Syphilis in the most at-risk populations in Latin America and the Caribbean: a systematic review.
OBJECTIVE
To describe syphilis prevalence in men who have sex with men (MSM), the transgender population, and sex workers and their clients, identifying critical geographical areas, trends, and data gaps in Latin America and the Caribbean.


METHODS
A systematic review of syphilis prevalence was conducted by searching PubMed, LILACS, EMBASE, conference records, and other sources (2000-2010).


RESULTS
Forty-eight articles were included in the review, from which 84 data points were identified relating to MSM and female sex workers and only 10 relating to the transgender population, male sex workers, and clients of sex workers. Most studies were from Latin America (83%), with fewer from the Caribbean (17%). Critical 'hotspot' cities were Sao Paulo, Buenos Aires, Guatemala, Puerto Barrios, San José, San Pedro, Managua, San Salvador, and Acajutla, with high syphilis prevalence in more than one study population. Gaps in the availability of information on syphilis prevalence were identified for Ecuador, Uruguay, and Bolivia, and most countries in the Caribbean. Chronological trends showed that syphilis infection is well-established among the study populations.


CONCLUSIONS
Consistently high levels of syphilis among the investigated populations throughout the study period show that there is a need to improve monitoring, surveillance, and evaluation of sexually transmitted infection control interventions among these populations. Improved reporting and standardization of syphilis testing is recommended, as well as a heightened focus on more effective syphilis control strategies.
HIV/STI Project, Family and Community Health Area, Pan American Health Organization, 525 Twenty-third Street, NW, Washington, DC 20037, USA.
Ana Clara
AC
Zoni
Mónica Alonso
MA
González
Helena Werin
HW
Sjögren
D017691:Caribbean Region / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology*; D014189:Transsexualism / Q000453:epidemiology