Case-control study of risk factors for incident syphilis infection among men who have sex with men in Tokyo, Japan
Introduction: In Japan, syphilis notifications have increased. Men who have sex with men (MSM) in Tokyo have contributed substantially to the increase in syphilis notifications. We thus aimed to determine the correlates of incident syphilis among them.
Methods: MSM who attended a Tokyo clinic that serves sexual minorities were recruited in a case-control study in 2015. A case was seropositive for primary/secondary/asymptomatic syphilis at enrolment visit and seronegative at prior visit or had oral ulcers positive for Treponema pallidum DNA at enrolment. For each case, two controls seronegative at enrolment and prior visit were selected. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to assess for correlates of case status.
Results: Among 35 cases, the median age was 37 (range = 21–63) years and was similar to the 71 controls. Among HIV-positive participants (26 cases and 67 controls), cases were independently associated with higher frequency of anal or oral sex (OR = 3.4; 95% CI = 1.4–8.6; increase per category from < 1/month, >= 1/month but < 1/week, to >= 1/week) and no or inconsistent condom use during anal or oral sex (OR = 3.0; 95% CI = 1.1–8.3; increase per category from using every time, occasionally, to never), adjusted for residency and time between visits.
Discussion: Modifiable behaviours were associated with incident syphilis, and dissemination of prevention messages are needed.
National Institute of Infectious Diseases. Syphilis in Japan 2008-2014. Infectious Agents Surveillance Report 2014; 35: 79-80.
Sugishita Y, Yamagishi T, Arima Y, et al. Increase in primary and secondary syphilis notifications in men in Tokyo, 2007-2013. Jpn J Infect Dis 2016; 69: 154-157.
Patton ME, Su JR, Nelson R, et al. Primary and secondary syphilis – United States, 2005-2013. MMWR Morb Mortal Wkly Rep 2014; 63: 402-406.
European Centre for Disease Prevention and Control (ECDC). Sexually Transmitted Infections in Europe, 1990-2010. Stockholm: ECDC; 2012, https://ecdc.europa.eu/en/publications-data/sexually-transmitted-infections-europe-1990-2010 (2012, accessed 9 March 2017).
Takahashi T, Arima Y, Yamagishi T, et al. Rapid Increase in Reports of Syphilis Associated With Men Who Have Sex With Women and Women Who Have Sex With Men, Japan, 2012 to 2016. Sex Transm Dis. 2018; 45: 139-143.
National Institute of Infectious Diseases in Japan. Infectious Agents Surveillance Report, http://www.nih.go.jp/niid/ja/iasr.html (2016, accessed 9 March 2017).
Cao Z, Xu J, Zhang H, et al. Risk factors for syphilis among married men who have sex with men in China. Sex Transm Dis 2014; 41: 98-102.
Champenois K, Cousien A, Ndiaye B, et al. Risk factors for syphilis infection in men who have sex with men: results of a case-control study in Lille, France. Sex Transm Infect 2013; 89: 128-132.
Jansen K, Schmidt AJ, Drewes J, et al. Increased incidence of syphilis in men who have sex with men and risk management strategies, Germany, 2015. Euro Surveill 2016; 21: doi: 10.2807/1560-7917.ES.2016.21.43.30382.
Shilaih M, Marzel A, Braun DL, et al. Factors associated with syphilis incidence in the HIV-infected in the era of highly active antiretrovirals. Medicine (Baltimore) 2017; 96: e5849. doi: 10.1097/MD.0000000000005849.
Phillips G 2nd, Magnus M, Kuo I, et al. Use of geosocial networking (GSN) mobile phone applications to find men for sex by men who have sex with men (MSM) in Washington, DC. AIDS Behav 2014; 18: 1630-1637.
Wei C, Lim SH, Guadamuz TE, et al. Virtual versus physical spaces: which facilitates greater HIV risk taking among men who have sex with men in East and South-East Asia? AIDS Behav 2014; 18: 1428-1435.
DeSilva M, Hedberg K, Robinson B, et al. A case-control study evaluating the role of internet meet-up sites and mobile telephone applications in influencing a syphilis outbreak: Multnomah County, Oregon, USA 2014. Sex Transm Infect 2016; 92: 353-358.
Nishijima T, Teruya K, Shibata S, et al. Incidence and Risk Factors for Incident Syphilis among HIV-1-Infected Men Who Have Sex with Men in a Large Urban HIV Clinic in Tokyo, 2008-2015. PLoS One 2016; 11: e0168642. doi: 10.1371/journal.pone.0168642. eCollection.
Janier M, Hegyi V, Dupin N, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2014; 28: 1581-1593.
Workowski KA and Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64(RR-03): 1-137.
Orle KA, Gates CA, Martin DH, et al. Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers. J Clin Microbiol 1996; 34: 49-54.
Liu H, Rodes B, Chen CY, et al. New tests for syphilis: rational design of a PCR method for detection of Treponema pallidum in clinical specimens using unique regions of the DNA polymerase I Gene. J Clin Microbiol 2001; 39: 1941-1946.
Ishikane M, Arima Y, Itoda I, et al. Responding to the syphilis outbreak in Japan: piloting a questionnaire to evaluate potential risk factors for incident syphilis infection among men who have sex with men in Tokyo, Japan, 2015. Western Pac Surveill Response J 2016; 7: 36-39.
Kenyon C, Lynen L, Florence E, et al. Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium - 1992 to 2012. Euro Surveill 2014; 19: 20958.
Winer RL, Lee SK, Hughes JP, et al. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol 2003; 157: 218-226.
Ichiro I. How much is the syphilis increasing (in Japanese)? The 28th Annual Meeting of the Japanese Society for AIDS Research; 2014 Dec 3; Osaka, Japan.
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