Syphilis still exists

Le résumé fourni par la source

The work of Nicolaidou et al.1 reports an increase in syphilis cases between two periods: 2 years after the outbreak of the COVID pandemic and 2 years before the pandemic. The observed a difference was revealed in the number of men having sex with men (MSM), with more MSM in the 'COVID-19' period (73.1% vs. 66%). This increase could be attributed to the greater use of PrEP. They also explain that due to reduced access to care in the 'COVID-19' period, patients with syphilis may have had their infection longer, providing more opportunities to transmit it. The growing use of pre-exposure prophylaxis (PrEP) is paralleled by some authors with the re-emergence of sexually transmitted infections (STIs). In 2018, Caumes E.2 was already alerting that between 2013 and 2015 in France, more than 100% of gonorrhoea was observed, more than 92% of C. trachomatis (non-L) proctitis and more than 56% of early syphilis in MSM. Also, he recalls that PrEP was estimated to increase the risk of gonorrhoea by a factor of 25, syphilis by a factor of 44 and lymphogranuloma venereum (LGV) by a factor of 11 in a previous meta-analyse. He reminds us that condoms are the prevention tool for all STIs. However, a new prevention tool may help to reduce syphilis incidence. In their review, Cannon et al.3 highlight that Doxy-PEP is an evidence-based prevention intervention that involves a person at risk of bacterial STIs taking a single dose of doxycycline 200 mg after condomless sex to proactively prevent infection. In the pilot study of ANRS, in MSM and transgender women (TGW) with HIV, the efficacy was similar for reductions in the occurrence of a first episode of chlamydia (HR, 0.30; 95% CI, 0.13–0.70; p = 0.006) and of syphilis (HR, 0.27; 95% CI, 0.07–0.98; p = 0.047). A larger randomized clinical trial called DoxyPEP performed in the USA shows that the relative risk reduction differed slightly between the cohorts on PrEP and people living with HIV for gonorrhoea (55% vs. 57%), chlamydia (88% vs. 74%) and syphilis (87% vs. 77%). The ARNS followed the IPERGAY sub study with DOXYVAC (combined prevention of STIs in MSM and using TDF/FTC for PrEP), and shows that the DOXYVAC interim review found reductions in gonorrhoea (51% risk reduction; 95% CI, 0.32–0.76; p = 0.001) and in chlamydia and syphilis (84% relative risk reduction; 95% CI, 0.08–0.30; p < 0.0001). However, in DoxyPEP and DOXYVAC, we observed an increase in gonococcal MICs. In addition, Whiley et al. show the transfer of the penA60 resistance gene under pressure from doxycycline, which could eventuall favour resistance to C3Gs. Apart from the MSM, the data are less convincing, with difficulties in compliance with preventive treatment in the Kenyan trial of women on PrEP.4 From another point of view, it should also be remembered that syphilis does not only affect MSM. In fact, several countries (Japan, Brazil, Australia, USA, etc.) are reporting a growing incidence of the disease among women, and particularly among pregnant women. Etienne et al.5 shows that between 2010 and 2018, the number of early syphilis diagnoses reported in Reunion Island (a French overseas department) increased by a factor of 4 (37–161 diagnoses). In 2018, in Reunion Island, 30% of reported cases were in women, of whom 27% were pregnant, 22% in heterosexual men and 47% in MSM, compared to 5%, 8% and 83%, respectively, in mainland France. Delfosse et al.6 showed that in the South Reunion Island STIs clinic, prevalence of syphilis between 2017 and 2020 concerned mainly patients <18 years (11.76%, 95% CI, 6.97–18.59%). Syphilis still exists. None. The authors declare no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.