BACKGROUND & AIMS: From 1993 to 1995, the number of primary and secondary syphilis cases reported in Baltimore City (1990 population736,014) increased 97%, from 179 to 352 cases per year (Figure 1). To identify potential reasons for this increase, CDC, in collaboration with the Baltimore City Health Department (BCHD) and the Maryland Department of Health and Mental Hygiene, analyzed data about primary and secondary syphilis cases during 1992-1995 and about temporal trends in factors that may affect syphilis rates (e.g., partner-notification results, access to medical care, and community illicit-drug use). In addition, data were analyzed from the two public sexually transmitted disease (STD) clinics in Baltimore City. BCHD collects demographic data for all cases of reported syphilis among patients who reside in Baltimore City and attempts to interview and provide partner notification and treatment for these patients. This report summarizes the results of the analysis, which suggest the outbreak has been associated with decreases in partner notification and health department clinical services and a substantial increase in community cocaine use.

背景与目标： 从1993 1995年开始，巴尔的摩市 (1990人口736,014) 报告的原发性和二期梅毒病例数97% 增加，从每年179例增加到352例 (图1)。为了确定这种增加的潜在原因，疾病预防控制中心与巴尔的摩市卫生局 (BCHD) 和马里兰州卫生与精神卫生部门合作，分析了1992-1995年期间原发性和二期梅毒病例的数据以及可能影响梅毒率的因素的时间趋势 (例如，合作伙伴-通知结果、获得医疗保健和社区非法药物使用)。此外，还分析了巴尔的摩市两个公共性传播疾病 (STD) 诊所的数据。BCHD收集居住在巴尔的摩市的患者中所有报告的梅毒病例的人口统计数据，并尝试对这些患者进行访谈并提供合作伙伴通知和治疗。本报告总结了分析结果，表明疫情与合作伙伴通知和卫生部门临床服务的减少以及社区可卡因使用量的大幅增加有关。

BACKGROUND & AIMS: :The clinical features and ophthalmologic findings of 20 patients with syphilitic posterior uveitis seen at the Detroit Medical Center from November 1993 through February 1996 were reviewed. The mean age was 58 years; 8 patients were male and 12 were female; and all patients were black. Three of 9 patients tested were HIV positive. Patients were divided into 2 groups: those with acute (8) and those with chronic (12) syphilitic posterior uveitis. Chorioretinitis was the predominant uveitic pattern (15/20). Eighteen patients presented with blurred vision. All patients had reactive serum fluorescent treponemal antibody, absorbed (FTA-ABS); 3 had nonreactive rapid plasma reagin (RPR). Mean RPR titer in the chronic uveitis group and in the acute uveitis group was 1:27.3 and 1:209.8, respectively. Seven patients had abnormal cerebrospinal fluid (CSF); CSF VDRL was reactive in 2 patients. All patients were treated with intravenous penicillin G. Eight of 14 patients seen at follow-up showed improvement of ophthalmologic findings. Syphilis should be considered in the differential diagnosis of posterior uveitis.

背景与目标： : 回顾了从1993年11月到1996年2月在底特律医学中心看到的20例梅毒性后葡萄膜炎患者的临床特征和眼科结果。平均年龄为58岁; 男性8例，女性12例; 所有患者均为黑人。接受测试的9名患者中有3名是HIV阳性。将患者分为2组: 急性 (8) 和慢性 (12) 梅毒性后葡萄膜炎。脉络膜视网膜炎是主要的葡萄膜模式 (15/20)。18名患者出现视力模糊。所有患者均具有反应性血清荧光抗体，吸收 (FTA-ABS); 3例无反应性快速血浆反应蛋白 (RPR)。慢性葡萄膜炎组和急性葡萄膜炎组的平均RPR滴度分别为1:27.3和1:209.8。7例患者脑脊液 (CSF) 异常; 2例患者CSF VDRL呈反应性。所有患者均接受静脉青霉素g治疗。在随访中看到的14例患者中有8例显示了眼科检查结果的改善。后葡萄膜炎的鉴别诊断疾病应考虑梅毒。

BACKGROUND & AIMS: The results of a multicentre study of 1668 Spanish prostitutes are described with regard to syphilis infection. For those women who permitted serological tests (n = 1095), 30.59% (confidence interval (CI)30.55%-30.63%) were positive for markers indicating current or prior infection. After adjustment was made for other variables, a significant association with syphilis infection was observed for periods of exposure (i.e. age and years working as a prostitute). No significant associations were detected for either intravenous drug use, or educational attainment. The results of this study are similar to those of some other investigations into the prevalence of syphilis amongst prostitutes.

背景与目标： 描述了针对1668名西班牙妓女的多中心研究结果，涉及梅毒感染。对于那些允许进行血清学检查的妇女 (n = 1095)，30.59% (置信区间 (CI)30.55%-30.63%) 的标记物呈阳性，表明当前或先前的感染。在对其他变量进行调整后，观察到接触期 (即年龄和妓女年龄) 与梅毒感染显着相关。未发现静脉吸毒或受教育程度有显着关联。这项研究的结果与其他一些有关妓女中梅毒患病率的调查结果相似。

BACKGROUND & AIMS: :We report a case of Addison's disease presumed to be secondary to syphilis. The patient presented with adrenal failure and a maculopapular rash on his trunk and palms. Syphilis was suspected but the non-treponemal serological test used (the rapid plasma reagin test (RPR)) was falsely negative due to the prozone phenomenon. Treatment with benzathine penicillin resulted in normalization of adrenal function and resolution of the cutaneous findings. Repeat testing of the previously obtained serum sample showed the RPR to be positive on increasing dilutions of serum, consistent with the prozone effect.

背景与目标： : 我们报告了一例Addison病，推测是继发于梅毒的病例。患者出现肾上腺功能衰竭，躯干和手掌出现斑丘疹。梅毒被怀疑，但由于前区现象，使用的非梅毒血清学试验 (快速血浆反应素试验 (RPR)) 错误地呈阴性。用苄星青霉素治疗可使肾上腺功能正常化并消除皮肤发现。对先前获得的血清样品进行的重复测试表明，RPR对增加的血清稀释度呈阳性，与前带效应一致。

BACKGROUND & AIMS: :Epidemic increases in active syphilis have been reported in the geographic areas hit hard by acquired immunodeficiency syndrome. Although both epidemics have been associated with illicit substance abuse, the extent to which recent increases in syphilis are linked to the human immunodeficiency virus (HIV-1) epidemic is uncertain. In order to define the frequency of syphilis and HIV-1 coinfection in the pregnant patients seen at City Hospital Center at Elmhurst, we saved syphilis-positive serologic specimens from obstetrical patients for anonymous HIV-1 antibody testing. Of 120 women who tested positive for syphilis, 7/120 (5.8%) had antibodies to HIV-1; of the 44 women with VDRL titers greater than or equal to 1:16 (suggestive of a recent infection), 1/44 (2.3%) had antibodies to HIV-1.

背景与目标： : 据报道，在获得性免疫缺陷综合症严重打击的地理区域，活动性梅毒的流行病增加。尽管这两种流行病都与非法药物滥用有关，但梅毒最近的增加与人类免疫缺陷病病毒 (HIV-1) 流行病有关的程度尚不确定。为了确定在Elmhurst市医院中心看到的孕妇中梅毒和HIV-1合并感染的频率，我们从产科患者中保存了梅毒阳性血清学标本，以进行匿名HIV-1抗体检测。在120名梅毒检测呈阳性的妇女中，7/120名 (5.8% 名) 有HIV-1抗体; 在44名VDRL滴度大于或等于1:16 (提示近期感染) 的妇女中，1/44名 (2.3% 名) 有HIV-1抗体。

BACKGROUND & AIMS: OBJECTIVES:The Centers for Disease Control and Prevention provides guidance on sexually transmitted disease (STD) testing specifically for men who have sex with men (MSM) in STD treatment guidelines to address increasing rates of gonorrhoea and syphilis among MSM in the USA. The guidelines recommend at least annual syphilis, gonorrhoea and chlamydia testing for sexually active MSM. The implementation of these guidelines was evaluated. METHODS:Data from the 2003-5 MSM cycle of the National HIV Behavioural Surveillance System were used. The proportion of sexually active HIV-negative MSM reporting syphilis and gonorrhoea testing during the previous year was determined and multivariate logistic regression was used to identify factors associated with testing. RESULTS:Of 10 030 MSM, 39% and 36% reported having been tested for syphilis and gonorrhoea in the previous year, respectively. Four factors were associated with syphilis and gonorrhoea testing, respectively: age 18-24 years versus > or =45 years (odds ratio (OR) 2.2, 95% CI 1.8 to 2.5; OR 2.7, 95% CI 2.3 to 3.2), black versus white race (OR 1.3, 95% CI 1.1 to 1.4; OR 1.4, 95% CI 1.2 to 1.6), private insurance versus no insurance (OR 1.3, 95% CI 1.1 to 1.4; OR 1.3, 95% CI 1.1 to 1.4) and disclosing male-male sex to a healthcare provider (OR 2.2, 95% CI 2.0 to 2.5; OR 2.1, 95% CI 1.9 to 2.3). CONCLUSIONS:Syphilis and gonorrhoea testing among MSM was low, despite specific testing recommendations in the STD treatment guidelines. To increase STD testing among MSM, healthcare providers should assess the risks of STD for male patients through routine enquiries about sexual activity.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Although previous case-control studies have observed positive associations among gonorrhea, syphilis, clinical prostatitis, and prostate cancer, many may have been susceptible to recall and interviewer biases due to their retrospective designs. Therefore, to investigate these associations without concerns of recall and interviewer biases, we conducted a large, prospective investigation in the Health Professionals Follow-up Study. METHODS:In 1992, participants were asked to report their histories of gonorrhea, syphilis, and clinical prostatitis by mailed questionnaire. Prostate cancer diagnoses were ascertained by self-report on the 1994 and each subsequent biennial follow-up questionnaire and confirmed by medical record review. RESULTS:Of the 36,033 participants in this analysis, 2,263 were diagnosed with prostate cancer between the date of return of the 1992 questionnaire and 2002. No association was observed between gonorrhea [adjusted relative risk (RR), 1.04; 95% confidence interval (95% CI), 0.79-1.36] or syphilis (RR, 1.06; 95% CI, 0.44-2.59) and prostate cancer. Overall null results were also observed between clinical prostatitis and prostate cancer (RR, 1.08; 95% CI, 0.96-1.20), although a significant positive association was observed among younger men (<59 years) screened for prostate cancer (RR, 1.49; 95% CI, 1.08-2.06; P(interaction) = 0.006). CONCLUSIONS:Gonorrhea and syphilis do not seem to be risk factors for prostate cancer in this cohort of men with a lower burden of sexually transmitted infections. Clinical prostatitis is also unlikely to be a risk factor, although possible roles for prostatitis in younger men and asymptomatic prostatic infection and inflammation cannot be ruled out.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Biological and behavioural surveillance of HIV and sexually transmitted infections (STIs) among populations at highest risk have been used to monitor trends in prevalence and in risk behaviours. Sex work in Panama is regulated through registration with the Social Hygiene Programme, Ministry of Health. We estimated prevalence of HIV and STIs, and factors associated with active syphilis among female sex workers (FSWs). METHODS:A cross-sectional study using venue-based, time-space sampling was conducted among FSWs in Panama from 2009 to 2010. FSWs were interviewed about sociodemographic characteristics, sexual risk behaviour, health history and drug use using an anonymous structured questionnaire. Blood was collected for serological testing of HIV and other STIs. Factors associated with active syphilis were studied using logistic regression analysis. RESULTS:The overall HIV-1 prevalence of 0.7% varied by FSW category; 1.6% in 379 unregistered, and 0.2% in 620 registered FSWs. Overall prevalence (and 95% CI) of STIs were: syphilis antibody, 3.8% (2.7% to 5.2%); herpes simplex virus type 2 antibody (anti-HSV-2), 74.2% (71.4% to 76.9%); hepatitis B surface antigen, 0.6% (0.2% to 1.3%); hepatitis B core antibody, 8.7% (7.0% to 10.6%); and hepatitis C antibody, 0.2% (0.0% to 0.7%). In multivariate analysis, registration (adjusted OR (AOR)=0.35; 95% CI 0.16 to 0.74), having a history of STI (AOR=2.37; 95% CI 1.01 to 5.58), forced sex (AOR=2.47; 95% CI 1.11 to 5.48), and anti-HSV-2 (AOR=10.05; 95% CI 1.36 to 74.38) were associated with active syphilis. CONCLUSIONS:Although HIV prevalence is low among FSWs in Panama, unregistered FSWs bear a higher burden of HIV and STIs than registered FSWs. Programmes aimed at overcoming obstacles to registration, and HIV, STI and harm reduction among unregistered FSWs is warranted to prevent HIV transmission, and to improve their sexual and reproductive health.

背景与目标：

BACKGROUND & AIMS: :Congenital syphilis was rare in most affluent countries but there has been a slight resurgence recently in several European countries. In large parts of the world and particularly sub-Saharan Africa congenital syphilis is a significant public health problem. The cornerstone of congenital syphilis control is antenatal screening and treatment of mothers with penicillin, which is a cost-effective intervention. In affluent countries it should be strengthened among those at high risk. Clinicians should be more vigilant for the possibility of babies being born with congenital syphilis, which is often asymptomatic. In developing countries not only does antenatal care screening need to be strengthened by implementing point-of-care decentralised screening and treatment but alternative innovative approaches to controlling congenital syphilis should be explored. There is an urgent need for international health agencies to support focused approaches to tackling the tragedy of continuing congenital syphilis. This could be a part of a pro-poor strategy to meet the Millennium Development Goals.

背景与目标： 先天性梅毒在大多数富裕国家很少见，但最近在几个欧洲国家略有复苏。在世界大部分地区，特别是撒哈拉以南非洲，先天性梅毒是一个重大的公共卫生问题。先天性梅毒控制的基石是对母亲进行产前筛查和青霉素治疗，这是一种具有成本效益的干预措施。在富裕国家，应在高风险国家中加强这一水平。临床医生应提高警惕婴儿出生时患有先天性梅毒的可能性，这种梅毒通常没有症状。在发展中国家，不仅需要通过实施护理点分散的筛查和治疗来加强产前保健筛查，而且还应探索控制先天性梅毒的替代创新方法。迫切需要国际卫生机构支持采取有针对性的方法来应对持续的先天性梅毒的悲剧。这可能是实现千年发展目标的扶贫战略的一部分。

BACKGROUND & AIMS: :Syphilis is a sexually transmitted infection caused by the Treponema pallidum subspecies pallidum spirochete bacterium. The killer cell immunoglobulin-like receptors (KIR), interacting with human leukocyte antigens (HLA), regulate the activations of natural killer (NK) cells and certain T-cell subsets in response to microbe infection. The objective of this study was to explore whether KIR and HLA-C gene polymorphisms were associated with syphilis in a Chinese Han population. Polymerase chain reaction with sequence-specific primers (PCR-SSP) method was used to genotype KIR and HLA-C genes in 231 syphilis patients and 247 healthy controls. Framework genes KIR2DL4, KIR3DL2, KIR3DL3 and KIR3DP1 were present in all individuals. The frequencies of KIR2DS3 and KIR3DS1 were higher in syphilis patients than in healthy controls (p = 0.030 and p = 0.038, respectively), while the frequency of KIR2DS5 was higher in healthy controls than in syphilis patients (p = 0.015; OR = 0.575). The homozygote for HLA-C1 allele (HLA-C1C1) was more common in controls compared with syphilis patients (p = 0.030; OR = 0.667). The frequency of individuals with HLA-C1C1 and KIR2DL3 genotype was higher in control group relative to syphilis patient group (p = 0.018; OR = 0.647). These data indicated that KIR2DS3 and KIR3DS1 were more prevalent in syphilis patients than in controls, and that KIR2DS5, HLA-C1C1 and HLA-C1C1-KIR2DL3 were more prevalent in controls than in syphilis patients, respectively. These will require further investigation using functional studies.

背景与目标： : 梅毒是由梅毒螺旋体亚种梅毒螺旋体细菌引起的性传播感染。杀伤细胞免疫球蛋白样受体 (KIR) 与人类白细胞抗原 (HLA) 相互作用，调节自然杀伤 (NK) 细胞和某些T细胞亚群对微生物感染的激活。这项研究的目的是探讨KIR和hla-c基因多态性是否与中国汉族人群的梅毒有关。采用序列特异性引物聚合酶链反应 (pcr-ssp) 方法对231例梅毒患者和247健康对照者进行KIR和hla-c基因的分型。框架基因KIR2DL4、KIR3DL2、KIR3DL3和KIR3DP1存在于所有个体中。梅毒患者的KIR2DS3和KIR3DS1频率高于健康对照组 (分别为p = 0.030和p = 0.038)，而健康对照组的KIR2DS5频率高于梅毒患者 (p = 0.015; OR = 0.575)。与梅毒患者相比，HLA-C1等位基因 (HLA-C1C1) 的纯合子在对照组中更为常见 (p = 0.030; OR = 0.667)。与梅毒患者组相比，对照组中具有HLA-C1C1和KIR2DL3基因型的个体的频率更高 (p = 0.018; OR = 0.647)。这些数据表明，KIR2DS3和KIR3DS1在梅毒患者中比在对照组中更为普遍，而KIR2DS5，HLA-C1C1和HLA-C1C1-KIR2DL3在对照组中比在梅毒患者中更为普遍。这些将需要使用功能研究进行进一步的研究。

BACKGROUND & AIMS: :The study aims were to determine the prevalence of positive syphilis serology and meningovascular neurosyphilis (NS) in patients admitted with transient ischaemic attack (TIA) and stroke to a tertiary hospital serving a culturally diverse community. A retrospective cohort analysis was conducted using routinely collected administrative data and medical records to identify patients admitted with TIA, stroke and other conditions, with positive syphilis serology, between 2005 and 2009. Direct medical record review confirmed diagnoses of meningovascular NS. Syphilis serology was requested in 27% (893/3270) of all patients with TIA and stroke (2005-09) of whom 4% (38/893) were positive. Thirty-seven patients with positive serology had clinical characteristics consistent with meningovascular NS. Their mean age was 72±13 years; 65% were male and 68% had a recorded place of birth in South-East Asia or the Pacific Islands. One of 12 patients with suspected meningovascular NS with cerebrospinal fluid (CSF) analysis had a positive CSF Venereal Disease Research Laboratory (VDRL) test. Three patients (8%) met diagnostic criteria for "definite or probable" meningovascular NS. All three patients with a "definite or probable" meningovascular NS and 15 (44%) of the remainder who had positive serology without confirmation of NS were treated with intravenous or intramuscular penicillin. Lumbar puncture (LP) and penicillin were underutilised in patients with TIA and stroke with positive serology. In conclusion, syphilis testing should be considered part of the diagnostic work-up of TIA and stroke, particularly in ethnically diverse populations. In patients with TIA and stroke with positive syphilis serology, it would seem appropriate to further pursue diagnosis and treatment and in patients unable to undergo LP, empiric treatment for NS should be considered.

背景与目标： : 该研究旨在确定患有短暂性脑缺血发作 (TIA) 和中风的患者到服务于文化多元化社区的三级医院的梅毒血清学阳性和脑膜血管性神经梅毒 (NS) 的患病率。使用常规收集的管理数据和病历进行回顾性队列分析，以识别患有TIA，中风和其他疾病，梅毒血清学阳性，2005年和2009的患者。直接病历审查证实了脑膜血管神经系统的诊断。所有TIA和中风患者 (2005-09) 的27% (893/3270) 均要求梅毒血清学检查，其中4% (38/893) 为阳性。37例血清学阳性患者的临床特征与脑膜血管神经系统一致。他们的平均年龄为72 ± 13岁; 65% 是男性，68% 有记录的出生地在东南亚或太平洋岛屿。12例疑似脑脊液 (CSF) 分析的脑膜血管NS患者中，有一例CSF性病研究实验室 (VDRL) 测试呈阳性。三名患者 (8%) 符合 “确定或可能” 的脑膜血管神经系统的诊断标准。所有三名具有 “确定的或可能的” 脑膜血管NS的患者以及其余15名 (44% 名) 血清学阳性而未确认NS的患者均接受静脉或肌内青霉素治疗。血清学阳性的TIA和中风患者未充分利用腰椎穿刺 (LP) 和青霉素。总之，梅毒测试应被视为TIA和中风的诊断工作的一部分，尤其是在不同种族的人群中。对于梅毒血清学阳性的TIA和中风患者，进一步进行诊断和治疗似乎是适当的，对于无法接受LP的患者，应考虑对NS进行经验性治疗。

BACKGROUND & AIMS: :A stenosing antral lesion was diagnosed in a patient with previous ulcer dyspepsia. Radiology, gastroscopy and serology made the diagnosis of gastric syphilis. The lesion disappeared with specific therapy. We present this case because of its rare gastric onset (0.3%) among visceral syphilis, though sexual transmission diseases are increasing nowadays.

背景与目标： : 在先前患有溃疡性消化不良的患者中诊断出狭窄的窦病变。放射学，胃镜和血清学诊断为胃梅毒。经特殊治疗后病变消失。我们提出这种情况是因为其在内脏梅毒中罕见的胃发作 (0.3%)，尽管如今性传播疾病正在增加。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:Treponemal tests provide advantage of better detection during early, late and latent stages of syphilis with equal or higher sensitivity & specificity in comparison to non-treponemal tests. The objective of the present study was to analyse the level of concordance between treponemal and non-treponemal tests for donor screening and to correlate them with donor history. MATERIALS AND METHODS:Retrospective analysis of syphilis screening by treponemal (Chemiluminescence & TPHA) and non-treponemal tests (RPR) was done and donor history for high-risk behaviour and factors associated with false positivity were collected from post-donation counselling and collected data was coded and analysed. RESULTS:Amongst the 12,000 donors screened, reactivity rate by RPR, TPHA and Chemiluminescence was 0.45%, 0.8% and 1.17% respectively. There was discordance of 62% and 32% for reactive results by RPR and TPHA respectively when compared with Chemiluminescence. History of high-risk behaviour was present in ∼ 50% and 15% of donors with discordant results by RPR and TPHA respectively. Of 34 donors who were reactive only by Chemiluminescence and were followed up, 15% had history of high-risk behaviour and 56% had factors associated with false reactivity. CONCLUSION:Treponemal tests showed high syphilis reactivity amongst blood donors as compared to non-treponemal tests most likely due to their ability to detect early, late and latent syphilis cases. This may confer added transfusion safety in centres dependent on replacement donors without NAT testing by identifying donors with high-risk history with negligible increase in discard rate due to false reactivity.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Despite widespread availability of rapid plasma reagin (RPR) for syphilis screening at sex worker (SW)-dedicated project clinics, uptake of syphilis testing remains low and prevalence of syphilis remains high among SWs in Maharashtra, India. The primary reasons given for refusal of RPR were fear of venipuncture and long waiting times for results. METHODS:Between December 2007 and February 2008, rapid point of contact diagnostic tests (Syphicheck-WB, Qualpro Diagnostics, India) using finger-prick samples were introduced for syphilis screening, with RPR confirmation test of positives. RESULTS:Uptake of syphilis screening among clinic attenders increased to 63.1% compared with an average of 14.3% before the intervention. Among the 19,809 SWs who were screened, 598 tested positive (3% prevalence of lifetime infection). Of these, 395 (66.1%) accepted RPR confirmation test; 337 (88.3%) were seroreactive, 160 (40.5%) had titers ≥1:8 (active syphilis). The projected overall prevalence of active syphilis among all SWs screened was 1.2% but varied by site and typology of sex work (brothel-based, 2.4%; bar-based, 0.5%; street-based, 2.3%; male SWs, 0.2%; transgender, 11.3%; home-based, 0.6%). CONCLUSIONS:The introduction of rapid tests dramatically increased the uptake of syphilis screening in this large-scale intervention among a high-risk population in India. However, only two-thirds of SWs with a positive rapid test accepted a confirmatory RPR test. The high proportion (40.5%) of active syphilis among those testing positive on the rapid screening test justifies treatment even if confirmatory testing is declined. A commercially available, simple, rapid nontreponemal test is needed to further strengthen syphilis screening.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:This paper presents the prevalence of human immunodeficiency virus (HIV) and syphilis infections among women attending antenatal clinics (ANC) in Tanzania obtained during the 2003/2004 ANC surveillance. METHODS:Ten geographical regions; six of them were involved in a previous survey, while the remaining four were freshly selected on the basis of having the largest population among the remaining 20 regions. For each region, six ANC were selected, two from each of three strata (urban, peri-urban and rural). Three of the sites did not participate, resulting into 57 surveyed clinics. 17,813 women who were attending the chosen clinics for the first time for any pregnancy between October 2003 and January 2004. Patient particulars were obtained by interview and blood specimens were drawn for HIV and syphilis testing. HIV testing was done anonymously and the results were unlinked. RESULTS:Of the 17,813 women screened for HIV, 1,545 (8.7% (95% CI = 8.3-9.1)) tested positive with the highest prevalence in women aged 25-34 years (11%), being higher among single women (9.7%) than married women (8.6%) (p < 0.07), and increased with level of education from 5.2% among women with no education to 9.3% among those at least primary education (p < 0.001). Prevalence ranged from 4.8% (95% CI = 3.8%-9.8%) in Kagera to 15.3% (95% CI = 13.9%-16.8%) in Mbeya and was; 3.7%, 4.7%, 9.1%, 11.2% and 15.3% for rural, semi-urban, road side, urban and 15.3% border clinics, respectively (p < 0.001). Of the 17,323 women screened for syphilis, 1265 (7.3% (95%CI = 6.9-7.7)) were positive, with highest prevalence in the age group 35-49 yrs (10.4%) (p < 0.001), and being higher among women with no education than those with some education (9.8% versus 6.8%) (p < 0.0001), but marital status had no influence. Prevalence ranged from 2.1% (95% CI = 1.4%-3.0%) in Kigoma to 14.9% (95% CI = 13.3%-16.6%) in Kagera and was 16.0% (95% CI = 13.3-18.9), 10.5% (95% CI = 9.5-11.5) and 5.8% (95% CI = 5.4-6.3) for roadside, rural and urban clinics, respectively. Syphilis and HIV co-infection was seen in 130/17813 (0.7%). CONCLUSION:The high HIV prevalence observed among the ANC clinic attendees in Tanzania call for expansion of current voluntary counselling and testing (VCT) services and access to antiretroviral drugs (ARV) in the clinics. There is also a need for modification of obstetric practices and infant feeding options in HIV infection in order to prevent mother to child transmission of HIV. To increase uptake to HIV testing the opt-out strategy in which all clients are offered HIV testing is recommended in order to meet the needs of as many pregnant women as possible.

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