International Journal of Infectious Diseases 28 (2014) 45–46

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Letter to the Editor Prevalence of syphilis among voluntary blood donors in Liguria region (Italy) from 2009 to 2013 The recent article by Chen et al.1 prompted us to track the syphilis prevalence among voluntary blood donations in our region over the last 5 years. Our centre, which collects data from all donations in Liguria, employs a non-treponemal lipid test (VDRL, Venereal Disease Research Laboratory) and a treponemal test (TPHA, Treponema pallidum hemagglutination) as initial screening tests, and a specific immunoenzymatic assay (EIA) as a confirmatory test. HIV is screened using an HIV1/2 ELISA kit and is confirmed by immunoblotting. All syphilis-positive samples were evaluated for gender, age, country of origin, educational status, and risk factors. Of the 419 740 donations over the last 5 years, 132 (0.031%) were positive for syphilis and 21 (0.005%) were positive for HIV. Only one sample was simultaneously positive for both diseases. In comparison to the study by Chen et al.,1 our study showed a lower percentage of syphilis (0.031%) and HIV (0.005%) positivity (versus 0.36% and 0.03%, respectively),1 and a trend in prevalence for syphilis slightly higher in males, as in other Western reports.2 In contrast to the study by Chen et al.1 and other reported studies,3,4 the syphilis annual trend remained steady and did not greatly

increase over the 5-year period (Table 1). The low rate of HIV co-infection in blood donors confirms the lack of correlation between HIV and syphilis.1 Syphilis prevalence peaked in the 40–49 years age group, followed by the 50–59 and 18–39 years age groups, while it was lowest in the 60–69 years group. Other studies have reported a lower age;1–5 this difference is probably because Liguria has the oldest population in Europe. Fifty-six percent of syphilis-positive donors were from Italy and 44% from other countries. In contrast with other studies,1,6 of the 69 syphilis-positive donors whose educational status was known, almost half (47%) were high school graduates and only 10 (14%) had completed university. Of 83 syphilis-positive donors (62%) whose transmission modalities were known, 21 (25%) admitted having a heterosexual partner positive for a sexually transmitted disease (STD) and 39 (47%) admitted to occasional heterosexual relationships. Overall, 60 donors had probably been infected through heterosexual intercourse. More than half of the infected donors (53%) were ‘first time donors’. In agreement with the authors who performed an external assessment of the quality of other Italian transfusion services,7 we recommend the use of two distinct treponemal and nontreponemal tests, since the non-treponemal test is the least sensitive means of identifying syphilis-positive samples.7

Table 1 Syphilis and HIV prevalence, with various demographic characteristics and a subgroup analysis, among voluntary blood donors Variable

2009

2010

2011

2102

2013

Overall (2009–2013)

Total donations, n (%) Syphilis positivity, n (%) Sex Male syphilis positivity, n (%) Female syphilis positivity, n (%) Age, years 18–29 syphilis positivity, n (%) 30–39 syphilis positivity, n (%) 40–49 syphilis positivity, n (%) 50–59 syphilis positivity, n (%) 60–69 syphilis positivity, n (%) HIV positivity, n (%) Syphilis positivity and HIV positivity, n (%) Country of origin of donors positive for syphilis Italy, n (%) Moldavia, n (%) Egypt, n (%) Spain, n (%) Brazil, n (%) Romania, n (%) Peru, n (%) Ecuador, n (%) Dominican Republic, n (%) Morocco, n (%) Turkmenistan, n (%) Bolivia, n (%)

82 678 30 (3.63)

83 895 36 (4.29)

85 585 21 (2.45)

85 024 19 (2.23)

82 558 26 (3.15)

419 740 132 (3.14)

19 (2.30) 11 (1.33)

24 (2.86) 12 (1.43)

10 (1.17) 11 (1.29)

11 (1.29) 8 (0.94)

15 (1.82) 11 (1.33)

78 (1.86) 54 (1.29)

6 (0.73) 2 (0.24) 6 (0.73) 6 (0.73) 10 (1.21) 5 (0.60) 0

6 (0.72) 5 (0.60) 14 (1.67) 7 (0.83) 4 (0.48) 4 (0.48) 0

5 (0.58) 4 (0.47) 6 (0.70) 3 (0.35) 3 (0.35) 6 (0.70) 0

19 (14.39) 0 0 0 0 5 (3.79) 0 2 (1.52) 0 1 (0.76) 0 1 (0.76)

18 (13.64) 1 (0.76) 0 0 1 (0.76) 4 (3.03) 2 (1.52) 3 (2.27) 1 (0.76) 3 (2.27) 0 0

14 (10.61) 4 (3.03) 1 (0.76) 1 (0.76) 1 (0.76) 0 0 0 0 0 0 0

3 3 10 1 2 2 1

(0.35) (0.35) (1.18) (0.12) (0.24) (0.24) (0.12)

4 (0.48) 7 (0.85) 6 (0.73) 9 (1.09) 0 4 (0.48) 0

24 21 42 26 19 21 1

(0.57) (0.50) (1.00) (0.62) (0.45) (0.50) (0.02)

10 (7.58) 1 (0.76) 0 0 0 4 (3.03) 1 (0.76) 1 (0.76) 0 1 (0.76) 0 0

13 (9.85) 1 (0.76) 0 0 1 (0.76) 3 (2.27) 0 3 (2.27) 1 (0.76) 2 (1.52) 1 (0.76) 0

74 7 1 1 3 16 3 9 2 7 1 1

(56.06) (5.30) (0.76) (0.76) (2.27) (12.12) (2.27) (6.82) (1.52) (5.30) (0.76) (0.76)

http://dx.doi.org/10.1016/j.ijid.2014.04.008 1201-9712/ß 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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Letter to the Editor / International Journal of Infectious Diseases 28 (2014) 45–46

Table 1 (Continued ) Variable Colombia, n (%) Argentina, n (%) Sri Lanka, n (%) India, n (%) Chile, n (%) Educational status of donors positive for syphilis Primary school or less, n (%) Middle school graduate, n (%) High school graduate, n (%) Completed University, n (%) Unknown, n (%) Risk factors in history of donors positive for syphilis Known, n (%) Unknown, n (%) Risk factors in history of donors positive for syphilis Occasional heterosexual relationships, n (%) Homosexual/bisexual occasional relationships, n (%) Casual sex at risk, n (%) Heterosexual partner positive for STD, n (%) Casual sex for a fee, n (%) Venereal diseases, n (%) Surgery (>4 months), n (%) Dental care (>7 days), n (%) Transfusions or blood products (4 months), n (%) Acupuncture, body piercing, tattoo, n (%) Donor category of donors positive for syphilis Periodic donor, n (%) Donor to the first non-deferred donation, n (%) Aspirant donor, n (%)

2009 1 (0.76) 1 (0.76) 0 0 0 1 1 5 1 22

(0.76) (0.76) (3.79) (0.76) (16.76)

2010

2011

0 0 1 (0.76) 1 (0.76) 1 (0.76) 2 4 10 3 17

(1.52) (3.03) (7.58) (2.27) (12.88)

0 0 0 0 0 2 6 4 1 8

2102 1 (0.76) 0 0 0 0

(1.52) (4.55) (3.03) (0.76) (6.06)

1 3 8 3 4

(0.76) (2.27) (6.06) (2.27) (3.03)

2013

Overall (2009–2013)

0 0 0 0 1 (0.76)

2 1 1 1 2

0 6 (4.55) 6 (4.55) 2 (1.52) 12 (9.09)

6 20 33 10 63

(1.52) (0.76) (0.76) (0.76) (1.52) (12.12) (15.15) (25.00) (7.58) (47.73)

11 (8.33) 19 (14.39)

23 (17.42) 13 (9.85)

15 (11.36) 6 (4.55)

14 (10.61) 5 (3.79)

20 (15.15) 6 (4.55)

83 (62.88) 49 (37.12)

2 (2.40) 1 (1.20) 2 (2.40) 0 0 6 (7.20) 0 0 0 0

14 (16.87) 1 (1.20) 1 (1.20) 3 (3.61) 4 (4.82) 0 0 0 0 0

7 (8.43) 0 0 7 (8.43) 1 (1.20) 0 0 0 1 (1.20) 0

10 1 (1.20) 1 (1.20) 1 (1.20) 0 1 (1.20) 1 (1.20) 1 (1.20) 0 0

7 (8.43) 1 (1.20) 0 10 (12.04) 0 2 (2.40) 2 (2.40) 0 0 2 (2.40)

40 4 4 21 5 9 3 1 1 2

13 (9.85) 16 (12.12) 1 (0.76)

11 (8.33) 15 (11.36) 10 (7.58)

2 (1.52) 17 (12.88) 2 (1.52)

2 (1.52) 12 (9.09) 5 (3.79)

8 (6.06) 10 (7.58) 8 (6.06)

36 (27.27) 70 (53.03) 26 (19.70)

(48.19) (4.82) (4.82) (25.30) (6.02) (10.84) (3.61) (1.20) (1.20) (2.40)

STD, sexually transmitted disease. a Results are n (%).

In conclusion, our findings provide evidence that the procedures employed by the Italian Blood Service are effective in maintaining a safe blood supply. Funding sources: None. Conflict of interest: None. References 1. Chen Y, Liu Z, Zhang Q, Chen J, Sun W, Yi J, et al. Trend in prevalence of syphilis among voluntary blood donors in Xi’an, China from 2006 to 2010. Int J Infect Dis 2014;19:98–9. 2. Righharts AA, Simms I, Wallace L, Solomou M, Fenton KA. Syphilis surveillance and epidemiology in the United Kingdom. Euro Surveill 2004;9:21–5. 3. Lucky TT, Seed CR, Keller A, Lee J, Mc Donald A, Ismay S, et al. Trends in transfusion-transmissible infections among Australian blood donors from 2005 to 2010. Transfusion 2013;53:2751–62. 4. Murphy D, Holt M. Responses to syphilis outbreaks among gayand other men who have sex with men: case studies from the United Kingdom and the United States. Sydney, Australia: Australian Federation of Aids Organisations; 2009. 5. Sasse A, Defraye A, Ducoffre G. Recent syphilis trends in Belgium and enhancement of STI surveillance systems. Euro Surveill 2004;9:6–8. 6. Zhang X, Yu J, Li M, Sun X, Han Q, Li M, et al. Prevalence and related risk behaviours of HIV. Syphilis and anal HPV infection among men who have sex with men from Beijing, China. AIDS Behav 2013;17:129–36. 7. Vulcano F, Milazzo L, Volpi S, Battista MM, Barca A, Hassan HJ, et al. Italian national survey of blood donors: external quality assessment (EQA) of syphilis testing. J Clin Microbiol 2010;48:753–7.

Francesco Dragoa Ludovica Cogornoa,* Giulia Ciccaresea Paolo Stradab Massimo Tognonib Alfredo Reboraa Aurora Parodia a DISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy b Regional Blood Service – Liguria Region, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy Corresponding Editor: Eskild Petersen, Aarhus, Denmark *Corresponding

author. Tel.: +39 010 5555750; fax: +39 010 5556509. E-mail address: [email protected] (L. Cogorno). Accepted 11 April 2014

Prevalence of syphilis among voluntary blood donors in Liguria region (Italy) from 2009 to 2013.

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