Syphilis on the rise: A prolonged syphilis outbreak among HIV-infected patients in Northern Greece.
BACKGROUND
Sexually transmitted diseases (STDs) are a major public health issue in Europe. Numerous outbreaks of syphilis have been described recently and an increased prevalence of high-risk sexual practices has raised concern about the transmission of HIV and other STDs. Similarly, an increase in sexually transmitted infections has been recorded in Northern Greece.


METHODS
This report describes a recent outbreak of syphilis in people living with HIV. The demographic, clinical, and serologic data of HIV patients diagnosed with syphilis were recorded and analyzed. Data on syphilis incidence from the general population was also compared to HIV patients' data.


RESULTS
Fifty-eight HIV-patients of the Infectious Diseases Unit of a tertiary hospital (5.2%) were diagnosed with syphilis during a three-year period (2008-2010). Highly active antiretroviral therapy (HAART) and coexistence of other STDs were independent predictors of syphilis (OR: 2.4, 95CI%: 1.26, 4.63, p=0.008; OR: 9.4, 95%CI: 4.49, 19.64, p<0.001, respectively). Origin from a country other than Greece (p=0.005), and homosexual contact (p=0.003), were separate risk factors for syphilis in the general population in the same area.


CONCLUSIONS
Diagnosis of a sexually transmitted disease in an HIV patient is a crucial clinical event that should trigger the clinician's suspicion for high-risk sexual behavior. Sexual health assessments should be a routine process for HIV patients.
MD, PhD, Resident in Internal Medicine, Research Associate in Infectious Diseases 1st Internal Medicine Department, Infectious Diseases Division, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Greece.
Olga
O
Tsachouridou
MD, PhD, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Lemonia
L
Skoura
MD, PhD, 1st Internal Medicine Department, Infectious Diseases Division, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Greece.
Eirini
E
Christaki
MD, 1st Internal Medicine Department, Infectious Diseases Division, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Greece.
Panagiotis
P
Kollaras
MD, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eleni
E
Sidiropoulou
MD, PhD, 1st Internal Medicine Department, Infectious Diseases Division, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Greece.
Pantelis
P
Zebekakis
MD, PhD, Dermatology and Venereal Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki Greece.
Efstratios
E
Vakirlis
MSc, National AIDS Reference Centre of Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Apostolia
A
Margariti
MSc, National AIDS Reference Centre of Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Symeon
S
Metallidis
HIV; Syphilis; coinfection; outbreak; sexually transmitted diseases