The Epidemiology of Syphilis and Co-infection with HIV in a Tertiary Care Center in Lebanon: A Retrospective Review
DOI:
https://doi.org/10.26738/poem.v2i1.40Keywords:
syphilis, hiv, sti, transmission, treatment, epidemicAbstract
Introduction: Syphilis is an ancient STI causing a new worldwide outbreak in general and in Lebanon specifically.
Methods: We conducted a retrospective chart review to assess the rate of syphilis increase in an infectious diseases clinic in Lebanon from 2006 to 2023. We studied the epidemiology of these cases, stage and treatment response and their association to HIV infection and its control.
Results: There was an 862% increase in syphilis cases from 2006 to 2019.Most of our cases were middle aged men living with HIV. Most of them had well-controlled HIV infection with good CD4 counts. Most of the diagnosed cases of syphilis were primary and secondary, responding to penicillin G.
Discussion: Our data mostly parallels international data, except for gender distribution. Despite successful treatment of most cases in our clinic, the alarming rise of new cases highlights the urgent need for public health measures to mitigate this epidemic.
Conclusion: Inclusive awareness is needed to stop syphilis spread in Lebanon, and more screening is key in identifying new cases early for a successful eradication.
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Copyright (c) 2024 Hilal Abdessamad, Dalida El Khatib, Moussa Hojeij, Rana Asmar, Julien Maamari, Hicham Baba, Ghazirabih@gmail.com, Wael T Azzam, Rola Husni, Jacques E. Mokhbat

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