Syphilis and gonorrhoea in Paris: the return

We report here on 10 cases of early syphilis in men diagnosed in our sexually transmited diseases (STD) centre in Paris between March and November 2000. We also report a 104% overall increase of bacteriological confirmed gonococcal infections (BCGI) during the same 9 month study period during 5 years. It has been reported that an increase in sexual risk-taking among San Fransisco gay men has correlated with increasing rates of rectal gonorrhoea in this population [1]. Recently, an increase in the incidence of gonorrhoea in London and in other places in the UK has been reported [2,3]. In 1999, an epidemiological study in France (the RENAGO study) [4] suggested an increase in the incidence of gonococcal infections between 1997 and 1998. A limited syphilis outbreak has also been reported in the USA [5], but no information on new cases of early syphilis is available from France. Between March 2000 and November 2000, one heterosexual man and nine homosexual men consulted at our STD centre for early syphilis. Five patients were HIV positive, three were HIV negative, and the HIV status was unknown in the last two cases because the patients declined a blood test for HIV serology. The mean clinical and biological features of the patients are summarized in Table 1. Three patients were diagnosed with primary syphilis and seven were diagnosed with secondary syphilis. One HIV-positive patient had previously been hospitalized in 1994 for neurosyphilis, another HIV-positive patient had urethritis 2 weeks before consulting for secondary syphilis, and a third HIV-infected patient had concomitant non-specific urethritis. Two HIV-infected patients were undergoing highly active antiretroviral therapy (HAART) combining stavudine, lamivudine and indinavir, with respective CD4 cell counts of 667 and 250/mm3, the HIV-RNA plasma viral load was 17 000 copies per ml in one patient and undetectable in the other. The three other HIV-infected patients were not treated with antiviral therapy, their CD4 cell count were 829, 601, and 260/mm3, respectively, and their HIV-RNA plasma viral loads were 4490 and 427 copies/ml and not available in the last case. None of the HIV-infected patients had neurosyphilis. Patients were treated with 2.4 × 106 units of benzathine penicillin G.Table 1: Mean clinical and biological features of the 10 gay men presenting with early syphilis. These observations suggest a large increase in high-risk sexual practices among gay men living in Paris, because during the past few years no new cases of early syphilis had been diagnosed at our STD center. This is in accordance with a large increase in gonoccocal infections reported in our center since 1995. In Table 2, we report the number of BCGI and the total of STD leading to treatment for gonococcal infection, comprising BCGI and urethritis or rectitis suspected of gonococcal origin because of both clinical symptoms and presence of intracellular Gram-negative diplococcus after Gram staining, but which cannot be isolated after culture (total gonococcal infections). As is shown, we observed a 104% overall increase in BCGI, with 23 cases in 1996 and 47 cases in 2000. As is reported, there was also an increase in the proportion of suspected versus BCGI cases since 1997, corresponding with the introduction of HAART for the treatment of HIV-infected patients. It could be that HAART may interact with the culture capacity of Neisseiria gonorrhoeae. This hypothesis needs to be explored further.Table 2: Number of gonococcal infections during 5 years The increase in both early syphilis and gonococcal infections contrasts with the decrease in the number of visits to our STD centre, with 6476 consultations for the first 9 months of 1998 falling to 5044 consultations during the same period in 2000 (Table 2). We therefore emphasize the need for continued surveillance of these STD in Paris and in other places in France, in order to focus sexual health promotion activities on controling their increasing incidence and preventing the risk of new HIV contaminations. Acknowledgements The authors would like to thank the staff of the STD Center at Hôpital Tarnier, Paris, France. Nicolas Dupin Randa Jdid Yen-Ti N'Guyen Isabelle Gorin Nathalie Franck Jean-Paul Escande