engleski

A case of primary syphilis in MSM patient - trend with increasing prevalence

Syphilis is a sexually transmitted infection (STI) caused by the bacteria Treponema pallidum. The disease has been known since ancient times, and its prevalence has significantly decreased after the introduction of effective antibiotic therapy. However, a new resurgence of this infection has been recorded in recent years. A population of men having sex with men (MSM) forms an extremely vulnerable and high-risk group for acquiring syphilis, HIV and other STIs. A recent study led by the ̋London School of Hygiene and Tropical Medicine ̋, London, United Kingdom and published in ̋The Lancet ̋ has found a large disproportion of syphilis prevalence in the MSM population compared to the general population of men - 7.5% versus 0.5%. In most MSM, primary syphilis often goes unnoticed, which increases the risk of further disease transmission. We present an MSM patient who acquired symptomatic syphilis infection. Medical data is collected from medical history and physical and laboratory examinations. A previously healthy 48-year-old man came as an emergency to the STI office of our Dermatology Clinic because of a penile ulcer. The patient, who identified himself as a man having sex with men (MSM), reported noticing the genital lesion two weeks before. His general practitioner prescribed him doxycycline capsules and mupirocin ointment for one week, with no improvement. The local status showed an ulcer on the prepuce, 1 cm in diameter. Inguinal lymph nodes were not enlarged. The patient ́s history and clinical manifestation raised the suspicion of primary syphi- lis, so we performed serology tests for syphilis, HIV and hepatitis. The serology tests for syphilis revealed positive TPHA (1:80), and nonreactive RPR titer, while HIV-1, HIV-2, hepatitis B and C tests were completely negative. Upon resuming the analysis results, we treated him with a single intramuscular (IM) dose of benzathine penicillin 2.4 million units, after which the ulcer resolved. On his next check-up, three months after, the repeated syphilis serology test showed both positive titers for TPHA (1:2560) and RPR (1:2), along with the positive Enterococcus faecalis culture from sampled urethral swabs and ejaculate. We prescribed him amoxicillin 3x500 mg for two weeks for a newly detected bacterial infection. Meanwhile, our patient ́s partner also acquired syphilis and received therapy. Since RPR titer in our patient persisted positive six months after the initial therapy, we decided to proceed with an additional three IM doses of benzathine penicillin 2.4 million units in a weekly regimen. Two months after, the RPR titer became and stayed nonreactive. Therefore, we have agreed on further control examinations once yearly. It is estimated that 7 million new syphilis infections occur every year worldwide. The MSM popu- lation has a high burden of syphilis infection. The syphilis rates in the MSM population have been increasing in the past few years, being up to 15-times higher than in the general population, espe- cially in the lower-middle income countries. This disparity indicates a current global health issue. Experiences from our Clinic fit into current epidemiological global trends, as we have observed an increased incidence of newly diagnosed cases of syphilis among the MSM population. Our patient and his infected partner confirm this observation. Although our MSM patient presented with a penile ulcer, many primary infections remain occult and asymptomatic, making the diagno- sis and therapy postponed and increasing the risk of syphilis transmission to sexual partners. The awareness should be additionally raised since syphilis facilitates the acquisition of HIV infection 3- to 5-fold. Due to the high transmission efficiency of syphilis, adequate prevention strategies for this population are of utmost importance. In order to stop this unwanted trend, MSM engaging in high-risk behaviours should be counselled, educated and regularly screened for syphilis and other treatable STIs at regular intervals, for example, every 3–6 months.

Syphilis ; Genital diseases ; Sexually Transmitted Diseases

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