Cent Eur J Public Health 2015, 23(1):65-68

Seroprevalence and Risk Factors of Syphilis among HIV/AIDS Patients in Istanbul, Turkey

Özlem Altuntaş Aydın1, Hayat Kumbasar Karaosmanoğlu1, Murat Sayan2, Emine Rahşan İnce1, Özcan Nazlıcan1
1 Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
2 University of Kocaeli, Kocaeli, Turkey

Objective: Data on syphilis seroprevalence among human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients are unavailable in Turkey although they have common transmission routes. Our study is oriented towards the assessment of the seroprevalence of syphilis and the related risk factors in the HIV/AIDS patients followed in our outpatient clinic.

Materials: Newly diagnosed HIV/AIDS cases (n=308) who attended our outpatient clinic between January 2006 and April 2013 were included in the study. Patient characteristics, medical history, physical examination findings, CD4+ T lymphocyte count, HIV RNA level, rapid plasma reagent (RPR) and Treponema pallidum hemagglutination (TPHA) test results were analyzed retrospectively. TPHA positivity was considered indicative of syphilis-causing T. pallidum exposure.

Results: HIV infection was transmitted through heterosexual (n=176) or homosexual (n=131) contact (266 male, 86.3%; age 38.3±11.7 years; CD4+ T lymphocyte count, 330.6±15.17/mm3). 50.7% of the patients attained only primary education. Out of the 245 cases, who were asked about the number of their sexual partners, 40 patients (26 women) lived in a monogamous relationship. Condom usage was not practiced (57.2%) or was only occasional (34.4% - particularly with their legal spouses and for contraception). Physical exam revealed no signs of syphilis or other STIs. TPHA (+/- RPR) positivity was determined in 40 patients (12.9%), indicating T. pallidum exposure. All patients with positive syphilis serology were male (p=0.0026). T. pallidum exposure was determined in 21.3% of homosexual and 6.8% of heterosexual cases (p=0.0003).

Conclusion: Since sexual contact is the most common route of transmission for both infections, syphilis seroprevalence was relatively high in our HIV/AIDS patients. Male and homosexual HIV/AIDS patients constituted a group at the highest risk for syphilis.

Keywords: syphilis, HIV, epidemiology, Turkey, seroprevalence

Received: December 25, 2013; Revised: January 5, 2015; Accepted: January 5, 2015; Published: March 1, 2015  Show citation

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Aydın ÖA, Karaosmanoğlu HK, Sayan M, İnce ER, Nazlıcan Ö. Seroprevalence and Risk Factors of Syphilis among HIV/AIDS Patients in Istanbul, Turkey. Cent Eur J Public Health. 2015;23(1):65-68. PubMed PMID: 26036101.
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References

  1. Lynn WA, Lightman S. Syphilis and HIV: a dangerous combination. Lancet Infect Dis. 2004 Jul;4(7):456-66. Go to original source... Go to PubMed...
  2. Zetola NM, Klausner JD. Syphilis and HIV infection: an update. Clin Infect Dis. 2007 May 1;44(9):1222-8. Go to original source... Go to PubMed...
  3. Buchacz K, Patel P, Taylor M, Kerndt PR, Byers RH, Holmberg SD, et al. Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS. 2004 Oct 21;18(15):2075-9. Go to original source... Go to PubMed...
  4. Schöfer H, Imhof M, Thoma-Greber E, Brockmeyer NH, Hartmann M, Gerken G, et al.; The German AIDS Study Group (GASG). Active syphilis in HIV infection: a multicentre retrospective survey. Genitourin Med. 1996 Jun;72(3):176-81. Go to original source... Go to PubMed...
  5. EACS Guidelines. Version 6.1 - November 2012. Paris: EACS; 2012.
  6. Centers for Disease Control and Prevention. HIV infection: detection, counseling, and referral. Sexually transmitted diseases treatment guidelines [Internet]. CDC; 2010 [cited 2013 Aug 29]. Available from: http://www.cdc.gov/std/treatment/2010/hiv.htm.
  7. Turkish Ministery of Health. Distrubution of HIV/AIDS patients by years in Turkey [Internet]. [cited 2013 Aug 29]. Available from: http://www.hatam.hacettepe.edu.tr/verilerAralik2012.pdf. (In Turkish.)
  8. Sayan M, Kumbasar Karaosmanoğlu H, Mete B, Gündüz A, Aydin O, Yemişen M, et al. Molecular epidemiological analysis of HIV-1 pol gene sequences isolated in Istanbul, Turkey. Mikrobiyol Bul. 2013 Jan;47(1):87-97. (In Turkish.) Go to original source... Go to PubMed...
  9. Oncul O, Emekdas G, Cavuslu S, Artuk C, Aksoy A. The sixteen-year trend of syphilis in Turkey: data from blood donors. Trop Doct. 2008 Jul;38(3):181-2. Go to original source... Go to PubMed...
  10. Akin L. Epidemiology of sexually transmitted infection: review. Turkiye Klinikleri J Med Sci. 2006;26(6):655-65. (In Turkish.)
  11. Orak S, Dalkiliç AE, Ozbal Y. Serological investigation of HIV infections, HBsAg and syphilis in prostitutes in Elaziğ. Mikrobiyol Bul. 1991 Jan;25(1):51-6. (In Turkish.) Go to PubMed...
  12. İnci R, Özbakkaloğlu B, BilgiçA, Tümbay E,AkiA, Taşdelen N. Syphilis antibodies in homosexual men. Ege Tip Dergisi. 1990;29:958-60. (In Turkish.)
  13. Aktaş G. Serological diagnosis of syphilis. Türk Mikrobiyol Cemiy Derg. 2005;35(1):73-9. (In Turkish.)
  14. KaracaY, Cöplü N, GözalanA, Oncül O,Akin L, Esen B. Establishment of an algorithm for serological testing of syphilis identification. Mikrobiyol Bul. 2010 Jan;44(1):35-45. (In Turkish.) Go to PubMed...
  15. Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1-110.
  16. Zhao YS, Su SI, Lv CX, Zhang XF, Lin L, Sun XG, et al. Seroprevalence of hepatitis C, hepatitis B virus and syphilis in HIV-1 infected patients in Shandong, China. Int J STD AIDS. 2012 Sep;23(9):639-43. Go to original source... Go to PubMed...
  17. Badie BM,Yavari Z, Esmaeeli S, Paydary K, Emamzadeh-Fard S, Seyed Alinaghi SA, et al. Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran.Asian Pac J Trop Biomed. 2013 Apr;3(4):334-6. Go to original source... Go to PubMed...
  18. Klausner JD. Frequency of syphilis testing in HIV-infected patients: more and more often. Sex Transm Dis. 2009 Feb;36(2):86-7. Go to original source... Go to PubMed...
  19. Seña AC,Torrone EA, Leone PA, Foust E, Hightow-Weidman L. Endemic early syphilis among young newly diagnosed HIV-positive men in a southeastern U.S. state.AIDS Patient Care STDS. 2008 Dec;22(12):95563. Go to original source...
  20. US Department of Health and Human Services, Centers for Disease Control and Prevention, Division of STD Prevention. Sexually transmitted disease surveillance 2011 [Internet]. Atlanta: US Department of Health and Human Services; 2012 [cited 2013 Aug 29]. Available from: http://cdc.gov/std/stats11/Surv2011.pdf.
  21. Kim AA, Kent CK, Klausner JD. Increased risk of HIV and sexually transmitted disease transmission among gay or bisexual men who use Viagra, San Francisco 2000-2001. AIDS. 2002 Jul 5;16(10):1425-8. Go to original source... Go to PubMed...
  22. Wong W, Chaw JK, Kent CK, Klausner JD. Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 20022003. Sex Transm Dis. 2005 Jul;32(7):458-63. Go to original source... Go to PubMed...
  23. Page-Shafer K, Shiboski CH, Osmond DH, Dilley J, McFarland W, Shiboski SC, et al. Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS. 2002 Nov 22;16(17):2350-2. Go to original source... Go to PubMed...
  24. Marcus U, Bremer V, Hamouda O, Kramer MH, Freiwald M, Jessen H, et al; MSM-STD-Sentinel Network. Understanding recent increases in the incidence of sexually transmitted infections in men having sex with men: changes in risk behavior from risk avoidance to risk reduction. Sex Transm Dis. 2006 Jan;33(1):11-7. Go to original source... Go to PubMed...
  25. Adler MW. Sexually transmitted diseases control in developing countries. Genitourin Med. 1996 Apr;72(2):83-8. Go to original source... Go to PubMed...
  26. Sadiq ST, McSorley J, Copas AJ, Bennett J, Edwards SJ, Kaye S, et al. The effects of early syphilis on CD4 counts and HIV-1 RNA viral loads in blood and semen. Sex Transm Infect. 2005 Oct;81(5):380-5. Go to original source... Go to PubMed...
  27. Kofoed K, Gerstoft J, Mathiesen LR, Benfield T. Syphilis and human immunodeficiency virus (HIV)-1 coinfection: influence on CD4 T-cell count, HIV-1 viral load, and treatment response. Sex Transm Dis. 2006 Mar;33(3):143-8. Go to original source... Go to PubMed...