Alarm over high global rate of syphilis among MSM

The World Health Organization (WHO) is concerned about the “unacceptably high” rate of syphilis among men who have sex with men (MSM) around the world.

A first of its kind study has found that the prevalence of syphilis among MSM is 15 times higher than men in the general population.

Led by the London School of Hygiene & Tropical Medicine (LSHTM), in partnership with the WHO and Avenir Health, the research was published in The Lancet Global Health.

The study – which reviewed data from 275 studies involving more than 600,000 participants in 77 countries – concluded that the worldwide prevalence of syphilis among MSM is 7.5% compared to 0.5% for men in the general population.

Latin America and the Caribbean region had the highest prevalence of syphilis (10.6%), whereas Australia and New Zealand had the lowest (1.9%).

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. When diagnosed, syphilis is easily treated with penicillin. One study found that annual screening and treatment of at least 62% of sexually active MSM is necessary to achieve local elimination.

“Men tend to be disadvantaged when it comes to syphilis testing and treatment,” said Dr Matthew Chico, Associate Professor at LSHTM and lead author. “Women are routinely screened for syphilis at their first antenatal care visit, and are offered testing at family planning services. Men in general do not have the same number of contacts with the health system as women, and MSM face additional barriers due to stigma and shaming.

“As diseases go, syphilis is terribly deceptive. In the primary and secondary stages of infection, skin lesions, such as chancre or rash, may present, only to then disappear as if the person has been cured. Unfortunately, without treatment, the bacterium will slowly invade internal organs, and can lead to physical deformity, loss of vision, dementia, and even death. There is no good reason for this to happen. We have effective treatment.”

In the study, pooled estimates of syphilis among MSM were highest in regions where HIV prevalence is more than 5%. Lower-middle income countries also had a high burden.

The researchers say that it is difficult to know if syphilis prevalence among MSM will be altered by the COVID-19 pandemic. While there is evidence the pandemic has impacted MSM sexual activity, there have also been reports that MSM have experienced difficulty accessing STI testing and treatment due to COVID-19, potentially translating into fewer syphilis cases being diagnosed, treated and removed from the MSM population.

“It’s important that everyone, including LGBTQ+ people and those at higher risk, is supported to understand how to protect themselves against syphilis and other sexually transmitted infections,” said Eloise Stonborough, Associate Director of Policy and Research at Stonewall.

She added: “It’s also vital that healthcare services are inclusive and welcoming of all lesbian, gay, bi, trans and queer people, so everyone feels comfortable getting the help and support they need.”

Dr Meg Doherty, Director of WHO’s Department of Global HIV, Hepatitis and STI Programmes called on stakeholders “to address structural barriers, like discrimination and violence; improve sexuality education, and expand access and delivery of syphilis testing and immediate treatment for all populations at higher risk of infection.”

Using condoms and dental dams during vaginal, anal and oral sex offers the best protection against contracting or passing on syphilis.