Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
Sex Transm Infect. 2023 Aug;99(5):324-329. doi: 10.1136/sextrans-2022-055550. Epub 2022 Nov 18.
Syphilis incidence is rising among men who have sex with men (MSM). An online tool based on a risk score identifying men with higher risk of infectious syphilis could motivate MSM to seek care. We aimed therefore to develop a symptoms-based risk score for infectious syphilis.
We included data from all consultations by MSM attending the Amsterdam Centre for Sexual Health in 2018-2019. Infectious syphilis (ie, primary, secondary or early latent syphilis) was diagnosed according to the centre's routine protocol. Associations between symptoms and infectious syphilis were expressed as odds ratios (OR), with 95% confidence intervals (CI). Based on multivariable logistic regression models, we created risk scores, combining various symptoms. We assessed the area under the curve (AUC) and cut-off based on the Youden Index. We estimated which percentage of MSM should be tested based on a positive risk score and which percentage of infectious syphilis cases would then be missed.
We included 21,646 consultations with 11,594 unique persons. The median age was 34 years (IQR 27-45), and 14% were HIV positive (93% on antiretroviral treatment). We diagnosed 538 cases of infectious syphilis. Associations with syphilis symptoms/signs were strong and highly significant, for example, OR for a painless penile ulcer was 35.0 (CI 24.9 to 49.2) and OR for non-itching rash 57.8 (CI 36.8 to 90.9). Yet, none of the individual symptoms or signs had an AUC >0.55. The AUC of risk scores combining various symptoms varied from 0.68 to 0.69. For all risk scores using cut-offs based on Youden Index, syphilis screening would be recommended in 6% of MSM, and 59% of infectious syphilis cases would be missed.
Symptoms-based risk scores for infectious syphilis perform poorly and cannot be recommended to select MSM for syphilis screening. All MSM with relevant sexual exposure should be regularly tested for syphilis.
梅毒发病率在男男性行为者（MSM）中呈上升趋势。一种基于风险评分的在线工具，可以识别出具有较高感染性梅毒风险的男性，从而激励 MSM 寻求医疗服务。因此，我们旨在开发一种基于症状的感染性梅毒风险评分。
我们纳入了 2018 年至 2019 年期间所有在阿姆斯特丹性健康中心就诊的 MSM 的咨询数据。根据中心的常规方案，诊断出感染性梅毒（即原发性、二期或早期潜伏性梅毒）。用比值比（OR）和 95%置信区间（CI）表示症状与感染性梅毒之间的关联。基于多变量逻辑回归模型，我们创建了风险评分，结合了各种症状。我们根据 Youden 指数评估了曲线下面积（AUC）和截断值。我们估计了根据阳性风险评分应测试的 MSM 百分比，以及随后会错过的感染性梅毒病例百分比。
我们纳入了 21646 次咨询，涉及 11594 名独特的个体。中位数年龄为 34 岁（IQR 27-45），14%为 HIV 阳性（93%接受抗逆转录病毒治疗）。我们诊断出 538 例感染性梅毒。与梅毒症状/体征的关联很强且具有高度显著性，例如，无痛性阴茎溃疡的 OR 为 35.0（95%CI 24.9 至 49.2），非瘙痒性皮疹的 OR 为 57.8（95%CI 36.8 至 90.9）。然而，没有任何单一症状或体征的 AUC 大于 0.55。结合各种症状的风险评分的 AUC 从 0.68 到 0.69 不等。使用基于 Youden 指数的截断值的所有风险评分，建议对 6%的 MSM 进行梅毒筛查，59%的感染性梅毒病例将被遗漏。
基于症状的感染性梅毒风险评分表现不佳，不能推荐用于选择 MSM 进行梅毒筛查。所有有相关性接触的 MSM 都应定期接受梅毒检测。
