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Background: Syphilis is a sexually transmitted infection (STI) with a global prevalence estimated at 0.5% in 2012. Syphilis has been on the rise among men who have sex with men (MSM) in high‐income countries and remains at endemic levels in low‐ and middle‐income countries. This trend, however, has not been observed in Reunion Island. Objectives: To determine the prevalence, clinical characteristics and risk factors of syphilis in at‐risk patients visiting the South Reunion STI clinic in Reunion Island. Methods: This monocentric cross‐sectional study included all patients who visited our STI clinic between 2017 and 2020. Syphilis serology was performed on all included patients, and data were collected using a standardized self‐administered questionnaire. Results: Over the 3‐year study period, 2593 patients were enrolled. The prevalence of syphilis was 7.52% (n = 195, 95% CI, 6.50–8.65%) in the overall study population, 11.76% (n = 18, 95% CI, 6.97–18.59%) in minors (aged under 18 years) and 36.36% (n = 16, 95% CI, 21–59%) in pregnant women. The risk factors identified in multivariate analysis were being female [adjusted Prevalence Ratio (aPR) 1.85, 95% CI, 1.10–3.11], being MSM (aPR 2.87, 95% CI, 1.71–4.80), being aged under 18 years (aPR 3.54, 95% CI, 1.90–6.57), living in precarious conditions [aPR 3.12, 95% CI, 2.11–4.62] and being born in Reunion Island (aPR 2.43, 95% CI, 1.42–4.13). The clinical presentation was heterogeneous (plaques and papules, chancre, atypical ulcerations, multiple ulcerations, condyloma lata, etc.). Conclusions: These findings suggest a high prevalence of syphilis in at‐risk patients visiting our STI clinic. Unlike the situation in other high‐income countries, the people most at risk of syphilis in Reunion Island are local‐born residents, minors, women and precarious patients. This is a source of concern, especially given the risk of resurgence of congenital syphilis on the island. [ABSTRACT FROM AUTHOR]

Objective: Since the beginning of the 21st century, Reunion Island has experienced a syphilis epidemic. Infected patients are mostly heterosexual, with a high proportion of women, suggesting that congenital syphilis is present on the island. To determine whether azithromycin can be used for mass treatment of syphilis on Reunion Island, we assessed the prevalence of macrolide resistance in Treponema pallidum (TP)., Methods: This monocentric cross-sectional study was conducted at the Reunion Island University Hospital. Samples were collected from lesions suggestive of primary or secondary syphilis. Samples positive for TP by multiplex polymerase chain reaction (PCR) were sent to the French National Reference Centre (NRC) for further analysis. Nested PCR-tpp47 was performed on these samples for detection of TP-DNA; 23s rRNA was amplified by PCR in confirmed positive samples. The Restriction Fragment Length Polymorphism (RFLP) technique was performed on samples with amplified 23s rRNA for detection of the A2058G mutation., Results: A total of 129 samples were collected from 119 patients. Of these, 18 tested positive for TP using multiplex PCR and were sent to the NRC. Fifteen (83.3%) of the 18 samples were confirmed positive by nested PCR-tpp47, and 23s rRNA was amplified in only 7 (38.9%) samples. Azithromycin resistance was detected in all TP strains with amplified 23s rRNA., Conclusion: Amplification of 23s rRNA was successful in only 7 TP strains, all of which displayed resistance to macrolides. Keeping in mind the small sample size of our study, this suggests that azithromycin should not be used for mass treatment of syphilis in Reunion Island., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)