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INFECTION AMONG PATIENTS WITH SYPHILIS AND CHANGE IN THE MORBIDITY STRUCTURE OF CONCURRENT SYPHILIS AND HIV INFECTION

CHAPTER 4. CHANGES IN THE MEDICAL, SOCIAL AND EPIDEMIOLOGICAL

CHARACTERISTICS OF PATIENTS WITH SYPHILIS CONCURRENT WITH HIV INFECTION IN OBSERVATION GROUPS AND RISK FACTORS OF

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INTRODUCTION

Research Rationale

Syphilis remains one of the most significant sexually transmitted infections (STI) globally. The disease is annually recorded in more than 20,000 people cross Russia [3]. Syphilis morbidity dropped from 59.6 to 9 cases per 100,000 people from 2008 to 2020, while cases have increased over the past two years amounting to as many as 17.5 cases per 100,000 people in 2022. However, the forms of syphilis are re-distributed with the prevalence of latent forms of syphilis and increased frequency of nervous system impairment [3]. The consistent pattern of this redistribution is still the subject of research [4, 9, 14].

An increase in the number of patients with concurrent syphilis and HIV infection requires special attention [5, 7, 10, 19, 22]. According to various researchers, the frequency of HIV infection in syphilis patients varies, averaging 3.4% and reaching 5% among the patients hospitalised for the treatment of syphilis [10, 22]. In some groups of patients, e.g., among men who have sexual contacts with men (MSM) suffering from syphilis, the frequency of HIV infection is significantly higher and tends to grow. Thus, 20 years ago, the number of MSM among patients with the concurrent infection did not exceed 20 to 25% [10], while currently, it reaches 90% of all cases.

The risk factors for STIs, including syphilis and HIV infection, are well known and include uncontrolled sexual behaviour, lack of a permanent partner, homosexual relations, concurrent STIs, and low level of awareness of these diseases. In this respect, the impact of each risk factor changes significantly depending on the region, the population studied, characteristics of the sexual behaviour, and the period of research [29]. The factors contributing to the development of syphilis and HIV concurrent infection are fast-changing [5, 22, 24]. Thus, in 2000s, the main route of HIV infection transmission was a blood-borne route, while in the latest 15 years, the cases of HIV infection transmission via genital tract have increased 10-fold in St. Petersburg from 7.5% to 76.7% [1]. A similar trend is observed in the country overall [2]. Therefore, as of lately, HIV infection has been increasingly often regarded as a sexually transmitted