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Excerpt
A recent increase of the incidence of syphilis has been observed in North America 1 and in Europe. 2 As this agent shares the sexual route of transmission with HIV, a rise of infection of HIV might also be expected. In France, most of the results have been reported from Paris 3 and data from other centers are lacking. The objective of this study is to report the recent increase of syphilis cases diagnosed in Lyon University hospitals and to describe the patient characteristics, with an emphasis on those co-infected with HIV.
The patients from an area of about 2.5 millions inhabitants were referred to the Lyon University Hospital, the second largest teaching medical center in France, for diagnosis and care of syphilis. All biologic tests for syphilis diagnosis were done in a single university laboratory and the tests were requested mostly by patients receiving care in the university hospital. The patients who were already followed for HIV infection and who had given their informed consent were registered in the French Hospital database. 4 The laboratory database was linked to the HIV database using anonymous cross-checked linkage. All the diagnostic tests for syphilis have been performed in the same university laboratory for >10 years. We found no case of syphilis in 1998, 1 case in 1999, and no case in 2000. A sexually transmitted disease research laboratory test (bioMérieux, Marcy l'Etoile, France), and a Treponema pallidum hemagglutination test (Biokit, Barcelona, Spain) were used for initial screening. In case of positive result, fluorescent treponemal antibody absorption tests (bioMérieux) (IgG and IgM) and a solid-phase hemadsorption assay for IgM detection (SPHA) were done. A diagnosis of recent infection or reinfection was based on the detection of fluorescent treponemal antibody IgM and solid-phase hemadsorption assay IgM. According to the request of the physicians, hepatitis B surface antigen (HBsAg) (Bio-Rad, Marnes-La-Coquette, France), HIV antibodies (bioMérieux), and hepatitis C virus antibodies (Bio-Rad or Janssen Ortho, Inc., Toronto, Canada) were performed. All these tests used an enzyme-linked immunosorbent assay technique. HIV RNA level was measured with the versant HIV-RNA 3. 0. according to the manufacturer's technique (Bayer, Puteaux, France).
A total of 2342, 2727, 2036, 2419, and 3421 syphilis screening tests were performed in 1998, 1999, 2000, 2001, and 2002, respectively. The first case of syphilis was identified in September 2001, and the cumulative number reached 28 cases on October 31, 2002. Most of the patients were men (92.9%), the median age was 34 years (range 23–89) and the men who had sex with men (MSM) accounted for 42.9% of cases (Table 1).
A total of 18 patients (64.3%) were HIV antibody positive. The median delay between the first positive HIV serology performed in the laboratory and acute syphilis was 38.7 months (range 0.2–106.3). At the time of syphilis diagnosis, the median HIV RNA level in the serum was 6719 copies/mL (range <50–325,809), 3 of 16 patients (19%) had <50 copies of HIV-RNA/mL, and the median CD4/mm3 was 416 (range 296–840). Among the 16 HIV-positive individuals followed in the Lyon HIV hospital database, 2 patients had AIDS, 9 patients were known to receive antiretroviral therapy at the time of syphilis, and 1 within 6 months of acute syphilis.
Antibodies against hepatitis C virus were positive for 2 patients of 18. HBsAg was detected in 2 individuals of 19. Two patients (7.1%) were infected by syphilis, HIV, and hepatitis C virus, and 1 was infected by syphilis, HIV, and hepatitis B virus. None of the tested patients had concomitant syphilis, HIV, hepatitis C and B virus infection.
