Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income countries. World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries; however, outbreaks among select populations need to be adequately addressed. Continued vigilance and investment are needed to address syphilis worldwide. The epidemiology of syphilis differs in high-, and low- and middle-income countries.

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An Update on the Global Epidemiology of Syphilis

Objectives Men who have sex with men (MSM) are at higher risk for coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis than the general population. HIV infection and these coinfections accelerate disease progression reciprocally. This study evaluated the prevalence and incidence of these coinfections in HIV1-positive MSM in Germany.

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High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany

HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention We conducted a systematic review of studies that examined behavioral trends (1990–2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners Studies included come from the United States, Europe, and Australia We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners The increase in condomless anal sex may help to explain the increase in HIV infections More explanatory research is needed to provide insight into factors that contribute to these behavior trends Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk

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Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990–2013: A Systematic Review

Background 
HIV-1 RNA plasma concentration at viral set-point is associated not only with disease outcome but also with the transmission dynamics of HIV-1. We investigated whether plasma HIV-1 RNA concentration and CD4 cell count at viral set-point have changed over time in the HIV epidemic in the Netherlands.


Methodology/Principal Findings 
We selected 906 therapy-naive patients with at least one plasma HIV-1 RNA concentration measured 9 to 27 months after estimated seroconversion. Changes in HIV-1 RNA and CD4 cell count at viral set-point over time were analysed using linear regression models. The ATHENA national observational cohort contributed all patients who seroconverted in or after 1996; the Amsterdam Cohort Studies (ACS) contributed seroconverters before 1996. The mean of the first HIV-1 RNA concentration measured 9–27 months after seroconversion was 4.30 log10 copies/ml (95% CI 4.17–4.42) for seroconverters from 1984 through 1995 (n = 163); 4.27 (4.16–4.37) for seroconverters 1996–2002 (n = 232), and 4.59 (4.52–4.66) for seroconverters 2003–2007 (n = 511). Compared to patients seroconverting between 2003–2007, the adjusted mean HIV-1 RNA concentration at set-point was 0.28 log10 copies/ml (95% CI 0.16–0.40; p<0.0001) and 0.26 (0.11–0.41; p = 0.0006) lower for those seroconverting between 1996–2002 and 1984–1995, respectively. Results were robust regardless of type of HIV-1 RNA assay, HIV-1 subtype, and interval between measurement and seroconversion. CD4 cell count at viral set-point declined over calendar time at approximately 5 cells/mm3/year.


Conclusion 
The HIV-1 RNA plasma concentration at viral set-point has increased over the last decade of the HIV epidemic in the Netherlands. This is accompanied by a decreasing CD4 cell count over the period 1984–2007 and may have implications for both the course of the HIV infection and the epidemic.

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Viral Load Levels Measured at Set-Point Have Risen Over the Last Decade of the HIV Epidemic in the Netherlands

Neisseria gonorrhoeae is an etiologic agent of gonorrhoea, one of the most common sexually transmitted diseases caused by bacteria. For many years, infections caused by N. gonorrhoeae were considered to be relatively easy to treat; however, resistance has emerged successively to all therapeutic agents used in treatment of the disease, e.g., penicillin, ciprofloxacin or azithromycin. Currently, the global problem is the emergence and a threat of spread of N. gonorrhoeae strains resistant to extended-spectrum cephalosporins (ESC), such as injectable ceftriaxone and oral-used cefixime. Especially, dangerous are multi-resistant strains resistant simultaneously to ESC and azithromycin. Three strains with high-level resistance to azithromycin and resistant to ESC were first time isolated in 2018. Moreover, in 2018, the first ESBL was described in N. gonorrhoeae and that makes the threat of appearing the ESBL mechanism of resistance in N. gonorrhoeae more real, even though the strain was sensitive to ceftriaxone. Molecular typing revealed that variants resistant to ESC occurred also among strains belonging to epidemic clonal complex CC1 (genogroup G1407) distinguished in NG-MAST typing system. The G1407 genogroup, in particular the ST1407 sequence type, is currently dominant in most European countries. The presence of different mechanisms of drug resistance significantly affects clinical practice and force changes in treatment regimens and introduction of new drugs.

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Multiresistant Neisseria gonorrhoeae: a new threat in second decade of the XXI century.

High annual figures of sexually transmitted infections (STIs) are diagnosed in the Netherlands despite significant efforts to control them. Herein, we analyse trends and determinants of STI diagnoses, co-infections, and sexual risks among visitors of 26 STI clinics between 2007 and 2011. We recorded increased positivity rates of STIs (chlamydia, syphilis, gonorrhoea, and/or HIV) in women and heterosexual men up to 12.6% and 13.4%, respectively, in 2011, while rates in men having sex with men (MSM) were stable but high (18.8%) through the documented years. Younger age, origin from Surinam/Antilles, history of previous STI, multiple partners, or a previous notification are the identified risk factors for an STI in this population. Known HIV-infected men (MSM and heterosexuals) were at highest risk for co-infections (relative rate heterosexual men: 15.6; MSM: 11.6). STI positivity rates remained high (MSM) or increased over time (women and heterosexual men), a fact that highlights the importance of continuing STI prevention. Most importantly, the very high STI co-infection rates among HIV-positive men requires intensified STI reduction strategies to put an end to the vicious circle of re-infection and spread of HIV and other STIs.

Sexual behaviour and sexually transmitted infections in sexually transmitted infection clinic attendees in the Netherlands, 2007-2011.

Sexually tranSmitted infectionS in the netherlandS in 2006

The nationally covered low threshold STI centres offering STI care
targeted at high risk groups, provide surveillance data to monitor
national trends in STI, including HIV. In 2006, chlamydia remained the
most commonly diagnosed bacterial STI in the Netherlands in the STI
centres, in spite of stabilizing trends in MSM and heterosexual men. The
majority of chlamydia diagnoses were made in young heterosexuals. The
decreasing trend in diagnoses of gonorrhoea (in heterosexuals) and
syphilis continued further in 2006. Both infections were most prevalent
among MSM. Additionally, a new increase in LGV diagnoses was observed
among MSM, indicating that continued awareness is needed. As of June
2007, a cumulative total of 13,086 HIV cases, under medical care, had
been recorded in the Netherlands. In 2006, 871 new cases were recorded
in the national HIV registry of the HMF. The proportion of MSM among HIV
cases reporting for care increased again in 2006. Concurrent STI were
often diagnosed among HIV positive MSM visiting STI centres. Continuing
STI and HIV transmission in this high risk group warrants intensified and
innovative interventions. As in previous years, specific ethnic
minorities (for instance from Surinam, the Netherlands Antilles and
Aruba) had higher positivity rates for genital chlamydial infection,
gonorrhoea and syphilis (heterosexual men) than autochthonous Dutch,
indicating the need for targeted intervention by risk profile. 
Furthermore, the majority of HIV infected heterosexuals entering in care,
reported to have acquired their infection abroad. In 2006, the
percentage of ciprofloxacin resistance in gonococci further increased up
to 38% (among MSM 45 %). So far, resistance to cephalosporins, current
recommended first line therapy, has not yet been recorded. Alertness
remains indicated.

Elm Op de Coul

Papers

Sexual behaviour and sexually transmitted infections in sexually transmitted infection clinic attendees in the Netherlands, 2007-2011.

Sexually tranSmitted infectionS in the netherlandS in 2006

Sexually transmitted infections, including HIV, in theNetherlands in 2006