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Background Substantial increases in syphilis have been reported since the early 2000s in northern countries, particularly among men who have sex with men (MSM). The authors aimed to identify risk factors for early syphilis in MSM in Lille, a large urban area of northern France. Methods A matched case–control study was conducted in MSM aged ≥18 years. Cases were diagnosed with primary, secondary or early latent syphilis between April 2008 and June 2010. Controls sought care in STIs clinics or were followed in an HIV clinic. Controls had no history of and no current syphilis. They were matched to cases for age and HIV status. Multivariate conditional logistic regression models were used to identify risk factors for early syphilis. Results 53 patients with early syphilis were enrolled. Average age was 37 years, and 47% were HIV-infected. For analysis, they were matched to 90 controls. Factors associated with syphilis were: low educational attainment (OR=5.38, 95% CI 1.94 to 14.94; p=0.001), receptive oral sex with casual male partners without a condom (OR=4.86, 95% CI 1.63 to 14.48; p=0.005) and anal sex toy use with casual male partners (OR=2.72, 95% CI 1.01 to 7.32; p=0.05). Seeking of sex partners online (OR=5.17, 95% CI 1.33 to 20.11), use of poppers (OR=2.2, 95% CI 1.1 to 4.3) and erectile dysfunction drugs (OR=1.9, 95% CI 1.0 to 13.2) were associated with syphilis only in the univariate analysis. Conclusions Receptive oral sex without a condom and use of anal sex toys were identified as presenting a major risk of syphilis infection. Although these practices have been shown to present low risk of HIV transmission, the general public is unaware of their impact on transmission of other STIs.

Objective To describe a community-based HIV testing programme. Design and setting An intervention of HIV voluntary testing conducted in non-medical settings in four French cities. Participants Men who have sex with men (MSM). Intervention Counselling and rapid HIV testing staffed by trained personnel from an HIV/AIDS community-based organisation. Primary and secondary outcome measures The population that has taken hold of the intervention and the satisfaction of participants. Data were collected on demographics, HIV testing history, sexual practices and satisfaction with the testing programme. Results 532 MSM were tested between February 2009 and June 2010, of whom 49 (9%) were tested two or more times. 468 MSM (88%) had casual male partners in the previous 6 months, and 152 (35%) reported having unprotected anal intercourse with risky casual partners (HIV infected or HIV serostatus unknown). 159 men (30%) had not been tested in the previous 2 years, and 50 (31%) of whom had unprotected anal intercourse with risky casual partners. Among the 15 patients who tested positive (2.8%), 12 (80%) received confirmation and were linked to care (median CD4 cell count =550/mm3). Satisfaction was high: 92% reported being ‘very satisfied’ with their experience. Steps of counselling and testing procedure were respected by testers and difficulties in handling tests were rare. Conclusions This community-based HIV testing programme reached high-risk MSM, of whom a substantial proportion had not been tested lately. This novel service supplements pre-existing HIV testing services and increases access to HIV testing in high-risk groups., Article summary Article focus How extend testing facilities to reach and test for HIV more MSM and diagnose HIV-infected MSM earlier? The presence of peers and non-clinical staff members who address sexuality more openly and avoid medical jargon during counselling sessions could offset cultural barriers and reduce fears of HIV and associated stigma. The article describes an experimental programme of community-based HIV testing: the population reached, the quality of the programme and the satisfaction of participants. Key messages This community-based HIV testing and counselling programme reaches MSM with high-risk sexual behaviour, a substantial proportion of whom has not tested for HIV recently. Community testers are able to perform rapid HIV test into a comprehensive prevention approach in line with participant's life. 2.8% of participants tested positive. Infection was confirmed in all cases, 80% were linked to care. Cases were diagnosed at early stages of disease. Strengths and limitations of this study This HIV testing and counselling programme is exclusively based on MSM community, and continuing the prevention counselling with the awareness of the HIV serostatus includes testing into a comprehensive prevention approach. Community-based HIV testing programmes may be attractive and efficient in large urban areas (like Paris), but perhaps less so in smaller cities, where an outreach approach may work better. The number of HIV diagnoses was small; the prevalence and median CD4 count among the few HIV-infected participants should therefore be interpreted with caution.