Value of targeting at-risk populations at outreach venues: findings from a local sauna.

An assessment of the need to increase access to an outreach venue, the local sauna in Walsall, UK, frequented only by men who have sex with men, was undertaken. A case-notes review of the clients who attended the monthly outreach sessions at the sauna in the year 2007 was performed. Among the 287 men seen at the 12 outreach sessions, 37% had a sexually transmitted infection (STI). Of those tested positive, 88% had never had a previous STI. Twenty-one men had syphilis and a further six tested positive for HIV. Hepatitis B vaccination was completed for 41% of the clients seen. Those who tested positive for an STI said they would not have attended a conventional setting but accepted screening at the sauna. This confirmed the need to increase access at this outreach venue, and further funding has now been provided to have outreach sessions twice a month.

Syphilis outbreak in Walsall, UK: lessons for control and prevention.

An assessment of risk-taking behaviour among men who have sex with men (MSM) attending a sauna venue was undertaken, using a standardized questionnaire, after which outreach screening was introduced targeting MSM. The epidemiology of the continuing outbreak of syphilis was reviewed to determine the factors driving the outbreak and assess the benefit of continuing outreach screening. Findings among the 163 respondents at the sauna included a high rate of casual sex and a tendency not to disclose HIV status. Over 12 months, 51 cases of early syphilis were recorded. Our review showed a decline in incidence in MSM after outreach screening, but an increase in heterosexual spread. Given the frequent anonymous nature of syphilis transmission, traditional contact tracing is ineffective. Outreach screening is required at gay venues and other community settings to target at-risk populations.

Syphilis clusters in Walsall: case profiles and public health implications.

Between the beginning of December 2002 and the end of March 2003, eight cases of infectious syphilis were diagnosed in Walsall. Two unrelated clusters were identified. The first consisted of three cases, two heterosexual patients and a baby with congenital syphilis. The infant had no congenital stigmata of syphilis, which is consistent with recent infection. The second cluster consisted of five cases in men who have sex with men (MSM) who attended a local sauna that attracts men from the Midlands and north west England. One infection was detected in an outreach screening initiative of 60 MSM. Both clusters illustrate the problems of case ascertainment and the need for continued vigilance to the potential of syphilis infection in high risk groups. Vigorous public health efforts are required to promote safer sex and awareness to infection with syphilis and human immunodeficiency virus, reinforced by targeted case finding in clinic and community settings.