Public Health Challenges of Syphilis Prevention Same, same but - - PowerPoint PPT Presentation

Public Health Challenges of Syphilis Prevention

Same, same but different

Sol

• lom
• mon
• n M

M, Mayer K r K. Evol

• lution
• n
• f the s

he syph philis epi epidem emic a among men who have s sex w with m men. Sexual Hea Health 201 2014

• Between 1969 and 1976, the proportion of

men with 1o & 2o syphilis who named other men among sex partners increased fro 24% to 46%

• Prompted screening in bars, bathhouses,

bookstores and supporting clinics

• Incidence declines in 1980s due to changes in

sexual behavior related to HIV prevention campaigns

• End of 1980s, rebound due to resurgence in

high-risk MSM sex behaviour

• 1990s, seroadaptive (serosorting or

seopositioning

• 2000s, outbreak among MSM. Risks =

anonymous sex, frequenting bathouses, meeting partners on Internet, contact with sex workers, condomless sex and use of crystam methamphetamine

Don’t ask, won’t tell Don’t look, won’t find

Same, same…..

Pre-AIDS

• Occult/asymptomatic infection
• Multiple partner
• Anonymous partners
• “poppers”
• Mistrust of medical community
• Prejudice
• Health equity

Post-AIDS

• Occult/asymptomatic infection
• Multiple partner
• Anonymous oddslot partners
• Methamphetamine, viagra
• Mistrust of medical community
• Prejudice
• Health equity

But different?

• An abandonment of safer sex practices
• ART and undetectable viral load
• PrEP
• Internet: geosocial networking phone apps (Grindr)
• Decreasing STD categorical clinics
• Decreasing DIS

Recommendations

• Screen, screen, screen
• Internet outreach, opt-out testing
• Counsel regarding limits of serosorting and other seroadaptive

behaviors

• May be good for HIV prevention but will not prevent STIs
• ORAL SEX IS NOT SAFER SEX FOR SYPHILIS
• Culturally tailor prevention counselling, education about pre-

exposure prophylaxis and repetitive screening