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Open Access Study protocol

Characterizing the syphilis epidemic among men who have sex with men in Lima, Peru to identify new treatment and control strategies

Robert G Deiss1, Segundo R Leon35, Kelika A Konda2, Brandon Brown4, Eddy R Segura2, Jerome T Galea36, Carlos F Caceres3* and Jeffrey D Klausner2

Author Affiliations

1 Division of Infectious Diseases, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 466, Torrance, CA 90502, USA

2 Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA

3 Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru

4 Program in Public Health, Department of Population Health & Disease Prevention, University of California, Irvine, 653 E. Peltason Road Suite 2010, Irvine, CA 92697-3957, USA

5 Department of Global Health, University of Washington, Harborview Medical Center, 325 9th Avenue Box 359931, Seattle, WA 98104, USA

6 Centre for Sexual Health and HIV Research, Faculty of Population Health, University College London, Gower St, London, Greater London WC1E 6BT, UK

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BMC Infectious Diseases 2013, 13:426  doi:10.1186/1471-2334-13-426

Published: 10 September 2013

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/Design

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.

Discussion

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.

Keywords:
Syphilis; Peru; Men who have sex with men (MSM); HIV; T. pallidum; Molecular epidemiology; Cytokine; Macrolide resistance