title: Characterizing the syphilis epidemic among men who have sex with men in Lima, Peru to identify new treatment and control strategies.
abstract: BACKGROUND
  Syphilis is an important sexually transmitted infection (STI) with serious public health consequences. Among men who have sex with men (MSM) in Lima, the prevalence and incidence are extraordinarily high. Current syndromic approaches, however, fail to identify asymptomatic cases, and in settings where large proportions of individuals test positive again after treatment, it is frequently difficult to distinguish treatment failure from re-infection. Thus, new approaches are needed to improve treatment strategies and public health control efforts.
  
  
  METHODS
  Study participants will undergo baseline testing for syphilis infection along with a behavioral survey covering demographics, sexual behavior, drug and alcohol abuse and health-care seeking behavior. The cohort will be followed for 18 months at three-month intervals. Blood and earlobe scrapings will also be collected for T. pallidum DNA testing, to create molecular markers for subtyping. We will also perform cytokine testing on collected samples in order to create host immunologic profiles associated with recurrence, re-infection, treatment failure and success.
  
  
  CONCLUSIONS
  Advances in social epidemiology, molecular typing and characterization of host immune responses will offer promise in developing new understandings of syphilis management. We will share our findings with the Peruvian Ministry of Health and other public health organizations, to identify new approaches of case detection and successful treatment.
authors.affiliation: Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru, Av, Armendariz 445 Lima 18, Peru. carlos.caceres@upch.pe.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Deiss
authors.forename: Segundo R
authors.initials: SR
authors.lastname: Leon
authors.forename: Kelika A
authors.initials: KA
authors.lastname: Konda
authors.forename: Brandon
authors.initials: B
authors.lastname: Brown
authors.forename: Eddy R
authors.initials: ER
authors.lastname: Segura
authors.forename: Jerome T
authors.initials: JT
authors.lastname: Galea
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Caceres
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
mesh_terms: D000328:Adult; D015331:Cohort Studies; D058872:Epidemics; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D014210:Treponema pallidum / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
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