{"id":1194,"date":"2016-07-18T17:25:07","date_gmt":"2016-07-18T16:25:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1194"},"modified":"2016-07-18T17:25:07","modified_gmt":"2016-07-18T16:25:07","slug":"global-patterns-in-ante-natal-syphilis-prevalence-why-is-sub-saharan-africa-different","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/07\/18\/global-patterns-in-ante-natal-syphilis-prevalence-why-is-sub-saharan-africa-different\/","title":{"rendered":"Global patterns in ante-natal syphilis prevalence: Why is sub-Saharan Africa different?"},"content":{"rendered":"

\u2018Can a meaningful pattern be discerned in the large variations in syphilis rates over the last century?\u2019 This is the question addressed by a recent systematic review \u2013 Kenyon & Tsoumanis<\/a> (K&T) \u2013 based on published data on ante-natal syphilis prevalence (ASP) from those countries for which that data is available since at least 1951.\u00a0\u00a0 This cutoff reduces the number of countries that qualify for inclusion, but allows more recent trends in the late twentieth, and early twenty-first, centuries, to be set against the background of the impact of the introduction of penicillin in the 1950s. A pattern emerges from the data, which K&T then to seek to explain by investigating its association with various potential variables through multivariate analysis: per capita GDP; circumcision practice; health expenditure; efficacy of diagnosis\/treatment; geographical region.<\/p>\n

The pattern itself is: in most parts of the world<\/strong>, a more or less steep decline following the introduction of penicillin \u2013 ultimately, by the 1990s, to below 1%<\/strong>, and by the 2000s, to below (massively below, in many cases) 0.5%<\/strong>; in sub-Saharan Africa<\/strong> alone, a decline plateauing out at around 6%<\/strong> up until the end of the twentieth century, when there is a further decline to just above 1.5%<\/strong>.\u00a0 A limitation of the study is its concentration on eleven countries for which ASP data is available from before the days of penicillin, with only two of those countries being in sub-Saharan Africa (South Africa and Zimbabwe).\u00a0 So far as concerns more recent evidence for ASP prevalence, the kind of rates that the authors give for SA and Zimbabwe seem, broadly, to be replicated in other countries of sub-Saharan Africa (Otieno-Nyunya & Kaiser\/STIs<\/a> (Kenya); Makasa & Sandoy\/STIs<\/a> (Zambia); Kirakoya-Samadoulougou & Nagot\/STIs<\/a> (Burkina-Faso);\u00a0 Ardu-Sarkodie & Peeling\/STIs<\/a> (Ghana), and their rates for the other regions to be replicated in other non-sub-Saharan African settings (Cheng & Cai\/STIs<\/a> (China); Galdava & Domeika\/STIs<\/a> (Georgia) Thirumoorthy & Lim\/STIs<\/a> (Singapore)).<\/p>\n

As for the explanation of this pattern, the authors find no association on multivariate analysis with any of their potential variables, save with residence in sub-Saharan Africa.\u00a0 This is itself an interesting negative finding, and prompts the authors to consider other population-level correlations also included in the evidence reviewed \u2013 notably, with prevalence of HIV and HSV-2; \u2018the populations that in the 1990s had high prevalences of syphilis and HSV-2 went on to have high HIV prevalences\u2019.\u00a0 The correlation with prevalence of HSV-2 is of particular interest because it is unlikely that the prevalence of the one infection could have influenced that of the other (see also: Hochberg & Dandona\/STIs<\/a>).\u00a0 To K&T, it suggests the likely importance of \u2018more connected sexual networks\u2019 and \u2018greater partner concurrency\u2019 in explaining traditionally \u2013 and currently \u2013 high relative ASP levels in sub-Saharan Africa.\u00a0 However, they refer to studies that contest this hypothesis, and emphasize the need for further research to elucidate the factors underpinning difference in syphilis rates \u2013 especially given the possibility that the successful use of ART in those countries may be accompanied by the re-establishment of former sexual networks.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u2018Can a meaningful pattern be discerned in the large variations in syphilis rates over the last century?\u2019 This is the question addressed by a recent systematic review \u2013 Kenyon & Tsoumanis (K&T) \u2013 based on published data on ante-natal syphilis prevalence (ASP) from those countries for which that data is available since at least 1951.\u00a0\u00a0 […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[151,2783,2273,2381],"tags":[],"class_list":["post-1194","post","type-post","status-publish","format-standard","hentry","category-epidemiology","category-historical","category-hsv-2","category-syphilis"],"yoast_head":"\nGlobal patterns in ante-natal syphilis prevalence: Why is sub-Saharan Africa different? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/07\/18\/global-patterns-in-ante-natal-syphilis-prevalence-why-is-sub-saharan-africa-different\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Global patterns in ante-natal syphilis prevalence: Why is sub-Saharan Africa different? 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