex (aOR 1.45, 95%CI: 1.27-1.65), and PrEP use (aOR 3.02, 95%CI: 2.30-3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77-4.05), selling sex (aIRR 4.39, 95%CI: 4.19-4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29-6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010.
Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe.
European Centre for Disease Prevention and Control.
在过去二十年中，欧洲男男性行为者（MSM）中的梅毒病例报告显著增加。我们对导致这种回升的几个潜在因素进行了测试。
利用欧洲男男性行为者互联网调查（EMIS-2010和EMIS-2017，来自31个欧洲国家的278,256名参与者）两个横断面调查阶段的自我报告数据，构建多变量分层逻辑回归模型，以评估梅毒诊断的潜在社会、行为和干预决定因素。另外构建多变量分层负二项式模型，研究非固定性男性无保护肛交（CAI）伴侣数量的决定因素。我们检验了以下假设：更多的CAI行为和梅毒筛查与梅毒回升有关，二者均与暴露前预防（PrEP）的使用有关。
2010年至2017年间，在过去12个月中梅毒诊断的发病率从2010年报告梅毒诊断的受访者的2.33%（95%CI：2.26 - 2.40）上升至2017年的4.54%（95%CI：4.42 - 4.66）。导致梅毒诊断的主要因素包括与已确诊HIV者共同生活（调整优势比（aOR）2.67，95%CI：2.32 - 3.07）、每增加一名非固定性男性CAI伴侣（aOR 1.01，95%CI：1.01 - 1.01）、最近进行性传播感染筛查（前一个月与未筛查相比，aOR 25.76，95%CI：18.23 - 36.41）、从事性交易（aOR 1.45，95%CI：1.27 - 1.65）以及使用PrEP（aOR 3.02, 95%CI：2.30 - 3.96）。与已确诊HIV者共同生活（调整发病率比（aIRR）3.91，95%CI：3.77 - 4.05）、从事性交易（aIRR 4.39，95%CI：4.19 - 4.59）以及使用PrEP（aIRR 5.82，95%CI：5.29 - 6.41）与更多非固定性男性CAI伴侣相关。PrEP使用与梅毒诊断几率增加之间的关联是由性传播感染筛查的近期性和非固定性男性CAI伴侣数量介导的，与2010年相比，2017年这两者均大幅增加。
梅毒病例集中在三个男男性行为者人群组中：已确诊HIV者、PrEP使用者和性工作者。行为和干预方面的变化，特别是更多非固定性男性CAI伴侣以及性传播感染筛查的近期性，是欧洲男男性行为者中梅毒诊断增加的主要促成因素。
欧洲疾病预防控制中心。
