Brief Reports

An Old Disease Returns: Syphilis in North America

By Carol A. Kemper, MD, FACP

Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center

Dr. Kemper does research for Abbott Laboratories and Merck. The article originally appeared in the August 2013 issue of Infectious Disease Alert.

Syphilis is making a resurgence in the u.s. and canada, especially in urban areas, where the rates of newly diagnosed infection have soared, especially in men-who-have-sex-with-men (MSM). The problem has begun "spilling over" into the heterosexual community. This epidemic may be largely attributed to the availability of internet hook-ups and networking mobile smartphone apps, such as Grindr, the increased use of methamphetamines, as well as what is termed "prevention fatigue." San Francisco County has recorded spikes in all STDs for six straight years — and the number of early syphilis cases rose from 659 in 2010 to 682 in 2011 (the last year for which unofficial numbers are available). It is estimated that each new cases of syphilis results, on average, in exposure to 10 additional people.

Grindr is a gay social networking application launched in 2009 and available worldwide — it runs on the iPhone, Blackberry, and Android. The app allows users to meet other men within close proximity who are interested and available for whatever specified sexual activity using the phone’s mobile location services. We tried it in our Santa Clara county HIV clinic the other day and someone was available and interested in having sex not more than 75 feet away — they were in the same building!

Some public health officials are now recommending syphilis screening of high-risk individuals every 3-6 months. This might make good sense — in our HIV clinic, we routinely screen on an annual basis — but based on these figures, screening at even shorter intervals makes sense.

Women Are at Greater Risk of Dying from Stroke Than Men

By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink is a retained consultant for MAQUET. The article originally appeared in the July 2013 issue of Neurology Alert.

Source: Zhou G, et al. Sex differences in stroke case fatality: A meta-analysis. Acta Neurol Scand 2013;128:1-8.

There is ongoing controversy regarding gender disparity in stroke treatment and outcomes. Many small studies suggest that women have worse outcomes than men after stroke, and some authors have suggested that women are less likely to receive thrombolysis or other interventions than men. However, there is a dearth of large, population-based studies that have examined gender differences in treatment and outcome. Zhou et al investigated sex differences in stroke case fatality in all published studies based on a comprehensive meta-analysis. A systematic search of all published databases was made for papers published from 1992 through 2009, groups were pooled, and a random effects model was used to find sex differences in cases of fatality of stroke with a Mantel-Haenzel method. A meta-regression analysis was also performed.

Thirty six population-based studies, along with three randomized clinical trials (RCTs), representing 125,227 men and 115,511 women, were included and analyzed. For the pooled group, there was an overall hazard risk of 1.13 for women compared to men. In the RCTs subgroup, there was a hazard risk of 1.27 for women and in the population-based studies a risk of 1.12. Although these data support the hypothesis that stroke case fatality is higher in women, more large, multicenter clinical trials are needed to determine this with more certainty.