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Abstract Background The awareness and willingness to use doxycycline-based syphilis chemoprophylaxis among men who have sex with men (MSM) in China remain largely unknown. Methods We recruited MSM online from Nanjing, Wuhan and Changsha between August and October of 2021, collected data from online survey, analyzed their data using descriptive statistics, and constructed binary logistic regression for factors associated with awareness and willingness to use chemoprophylaxis for syphilis and HIV. Results Of 725 participants (44.0% of which resided in Nanjing, 37.7% in Changsha, and 18.3% in Wuhan), a majority were under 25 years of age; 62.2% had college degrees; 11.3% were HIV positive; and 5.10% had prior syphilis infection. Only 28.83% of participants had heard of syphilis chemoprophylaxis before. Odds of knowing syphilis chemoprophylaxis were higher in those who think it is necessary to have syphilis chemoprophylaxis versus those who think it is unnecessary (P = 0.002), and were higher in those whose acquaintance had chemoprophylaxis experience before (P

Considered the increased threaten of neurosyphilis in China, a review on cases reported in the literature to describe the clinical epidemiological characteristics of neurosyphilis cases, may be beneficial to the early detection and management strategies of neurosyphilis for clinicians. We searched the literature on Chinese neurosyphilis cases published from January 1, 2009 to December 31, 2021, described their clinical epidemiological characteristics and calculated the prevalence of neurosyphilis amongst other associated diseases, according to the individual study criteria. A total of 284 studies including 7,486 neurosyphilis cases were included. No meta-analysis was performed due to the heterogeneity of the data. Among 149 case reports and 93 retrospective case series studies, the main clinical manifestation of 3,507 neurosyphilis cases was cerebral parenchymal syphilis (57.3%), followed by asymptomatic neurosyphilis (16.7%), meningovascular syphilis (13.6%), meningitis syphilis (7.7%) and ocular syphilis (2.8%), etc. In addition, the initial diagnosis was incorrect in 53.2% patients, and the most frequent misdiagnoses were mental disorders (31.0%), stroke (15.9%), cognitive impairment (9.0%), etc. The positive or abnormal rates of cerebrospinal fluid non-treponemal and treponemal tests, white blood cell counts and protein concentrations were 74.2%, 96.2%, 61.5%, and 60.9%, respectively. Aqueous penicillin was the first choice for treatment in 88.3% cases, and 81.7% and 50.0% patients had response in the improvement of symptoms and serological effective in CSF, respectively. Among 26 studies on neurosyphilis patients amongst other associated diseases, the prevalence of neurosyphilis amongst central nervous system infectious diseases, syphilis-associated neurological symptoms, serofast status, coinfected with human immunodeficiency virus were 10.6%–30.1%, 23.2%–35.5%, 9.8%–56.1%, and 8.9%, respectively. In summary, the lack of early detection of neurosyphilis cases remains a clinical challenge. The high rate of misdiagnosis and high prevalence of neurosyphilis amongst associated diseases strongly remind clinicians to focus on the early detection among suspected cases. Besides, the standard treatment regimen and long-term follow-up, which complied with guideline should be provided. Further prospective studies are urgent to better delineate the clinical epidemiological characteristics of neurosyphilis in China.

Abstract. Objective:. Although azithromycin is effective against Treponema pallidum (T. pallidum), the causative agent of syphilis, recent reports indicate that the prevalence of azithromycin resistance in China is very high, which may result in the failure of treatment. In this study, we aimed to investigate the association between azithromycin resistance and therapeutic outcomes in early syphilis patients. Methods:. Between February 2010 and December 2014, patients aged 18-65 years with early syphilis were enrolled. T. pallidum DNA were extracted to test the presence of A2058G and A2059G mutations. Then, eligible patients were randomly assigned to receive oral azithromycin (0.5 g, once daily for 15 days) or intramuscular BPG (2.4 million units, once weekly for 3 weeks). All patients were followed up in 2 weeks and 3, 6, 9, and 12 months after treatment to collect demographic and clinical characteristics and laboratory results. The differences on serological response, serological failure and serofast rate were compared between the two groups by Chi-square test. Results:. Among the 187 T. pallidum-infected patients enrolled, 172 (92.0%) cases had a mutation associated with azithromycin resistance (A2058G, 153 cases; A2059G, 19 cases). During the 5-year study period, the percentage of cases enrolled with these mutations steadily increased, from 90.9% in 2010 to 95.3% in 2014. Of the 172 patients presenting with these mutations, only 78 (45.3%; all benzathine penicillin G [BPG]-treated) obtained a serological response to treatment; 32.6% and 22.1% of patients presented with serological failure and serofast results, respectively. For azithromycin-treated cases, 66.3% and 33.7% had serological failure and serofast results, respectively, in contrast with 1.1% and 11.3% of BPG-treated cases. However, among the A2058G- and A2059G-negative patients, the serological response rates between the two treatment groups were similar. In multivariate analyses, patients with lower rapid plasma reagin (RPR) titers (RPR, ≤ 1:8; odds ratio [OR], 0.23; 95% confidence interval [CI], 0.09–0.37) or who received azithromycin treatment (OR, 121.50; 95% CI, 35.38–386.17) were more likely to display serological failure and serofast results. Conclusion This prospective study found that the 23S rRNA A2058G and A2059G point mutations in T. pallidum are currently circulating with high frequency in China, suggesting a correlation between the high prevalence of macrolide resistance and a lower serolo gical response rate to azithromycin treatment.