{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T13:49:26Z","timestamp":1789912166844,"version":"4.0.1"},"reference-count":26,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,6,7]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In France, surveillance of early syphilis (primary, secondary and early latent) relies on the clinician-based ResIST sentinel network. Although ResIST enables the monitoring of trends, a complete picture of the syphilis epidemic is not possible. More specifically, cases reported by this network are mostly diagnosed in free sexually transmitted infection clinics and hospitals (75% and 24%, respectively). This study aims to estimate the number and rate of diagnoses made outside these health facilities by exploring health insurance data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An algorithm combining healthcare reimbursements for specific diagnostic tests and recommended treatment was fitted to identify syphilis cases. Sensitivity analyses were used to validate the algorithm. Age-standardised and gender-standardised diagnosis rates were estimated using census data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2011 and 2013, 12 644 (7.5 cases per 100 000 inhabitants) reimbursements were made for syphilis-related diagnoses. The annual number of cases increased by 22% from 2011 (n=3771, rate=6.7\/100 000) to 2013 (n=4589, rate=8.2\/100 000). The rate of syphilis diagnosis increased in men from 12.9\/100 000\u2009to 16.0\/100\u2009000, while it remained steady in women at approximately 1.8\/100\u2009000. The disease burden was greatest in French overseas territories (18.1\/100\u2009000) and in the Paris area (11.7 cases\/100\u2009000).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the lack of data on the number of confirmed diagnoses and information on sexual behaviour, these findings demonstrate the relevance of analysing insurance data to help monitor the syphilis epidemic in patients who visit general practitioners and non-hospital-based specialists. Thus, reimbursement database might be a relevant alternative source of continuous information on syphilis in countries with similar insurance-based healthcare systems.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2017-020336","type":"journal-article","created":{"date-parts":[[2018,7,23]],"date-time":"2018-07-23T07:35:43Z","timestamp":1532331343000},"page":"e020336","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Relevance of healthcare reimbursement data to monitor syphilis epidemic: an alternative surveillance through the national health insurance database in France, 2011\u20132013"],"prefix":"10.1136","volume":"8","author":[{"given":"Ndeindo","family":"Ndeikoundam Ngangro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphine","family":"Viriot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Lucas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjorie","family":"Boussac-Zarebska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Lot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Dupin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"La Ruche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,23]]},"reference":[{"key":"2024051711381118000_8.7.e020336.1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2807\/esm.09.12.00493-en","article-title":"Syphilis surveillance in France, 2000-2003","volume":"9","author":"Couturier","year":"2004","journal-title":"Euro Surveill"},{"key":"2024051711381118000_8.7.e020336.2","unstructured":"Ndeikoundam N , Viriot D , Fournet N , et al . 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