Assessing the drivers of syphilis among men who have sex with men in Switzerland reveals a key impact of screening frequency: A modelling study

• Main Authors: Anagnostopoulos, A. (Author), Balakrishna, S. (Author), Battegay, M. (Author), Bernasconi, E. (Author), Böni, J. (Author), Braun, D.L (Author), Bucher, H.C (Author), Calmy, A. (Author), Cavassini, M. (Author), Ciuffi, A. (Author), Dollenmaier, G. (Author), Egger, M. (Author), Elzi, L. (Author), Fehr, J. (Author), Fellay, J. (Author), Furrer, H. (Author), Fux, C.A (Author), Günthard, H. (Author), Günthard, H.F (Author), Haerry, D. (Author), Hasse, B. (Author), Hirsch, H.H (Author), Hoffmann, M. (Author), Hösli, I. (Author), Huber, M. (Author), Kachalov, V. (Author), Kahlert, C.R (Author), Kaiser, L. (Author), Keiser, O. (Author), Klimkait, T. (Author), Kouyos, R.D (Author), Kovari, H. (Author), Kusejko, K. (Author), Ledergerber, B. (Author), Martinetti, G. (Author), Martinez de Tejada, B. (Author), Marzolini, C. (Author), Metzner, K.J (Author), Müller, N. (Author), Nicca, D. (Author), Paioni, P. (Author), Pantaleo, G. (Author), Perreau, M. (Author), Rauch, A. (Author), Roth, J.A (Author), Rudin, C. (Author), Salazar-Vizcaya, L. (Author), Scherrer, A.U (Author), Schmid, P. (Author), Schmidt, A.J (Author), Speck, R. (Author), Stöckle, M. (Author), Tarr, P. (Author), the Swiss HIV Cohort Study (SHCS) (Author), Thurnheer, M.C (Author), Trkola, A. (Author), Vernazza, P. (Author), Wandeler, G. (Author), Weber, R. (Author), Yerly, S. (Author)
• Format: Article
• Language: English
• Published: Public Library of Science 2021
• Subjects: adult; Adult; Article; biology; bisexual male; cohort analysis; Computational Biology; condom use; controlled study; disease duration; disease transmission; HIV Infections; homosexual male; Homosexuality, Male; human; Human immunodeficiency virus infection; Humans; incidence; Incidence; infection risk; major clinical study; male; Male; male homosexuality; mass screening; Mass Screening; mathematical model; men who have sex with men; middle aged; Middle Aged; risk behavior; risk factor; screening; Switzerland; syphilis; Syphilis; unsafe sex; Unsafe Sex
• Online Access: View Fulltext in Publisher

 Over the last decade, syphilis diagnoses among men-who-have-sex-with-men (MSM) have strongly increased in Europe. Understanding the drivers of the ongoing epidemic may aid to curb transmissions. In order to identify the drivers of syphilis transmission in MSM in Switzerland between 2006 and 2017 as well as the effect of potential interventions, we set up an epidemiological model stratified by syphilis stage, HIV-diagnosis, and behavioral factors to account for syphilis infectiousness and risk for transmission. In the main model, we used 'reported non-steady partners' (nsP) as the main proxy for sexual risk. We parameterized the model using data from the Swiss HIV Cohort Study, Swiss Voluntary Counselling and Testing center, cross-sectional surveys among the Swiss MSM population, and published syphilis notifications from the Federal Office of Public Health. The main model reproduced the increase in syphilis diagnoses from 168 cases in 2006 to 418 cases in 2017. It estimated that between 2006 and 2017, MSM with HIV diagnosis had 45.9 times the median syphilis incidence of MSM without HIV diagnosis. Defining risk as condomless anal intercourse with nsP decreased model accuracy (sum of squared weighted residuals, 378.8 vs. 148.3). Counterfactual scenarios suggested that increasing screening of MSM without HIV diagnosis and with nsP from once every two years to twice per year may reduce syphilis incidence (at most 12.8% reduction by 2017). Whereas, increasing screening among MSM with HIV diagnosis and with nsP from once per year to twice per year may substantially reduce syphilis incidence over time (at least 63.5% reduction by 2017). The model suggests that reporting nsP regardless of condom use is suitable for risk stratification when modelling syphilis transmission. More frequent screening of MSM with HIV diagnosis, particularly those with nsP may aid to curb syphilis transmission. Copyright: © 2021 Balakrishna et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.