Syphilis in the most at-risk populations in Latin America and the Caribbean: a systematic review

Objective: To describe syphilis prevalence in men who have sex with men (MSM), the transgender population, and sex workers and their clients, identifying critical geographical areas, trends, and data gaps in Latin America and the Caribbean. Methods: A systematic review of syphilis prevalence was conducted by searching PubMed, LILACS, EMBASE, conference records, and other sources (2000-2010). Results: Forty-eight articles were included in the review, from which 84 data points were identified relating to MSM and female sex workers and only 10 relating to the transgender population, male sex workers, and clients of sex workers. Most studies were from Latin America (83%), with fewer from the Caribbean (17%). Critical 'hotspot' cities were Sao Paulo, Buenos Aires, Guatemala, Puerto Barrios, San Jose, San Pedro,Managua, San Salvador, and Acajutla, with high syphilis prevalence in more than one study population. Gaps in the availability of information on syphilis prevalence were identified for Ecuador, Uruguay, and Bolivia, and most countries in the Caribbean. Chronological trends showed that syphilis infection is well-established among the study populations. Conclusions: Consistently high levels of syphilis among the investigated populations throughout the study period show that there is a need to improve monitoring, surveillance, and evaluation of sexually transmitted infection control interventions among these populations. Improved reporting and standardization of syphilis testing is recommended, as well as a heightened focus on more effective syphilis control strategies. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.