Epidemiology, syphilis, epidemic, investigation, health protection, outbreak control, public health, surveillance
In the late 1990s, cases of infectious
syphilis started to increase in north
Wales in men reporting sex with
men (MSM). In 2002, an increase
was also observed in south Wales
following an outbreak in a network
of MSM in a sauna. Consequently, an
enhanced surveillance scheme was
implemented in Wales, and these
data have since been collected and
analysed. Between 2002 and 2011,
676 cases were reported; 72%
(n=487) were in MSM, 17% (n=114)
were in heterosexual men and 11 %
(n=71) were in heterosexual women.
Over the 10 year period, the number
of recorded heterosexual cases
remained relatively level, peaking
in 2006 and 2007 in females and
males, respectively. The majority of
heterosexual men (78%) were UK-born, and 55% were thought to have
acquired their infection in Wales. The
majority of heterosexual men (66%) were diagnosed as primary or
secondary syphilis, as was also the
case for MSM (73%). In heterosexual
women, however, 41% of cases
were not detected until the early
latent stage and of these a third was
detected via antenatal screening,
highlighting the importance of this
programme. Only 59% of women
presenting during early latent
syphilis were born in the UK, whereas 92% of those presenting during
primary or secondary syphilis were
UK-born. A greater understanding
of the epidemiology of syphilis in
heterosexual individuals will enable
us to deliver more effective, targeted
public health interventions.