Social and behavioural determinants of syphilis: Modelling based on repeated cross-sectional surveys from 2010 and 2017 among 278,256 men who have sex with men in 31 European countries.
Condomless anal intercourse
Europe
Homosexual
MSM
Men who have sex with men
PrEP
Pre-exposure prophylaxis
STI-screening
Survey
Syphilis
Journal
The Lancet regional health. Europe
ISSN: 2666-7762
Titre abrégé: Lancet Reg Health Eur
Pays: England
ID NLM: 101777707
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
entrez:
22
8
2022
pubmed:
23
8
2022
medline:
23
8
2022
Statut:
epublish
Résumé
Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence. Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP). Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26-2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42-4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32-3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01-1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23-36.41), selling sex (aOR 1.45, 95%CI: 1.27-1.65), and PrEP use (aOR 3.02, 95%CI: 2.30-3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77-4.05), selling sex (aIRR 4.39, 95%CI: 4.19-4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29-6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010. Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe. European Centre for Disease Prevention and Control.
Sections du résumé
Background
UNASSIGNED
Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence.
Methods
UNASSIGNED
Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP).
Findings
UNASSIGNED
Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26-2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42-4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32-3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01-1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23-36.41), selling sex (aOR 1.45, 95%CI: 1.27-1.65), and PrEP use (aOR 3.02, 95%CI: 2.30-3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77-4.05), selling sex (aIRR 4.39, 95%CI: 4.19-4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29-6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010.
Interpretation
UNASSIGNED
Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe.
Funding
UNASSIGNED
European Centre for Disease Prevention and Control.
Identifiants
pubmed: 35990256
doi: 10.1016/j.lanepe.2022.100483
pii: S2666-7762(22)00179-X
pmc: PMC9382326
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100483Informations de copyright
© 2022 The Author(s).
Déclaration de conflit d'intérêts
We declare no competing interests.
Références
Euro Surveill. 2015 Apr 16;20(15):
pubmed: 25953130
PLoS One. 2016 Jul 22;11(7):e0159309
pubmed: 27447943
PLoS Comput Biol. 2021 Oct 26;17(10):e1009529
pubmed: 34699524
Int J Drug Policy. 2016 Dec;38:4-12
pubmed: 27788450
BMC Public Health. 2012 Nov 14;12:978
pubmed: 23151263
Sex Transm Dis. 2006 Jan;33(1):11-7
pubmed: 16385216
Euro Surveill. 2016 Oct 27;21(43):
pubmed: 27813472
Sex Transm Dis. 2018 Sep;45(9S Suppl 1):S86-S92
pubmed: 30102682
Euro Surveill. 2012 Jul 19;17(29):
pubmed: 22835466
BMJ. 2002 Jun 1;324(7349):1324-7
pubmed: 12039830
PLoS One. 2021 Mar 15;16(3):e0248582
pubmed: 33720969
BMC Med Res Methodol. 2022 Mar 6;22(1):59
pubmed: 35249527
Sex Transm Infect. 2011 Apr;87(3):191-8
pubmed: 21262786
Sex Transm Dis. 2007 Oct;34(10):783-90
pubmed: 17495592
BMC Infect Dis. 2019 Aug 5;19(1):686
pubmed: 31382923
HIV Med. 2019 Mar;20 Suppl 2:s2-s80
pubmed: 30869189
J Acquir Immune Defic Syndr. 2017 Dec 1;76(4):356-366
pubmed: 28787329
Sex Transm Infect. 2016 Sep;92(6):455-63
pubmed: 26965869
Infect Dis Clin North Am. 2005 Jun;19(2):311-31
pubmed: 15963874
Sex Transm Infect. 2021 May;97(3):201-208
pubmed: 33144345
Euro Surveill. 2009 Nov 26;14(47):
pubmed: 19941803
Swiss Med Wkly. 2020 Dec 31;150:w20392
pubmed: 33382077
Euro Surveill. 2019 Jan;24(5):
pubmed: 30722812
Lancet Glob Health. 2021 Aug;9(8):e1110-e1118
pubmed: 34246332