Screen more or screen more often? Using mathematical models to inform syphilis control strategies.
Open accessAbstract
BACKGROUND: Syphilis incidence among men who have sex with men (MSM) continues to rise despite attempts to increase screening and treatment uptake. We examined the marginal effect of increased frequency versus increased coverage of screening on syphilis incidence in Toronto, Canada. METHODS: We developed an agent-based, network model of syphilis transmission, representing a core population of 2,000 high-risk MSM. Epidemiological and biological parameters were drawn from regional surveillance data and literature-derived estimates. The pre-intervention period of the model was calibrated using surveillance data to identify 1000 credible simulations per strategy. Evaluated strategies included: annual syphilis screening at baseline coverage, increased screening frequency at baseline coverage, and increased coverage of annual screening. Intervention impact was measured as annual prevalence of detected infectious cases and syphilis incidence per year over 10 years. RESULTS: Of the strategies evaluated, increasing the frequency of syphilis screening to every three months was most effective in reducing reported and incident syphilis infections. Increasing the fraction of individuals tested, without increasing test frequency, resulted a smaller decline in incidence, because reductions in infectious syphilis via treatment were counterbalanced by increased incident syphilis among individuals with prior latent syphilis. For an equivalent number of additional tests performed annually, increased test frequency was consistently more effective than improved coverage. CONCLUSIONS: Strategies that focus on higher frequency of testing in smaller fractions of the population were more effective in reducing syphilis incidence in a simulated MSM population. The findings highlight how treatment-induced loss of immunity can create unexpected results in screening-based control strategies.
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In a compartmental model applied to different populations in Canada, quarterly syphilis screening averted more than twice the number of syphilis cases, compared with semiannual screening.
“In a compartmental model applied to different populations in Canada, quarterly syphilis screening averted more than twice the number of syphilis cases, compared with semiannual screening (225).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [225]
The Results report that three-monthly screening was projected to avert approximately 650 incident cases over 10 years, versus 300 with six-monthly screening—more than twice as many. However, the Background and Methods describe a model of high-risk MSM in Toronto, not a model applied to different populations across Canada. (LLM, conf=0.88)
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SYPHILIS INFECTION IN A MALE POPULATION: PREVALENCE AND RISK FACTORS
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- Authors
- Tuite, A. R., Fisman, D. N., & Mishra, S.
- Affiliations
- University of Toronto (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Mishra, Sharmistha
- Venue
- BMC Public Health
- Published
- 2013-06-24
- Volume
- 13
- Issue
- 1
- Pages
- 606-606
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC3699384
- OpenAlex
- W1964216735
- Cited by
- 70
- References
- 46
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 8 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 2 · 2016: 9 · 2015: 7 · 2014: 3
- FWCI
- 6.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- Funders
- University of Toronto
- Canadian Institutes of Health Research (88223_1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mathematical and Theoretical Epidemiology and Ecology Models
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
- Keywords
- syphilis, men who have sex with men, syphilis screening, screening frequency, screening coverage, syphilis incidence, syphilis transmission, latent syphilis
- MeSH terms
- Canada, Humans, Male, Mass Screening, Patient Acceptance of Health Care, Sexual Partners, Sexually Transmitted Diseases, Syphilis, Time Factors, Models, Statistical, Incidence, Homosexuality, Male, Disease Transmission, Infectious, Risk Assessment, Coinfection
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