Syphilis in Martinique | CDC EID

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Volume 16, Number 1–January 2010
Dispatch
Reemergence of Syphilis in Martinique, 2001–2008
André Cabié, Bruno Rollin, Sandrine Pierre-François, Sylvie Abel, Nicole Desbois, Pascale Richard, Patrick Hochedez, Raphaëlle Théodose, Danielle Quist, Raymond Hélénon, Christian Derancourt, Annick Cavelier, and Bernard Liautaud
Author affiliations: Centre Hospitalier Universitaire de Fort-de-France, Fort-de-France, Martinique (A. Cabié, B. Rollin, S. Pierre-François, S. Abel, N. Desbois, P. Hochedez, R. Théodose, D. Quist, R. Hélénon, C. Derancourt, B. Liautaud); Clinical Research Center of French West Indies and French Guiana, Inserm CIE 802 (A. Cabié); Unité de Consultation et de Soins Ambulatoires Centre Médical Pénitentiaire de Fort-de-France (S. Abel, D. Quist); Etablissement Français du Sang, Fort-de-France (P. Richard); and Vernes STD Clinic, Fort-de-France (R. Hélénon, A. Cavelier)

Suggested citation for this article

Abstract
Syphilis reemerged in Martinique in 2004 and initially affected 3 HIV-infected patients. By March 2008, syphilis was diagnosed for 37 men and 18 women. As of October 31, 2009, this outbreak had not yet been brought under control. It initially affected mainly men who had sex with men before it spread to heterosexual persons, minority group members, and crack cocaine users.

Syphilis was expected to reemerge in Martinique after outbreaks occurred in large western urban centers in 1998 (1,2), and cases were reported in Guadeloupe in 2001 (3). Soon after the first cases were diagnosed in Martinique, we conducted a study to determine whether these cases represented an outbreak and to identify demographic and social determinants (4) of this outbreak.

The Study
In 2001, we increased syphilis screening at University Hospital in Fort-de-France, Martinique. Screening included use of the rapid plasma reagin (RPR) test and the Treponema pallidum hemaglutination assay (TPHA). All positive and discordant results were verified by using fluorescent treponemal antibody absorption, which detects T. pallidum–specific immunoglobulin (Ig) G and IgM. Darkfield microscopy was used whenever possible. We reviewed medical files of all patients who had received a diagnosis of syphilis during January 1, 2001–March, 31, 2008. Patients were included in the study if they had recent syphilis (primary, secondary, or early latent stage) as defined by the US Centers for Disease Control and Prevention (Atlanta, GA, USA) (5).

We investigated the yearly incidence of recent syphilis among HIV-infected patients treated at the infectious diseases unit of the hospital, at the Vernes Sexually Transmitted Disease (STD) Clinic (Fort-de-France, Martinique), and at anonymous voluntary counseling and testing clinics. We also obtained syphilis test results of all persons who were tested at the central laboratory of the hospital. Laboratory definition of active syphilis was an RPR titer >4 and a TPHA titer >80 for an initial screening test, or a 4-fold increase in RPR titer in samples after previously positive results. TPHA screening results for voluntary blood donors were collected at a blood bank.

Recent syphilis was diagnosed for 55 patients at University Hospital during 2001–2008 (Table 1). Patients (37 men and 18 women) had a median age of 41 years (interquartile range [IQR] 36–44 years). Twenty-one (57%) of 37 men were men who have sex with men (MSM), and 9 (43%) of 21 were bisexual. One fourth of the patients never used condoms. Of 36 patients questioned about oral sex, 30 admitted practicing oral sex, of whom only 2 (6.6%) always used condoms. Each patient's median number of sexual partners during the previous 12 months was 2.5 (IQR 1.5–3.5).

One of the first patients to receive a diagnosis in 2004 reported >100 sexual partners, most during a recent stay in Paris. Primary, secondary, and early latent syphilis was diagnosed in 12, 33, and 10 patients, respectively, and 21 patients with secondary syphilis had genital lesions. Cholestatic hepatitis developed in 7 of 29 HIV-positive patients. Six patients had neurosyphilis or ophthalmic syphilis, all of whom also had secondary rashes.

Median RPR titer for the 55 patients was 32. Results of darkfield microscopy were positive for 17 (74%) of 23 patient specimens, 5 from genital mucosa and 12 from skin lesions. All patients had prevention counseling and were successfully treated with penicillin (except for 1 patient who was successfully treated with azithromycin). Seven relapses occurred. More than half of the patients were HIV positive (53%): 22 with a previous diagnosis of HIV infection and 7 with a new diagnosis of HIV infection at the time of syphilis diagnosis. Median duration of HIV infection was 48 months (IQR 21–91 months), and median CD4 lymphocyte count was 516 cells/μL (IQR 340–639 cells/μL).

At the time of syphilis diagnosis, 8 patients were receiving highly active antiretroviral therapy, and 4 had an HIV viral load <50 copies/mL. Twenty-three patients (42%) were crack cocaine users, and 17 patients (7 heterosexual men, 2 MSM, and 8 women) (31%) lived in precarious conditions (defined as >1 of the following: homelessness, lack of welfare, being followed-up in a psychiatry unit, mental deficiency, having paid sex, incarceration in a correctional facility >2× in the past 5 years).


Suggested Citation for this Article
Cabié A, Rollin B, Pierre-François S, Abel S, Desbois N, Richard P, et al. Reemergence of syphilis in Martinique, 2001–2008. Emerg Infect Dis [serial on the Internet]. 2010 Jan [date cited]. Available from http://www.cdc.gov/EID/content/16/1/106.htm
DOI: 10.3201/eid1601.081730

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