Why is syphilis rising in Europe? Multi-level modelling of alternative hypotheses in 31 countries Article Swipe
Ana Mendez‐Lopez
,
David Stückler
,
Teymur Noori
,
J C Semenza
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1093/eurpub/ckaa165.534
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1093/eurpub/ckaa165.534
Background Syphilis transmission has increased markedly over the past two decades in Europe, concentrated in men who have sex with men. We test alternative potential social and behavioral individual- and population-level determinants of this resurgence. Methods Two rounds of the cross-sectional European Men who have sex with men Internet Survey (EMIS 2010 and 2017, n = 272,902) were used to fit multi-level linear probability models to evaluate determinants of the incidence of self-reported syphilis, capturing risky sexual behaviours and pre-exposure prophylaxis use, among others, adjusting for potential sociodemographic confounders. Results Self-reported syphilis incidence rates rose by about 1.8 percentage points (within the last 12 months) and 3.9 (within the last 5 years) between the 2010 and 2017 waves, after adjusting for sociodemographic factors. HIV status was a major risk factor for syphilis infection (27.6 ppt higher incident rate, 95%CI: 24.7 to 30.5). A dose-response relationship was observed between greater numbers of condomless non-steady partners and syphilis infection, with more than 10 partners estimating increases in the probability of diagnosis of over 25 ppt (11-20 partners vs none: 24.5 ppt, 95%CI: 20.5 to 28.5); further, we observed evidence of mediation for number of condomless non-steady partners, which attenuated the estimated rise in 2017 vs 2010 by about 35%. STI testing uptake also accounted for a substantial increase in syphilis incidence signaling higher detection rates over time. While country-level PrEP use was linked to greater number of condomless partners, there was no substantial impact of population-wide factors, including GDP and PrEP use, on overall syphilis trends. Conclusions Risky sexual behavior changes, particularly condomless sex with non-steady partners, appears to be a major contributing factor to rising syphilis incidence. Further research is needed to understand what accounts for this substantial behavior change. Key messages Increased number of condomless non-steady partners accounts for a substantial rise in syphilis trends. Population-level PrEP use was linked to increasing numbers of condomless non-steady partners but had no substantial impact on overall syphilis trends.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/eurpub/ckaa165.534
- https://academic.oup.com/eurpub/article-pdf/30/Supplement_5/ckaa165.534/33818355/ckaa165.534.pdf
- OA Status
- bronze
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3091791345Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1093/eurpub/ckaa165.534Digital Object Identifier
- Title
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Why is syphilis rising in Europe? Multi-level modelling of alternative hypotheses in 31 countriesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2020Year of publication
- Publication date
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2020-09-01Full publication date if available
- Authors
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Ana Mendez‐Lopez, David Stückler, Teymur Noori, J C SemenzaList of authors in order
- Landing page
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https://doi.org/10.1093/eurpub/ckaa165.534Publisher landing page
- PDF URL
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https://academic.oup.com/eurpub/article-pdf/30/Supplement_5/ckaa165.534/33818355/ckaa165.534.pdfDirect link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
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https://academic.oup.com/eurpub/article-pdf/30/Supplement_5/ckaa165.534/33818355/ckaa165.534.pdfDirect OA link when available
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Syphilis, Demography, Confounding, Medicine, Incidence (geometry), Population, Mediation, Men who have sex with men, Environmental health, Immunology, Human immunodeficiency virus (HIV), Internal medicine, Political science, Optics, Physics, Sociology, LawTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.GDP | 247 |
| abstract_inverted_index.HIV | 124 |
| abstract_inverted_index.Key | 290 |
| abstract_inverted_index.Men | 43 |
| abstract_inverted_index.STI | 208 |
| abstract_inverted_index.Two | 37 |
| abstract_inverted_index.and | 27, 30, 53, 79, 106, 116, 155, 248 |
| abstract_inverted_index.but | 318 |
| abstract_inverted_index.fit | 61 |
| abstract_inverted_index.for | 86, 121, 131, 190, 213, 285, 299 |
| abstract_inverted_index.had | 319 |
| abstract_inverted_index.has | 4 |
| abstract_inverted_index.men | 16, 48 |
| abstract_inverted_index.ppt | 135, 173 |
| abstract_inverted_index.sex | 19, 46, 262 |
| abstract_inverted_index.the | 8, 40, 70, 102, 109, 114, 166, 198 |
| abstract_inverted_index.two | 10 |
| abstract_inverted_index.use | 229, 308 |
| abstract_inverted_index.was | 126, 146, 230, 239, 309 |
| abstract_inverted_index.who | 17, 44 |
| abstract_inverted_index.20.5 | 181 |
| abstract_inverted_index.2010 | 52, 115, 204 |
| abstract_inverted_index.2017 | 117, 202 |
| abstract_inverted_index.24.5 | 178 |
| abstract_inverted_index.24.7 | 140 |
| abstract_inverted_index.35%. | 207 |
| abstract_inverted_index.PrEP | 228, 249, 307 |
| abstract_inverted_index.also | 211 |
| abstract_inverted_index.have | 18, 45 |
| abstract_inverted_index.last | 103, 110 |
| abstract_inverted_index.men. | 21 |
| abstract_inverted_index.more | 159 |
| abstract_inverted_index.over | 7, 171, 224 |
| abstract_inverted_index.past | 9 |
| abstract_inverted_index.ppt, | 179 |
| abstract_inverted_index.rise | 200, 302 |
| abstract_inverted_index.risk | 129 |
| abstract_inverted_index.rose | 95 |
| abstract_inverted_index.test | 23 |
| abstract_inverted_index.than | 160 |
| abstract_inverted_index.this | 34, 286 |
| abstract_inverted_index.use, | 82, 250 |
| abstract_inverted_index.used | 59 |
| abstract_inverted_index.were | 58 |
| abstract_inverted_index.what | 283 |
| abstract_inverted_index.with | 20, 47, 158, 263 |
| abstract_inverted_index.(27.6 | 134 |
| abstract_inverted_index.(EMIS | 51 |
| abstract_inverted_index.2017, | 54 |
| abstract_inverted_index.Risky | 256 |
| abstract_inverted_index.While | 226 |
| abstract_inverted_index.about | 97, 206 |
| abstract_inverted_index.after | 119 |
| abstract_inverted_index.among | 83 |
| abstract_inverted_index.major | 128, 270 |
| abstract_inverted_index.none: | 177 |
| abstract_inverted_index.rate, | 138 |
| abstract_inverted_index.rates | 94, 223 |
| abstract_inverted_index.risky | 76 |
| abstract_inverted_index.there | 238 |
| abstract_inverted_index.time. | 225 |
| abstract_inverted_index.which | 196 |
| abstract_inverted_index.(11-20 | 174 |
| abstract_inverted_index.28.5); | 183 |
| abstract_inverted_index.30.5). | 142 |
| abstract_inverted_index.95%CI: | 139, 180 |
| abstract_inverted_index.Survey | 50 |
| abstract_inverted_index.factor | 130, 272 |
| abstract_inverted_index.higher | 136, 221 |
| abstract_inverted_index.impact | 242, 322 |
| abstract_inverted_index.linear | 63 |
| abstract_inverted_index.linked | 231, 310 |
| abstract_inverted_index.models | 65 |
| abstract_inverted_index.needed | 280 |
| abstract_inverted_index.number | 191, 234, 293 |
| abstract_inverted_index.points | 100 |
| abstract_inverted_index.rising | 274 |
| abstract_inverted_index.rounds | 38 |
| abstract_inverted_index.sexual | 77, 257 |
| abstract_inverted_index.social | 26 |
| abstract_inverted_index.status | 125 |
| abstract_inverted_index.uptake | 210 |
| abstract_inverted_index.waves, | 118 |
| abstract_inverted_index.years) | 112 |
| abstract_inverted_index.(within | 101, 108 |
| abstract_inverted_index.Europe, | 13 |
| abstract_inverted_index.Further | 277 |
| abstract_inverted_index.Methods | 36 |
| abstract_inverted_index.Results | 90 |
| abstract_inverted_index.appears | 266 |
| abstract_inverted_index.between | 113, 148 |
| abstract_inverted_index.change. | 289 |
| abstract_inverted_index.decades | 11 |
| abstract_inverted_index.greater | 149, 233 |
| abstract_inverted_index.months) | 105 |
| abstract_inverted_index.numbers | 150, 313 |
| abstract_inverted_index.others, | 84 |
| abstract_inverted_index.overall | 252, 324 |
| abstract_inverted_index.testing | 209 |
| abstract_inverted_index.trends. | 254, 305, 326 |
| abstract_inverted_index.272,902) | 57 |
| abstract_inverted_index.Abstract | 0 |
| abstract_inverted_index.European | 42 |
| abstract_inverted_index.Internet | 49 |
| abstract_inverted_index.Syphilis | 2 |
| abstract_inverted_index.accounts | 284, 298 |
| abstract_inverted_index.behavior | 258, 288 |
| abstract_inverted_index.changes, | 259 |
| abstract_inverted_index.evaluate | 67 |
| abstract_inverted_index.evidence | 187 |
| abstract_inverted_index.factors, | 245 |
| abstract_inverted_index.factors. | 123 |
| abstract_inverted_index.further, | 184 |
| abstract_inverted_index.incident | 137 |
| abstract_inverted_index.increase | 216 |
| abstract_inverted_index.markedly | 6 |
| abstract_inverted_index.messages | 291 |
| abstract_inverted_index.observed | 147, 186 |
| abstract_inverted_index.partners | 154, 162, 175, 297, 317 |
| abstract_inverted_index.research | 278 |
| abstract_inverted_index.syphilis | 92, 132, 156, 218, 253, 275, 304, 325 |
| abstract_inverted_index.Increased | 292 |
| abstract_inverted_index.accounted | 212 |
| abstract_inverted_index.adjusting | 85, 120 |
| abstract_inverted_index.capturing | 75 |
| abstract_inverted_index.detection | 222 |
| abstract_inverted_index.diagnosis | 169 |
| abstract_inverted_index.estimated | 199 |
| abstract_inverted_index.incidence | 71, 93, 219 |
| abstract_inverted_index.including | 246 |
| abstract_inverted_index.increased | 5 |
| abstract_inverted_index.increases | 164 |
| abstract_inverted_index.infection | 133 |
| abstract_inverted_index.mediation | 189 |
| abstract_inverted_index.partners, | 195, 237, 265 |
| abstract_inverted_index.potential | 25, 87 |
| abstract_inverted_index.signaling | 220 |
| abstract_inverted_index.syphilis, | 74 |
| abstract_inverted_index.Background | 1 |
| abstract_inverted_index.attenuated | 197 |
| abstract_inverted_index.behavioral | 28 |
| abstract_inverted_index.behaviours | 78 |
| abstract_inverted_index.condomless | 152, 193, 236, 261, 295, 315 |
| abstract_inverted_index.estimating | 163 |
| abstract_inverted_index.incidence. | 276 |
| abstract_inverted_index.increasing | 312 |
| abstract_inverted_index.infection, | 157 |
| abstract_inverted_index.non-steady | 153, 194, 264, 296, 316 |
| abstract_inverted_index.percentage | 99 |
| abstract_inverted_index.understand | 282 |
| abstract_inverted_index.Conclusions | 255 |
| abstract_inverted_index.alternative | 24 |
| abstract_inverted_index.individual- | 29 |
| abstract_inverted_index.multi-level | 62 |
| abstract_inverted_index.probability | 64, 167 |
| abstract_inverted_index.prophylaxis | 81 |
| abstract_inverted_index.resurgence. | 35 |
| abstract_inverted_index.substantial | 215, 241, 287, 301, 321 |
| abstract_inverted_index.concentrated | 14 |
| abstract_inverted_index.confounders. | 89 |
| abstract_inverted_index.contributing | 271 |
| abstract_inverted_index.determinants | 32, 68 |
| abstract_inverted_index.particularly | 260 |
| abstract_inverted_index.pre-exposure | 80 |
| abstract_inverted_index.relationship | 145 |
| abstract_inverted_index.transmission | 3 |
| abstract_inverted_index.Self-reported | 91 |
| abstract_inverted_index.country-level | 227 |
| abstract_inverted_index.dose-response | 144 |
| abstract_inverted_index.self-reported | 73 |
| abstract_inverted_index.cross-sectional | 41 |
| abstract_inverted_index.population-wide | 244 |
| abstract_inverted_index.Population-level | 306 |
| abstract_inverted_index.population-level | 31 |
| abstract_inverted_index.sociodemographic | 88, 122 |
| cited_by_percentile_year | |
| countries_distinct_count | 3 |
| institutions_distinct_count | 4 |
| citation_normalized_percentile.value | 0.15514923 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |