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Background: Earlier detection of syphilis is needed to reduce infectiousness and transmission and improve control. PCR for Treponema pallidum is highly sensitive for detecting primary syphilis but in many settings is not widely available or used. The aim of this systematic review was to investigate what proportion of PCR-positive primary syphilis infections are seronegative for syphilis, when serology is performed at clinical presentation for primary syphilis. Methods: We undertook a systematic review to identify studies of patients presenting with primary syphilis where PCR for T. pallidum was performed on the primary syphilis lesion and serology for syphilis on the same occasion. The review was conducted according to the PRISMA checklist. Three databases (Medline, Embase, PubMed) were searched from 1 January 2000 to 27 November 2022. Only studies published in English were included. The search terms used were: 'primary syphilis', 'Treponema pallidum', 'polymerase chain reaction', 'PCR', 'nucleic acid amplification test', 'NAAT'. Medical subject headings (MeSH) were used where possible. Results: Of 2,569 studies identified, 10 studies were included: 2 prospective, 7 retrospective and 1 mixed prospective and retrospective. All studies were conducted in clinical/sexual health settings (Canada, Australia, UK, France, Czechia, Cuba). Across the 10 studies, there were a total of 1084 individuals who had T. pallidum positive primary lesions. This included 867 men: gender was not specified in 2 studies. A total of 1043 individuals with T. pallidum positive primary lesions had serology performed. Among these, 14% (147/1043) (95% CI: 12-16%) were negative by serology, ranging between 4% (4/108) (95% CI 1-9%) and 50% (51/102) (95% CI: 40- 60%). Among studies where the anatomical site of the primary lesion was provided there were a total of 503 anogenital and 8 oral primary lesions that were T. pallidum PCR-positive. Conclusion: Among patients with primary syphilis, a proportion will have PCR-confirmed primary infection when serology is negative. This proportion may vary depending on a number of factors. More widespread availability and appropriate testing with PCR for T. pallidum may improve detection of primary syphilis, resulting in earlier diagnosis. [ABSTRACT FROM AUTHOR]

Background: Syphilis epidemics are worsening in many countries and earlier diagnosis is needed to reduce infectiousness and transmission. Better detection of primary syphilis is needed in primary care settings as this is where many syphilis cases present. The aim of this study was to evaluate whether the use of multiplex PCR testing of anogenital lesions for Treponema pallidum and herpes simplex virus (HSV) in general practice improves the detection of primary syphilis. Methods: Between September and December 2022, multiplex PlexPCR VHS (SpeeDx) testing for T. pallidum and HSV type-1 and -2 was performed on all clinical specimens received from general practitioners across Victoria using the Melbourne Pathology laboratory network if HSV PCR testing of anogenital lesions was requested in a patient aged ≥18, even if T. pallidum PCR was not requested. Multiplex PCR was also performed if testing for other STIs or T. pallidum PCR was requested. Clinics were made aware of this testing via a letter that included a link to an educational video on PCR testing for syphilis. Results: During the period,1,291 multiplex tests were performed, 882 in women and 398 in men, 18 of which were positive for T. pallidum. Of the positive T. pallidum samples, 6/18 (33%) (95%CI: 13-59%) were from patients where the practitioner had requested PCR for HSV but not T. pallidum: 2 female and 4 male. All 6 cases were negative for HSV on PCR. Among the 2 females, both swabs were from genital sites. Among the 4 males, 3 swabs were genital and one anal. Four individuals (2 women, 2 men) resided in more socioeconomically disadvantaged areas known to have higher rates of syphilis in women of reproductive age. Conclusion: Multiplex PCR testing for syphilis and herpes in primary care resulted in the detection of primary syphilis in male and female patients which may have otherwise not been identified. This is likely to have led to earlier diagnosis and treatment, potentially reducing infectiousness and progression of infection. [ABSTRACT FROM AUTHOR]

Project: Implementation of routine syphilis screening in later pregnancy at antenatal services across Victoria, Australia. Issue: Syphilis is increasing among women globally, leading to an increase in congenital syphilis in many countries. Screening for syphilis in later pregnancy could help prevent congenital syphilis but is generally only advised for women identified as being at high risk for infection. However, there are barriers to the identification of risk. This project adopted an implementation science approach to embed syphilis screening into the routine 28-week antenatal clinic visit undertaken by pregnant women across several antenatal services in Victoria with differing health service systems. Results: Data analysis from seven metropolitan and rural antenatal services informed the development of a low-cost implementation package to support practice change, with routine syphilis screening at the 28-week visit. The package comprises four core elements: (1) clinical guidelines recommending routine inclusion of syphilis serology with other blood tests taken for the 28-week visit; (2) automation of pathology ordering that includes syphilis testing with other tests; (3) clinician reminders within clinical records; and (4) training and resources for midwives and obstetricians including an educational video on screening and management for syphilis (Table 1). Use of a hybrid implementation framework identified contextual and behavioural barriers and facilitators that guided the development and integration of these elements to fit within existing clinical workflows and systems, including different systems for pathology ordering and electronic records. The Consolidated Framework for Implementation Research facilitated a deep contextual analysis of the intervention settings, informing tailored implementation strategies. The COM-B model for behaviour change assessed motivation, capability, and opportunity for change, which informed the development of training and resources. Lessons learned: Applying a change in process across varied health service settings required a deep contextual analysis of existing systems, local practices and resources within each setting. Meaningful engagement with clinical staff underpinned by implementation frameworks enabled identification of key elements for implementation that can be tailored according to local conditions. The resulting implementation package could be useful across a variety of healthcare settings to address the preventable epidemic of congenital syphilis. [ABSTRACT FROM AUTHOR]

Background: Crowdsourcing methods have been widely used in business, but rarely in sexual health research. We evaluated a crowdsourced logo contest as part of an international human immunodeficiency virus conference.Methods: A logo crowdsourcing contest was conducted for the 20th International Acquired Immunodeficiency Syndrome Conference. Crowdsourcing has a group of individuals solve a task, often as part of an open contest. Semistructured interviews were conducted with key informants including contest organizers, contest contributors, and conference attendees. Interviews were transcribed verbatim and analysed using a content analysis approach.Results: In total, 22 interviews were conducted with 3 contest organizers, 7 contest contributors, and 12 conference attendees. All individuals reported that the crowdsourced logo provided benefits beyond branding the conference, including creating a shared sense of purpose among diverse conference participants and explicitly demonstrating the strong community orientation of the conference. Conference organizers and attendees all reported deeper engagement because of the story of the Tanzanian artist who won the contest. Most conference attendees (11/12) preferred the crowdsourced logo compared with the previous company-organized logo, and all (22/22) supported the logo contest continuing. Implementing a logo contest was simple and relatively inexpensive. Stakeholders identified several ways to enhance crowdsourcing logo contest methods including wider promotion of the contest to encourage broader participation, greater transparency in the selection process, and a different prize structure which acknowledges the contribution of more contestants.Conclusions: We found that a crowdsourcing contest helped engage local and global communities in the lead-up before and during an international conference. Similar participatory events may be useful for sexual health conferences and research projects. [ABSTRACT FROM AUTHOR]

The article presents a study regarding an online partner notification website, Let Them Know, which offers e-mail and text message notification services to individuals diagnosed with chlamydia. It mentions that partner notification, in which individuals with a sexually transmitted infection (STI) inform their partners in order for their partner to be treated, is central to chlamydia control. It states that the use of communication technologies such as the Internet is an effective notification tool.