Seroprevalence and Risk Factors of Syphilis among Hiv/aids Patients in Istanbul, Turkey

By Aydin, Özlem Altuntas; Karaosmanoglu, Hayat Kumbasar et al. | Central European Journal of Public Health, March 2015 | Go to article overview

Seroprevalence and Risk Factors of Syphilis among Hiv/aids Patients in Istanbul, Turkey


Aydin, Özlem Altuntas, Karaosmanoglu, Hayat Kumbasar, Sayan, Murat, Ince, Emine Rahsan, Nazlican, Özcan, Central European Journal of Public Health


SUMMARY

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^sup +^ T lymphocyte count, HIV RNAIevel, 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/mm^sup 3^). 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.

Key words: syphilis, HIV, epidemiology, Turkey, seroprevalence

INTRODUCTION

Sexually transmitted infections (STI) cause serious public health problems in many parts of the world. Syphilis is an STI caused by Treponema pallidum. Unprotected sexual contact, blood transfusion, vertical transmission from mother to baby are the main transmission routes for syplulis and human immunodeficiency virus (HIV) infections (1). The relationship between HIV and syplulis has not been clearly identified despite 30 years of clinical experience (2). HIV/AIDS patients with early-stage syplulis have greater HIV transmission risk due to the presence of gemtal/oral ulcers, decreased CD4+ T lymphocyte count and increased viral load. On the other hand, impaired cellular and humoral immunity in HIV infection lowers host defense against T. pallidum, leading to changes in the natural course and clinic progression of syphilis, shortened incubation time, and increased number and infectiousness of syphilis lesions (3, 4). Therefore, international guidelines recommend periodic serological testing of syplulis in all HIV-infected patients (5, 6). The first case of HIV/AIDS in Turkey was reported in 1985. The current number of HIV-infected cases in Turkey is 6,188 according to the surveillance conducted by the Turkish Ministry of Health from October 1985 to December 2012 (7). In a recent study of antiretroviral naive HIV-1 infected patients, sexual contact was predominantly reported as an infection transmission route - heterosexual contact in 64% and homosexual contact in 32% of cases (8). An increase m the number of HIV/AIDS patients as a sexually active group has been observed in Turkey, which might have led to an increase m the number of syplulis cases. In Turkey, various investigations on potential risk groups revealed syphilis seroprevalence as 0.11% among blood donors, 4.4-9.1% among sex workers, and 14% among homosexual men (9-12). Even though they share transmission routes, there are no data on syphilis seroprevalence of HIV/AIDS cases in Turkey. …

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