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HIV, Black Race, and Multiple Partners Raise
Risk of Repeat Syphilis in California Gays
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18th Conference on Retroviruses and Opportunistic Infections, February 27-March 2, 2011, Boston
Mark Mascolini
Among all gay men with a positive syphilis test in California from 2002 through 2006, three factors independently raised the risk of a repeated positive test: being HIV-positive, being black, and having 10 or more sex partners in the past 6 months [1].
About three quarters of reported syphilis cases in California involve gay men, according to a team of California public health researchers. And almost 60% of gays with primary or secondary syphilis have HIV infection. Syphilis incidence (the new diagnosis rate) climbed "dramatically" in California over the last decade. The researchers planned this study to gauge the rate of repeat syphilis diagnoses and to identify risk factors for repeat positive tests.
The investigators used a statewide syphilis database to create a retrospective cohort of all gay men with reported primary or secondary syphilis from the start of 2002 to the end of 2006. They compared demographic, clinical, and behavioral characteristics of interviewed men who did and did not have a repeat positive syphilis test.
Of the 2862 men studied, 162 (5.7%) had a repeat positive syphilis test. Median age was lower in repeaters than nonrepeaters (36.5 versus 38, crude odds ratio 0.99, 95% confidence interval [CI] 0.98 to 1.0). Neither geographic region nor substance use in the past 12 months independently predicted a repeat positive syphilis test, but three factors did, at the following adjusted odds ratios (AOR) (and 95% CIs):
-- HIV positive versus negative: AOR 1.65 (1.14 to 2.37)
-- Black versus white race: AOR 1.84 (1.12 to 3.04)
-- 10 or more sex partners in past 6 months versus 1: AOR 1.98 (1.12 to 3.50)
When the repeat diagnosis was early latent syphilis, HIV infection more than tripled the risk (AOR 3.45, 95% CI 2.19 to 5.44). When the diagnosis was primary, secondary, or early latent syphilis, HIV more than doubled the risk (AOR 2.27, 95% CI 1.70 to 3.02). And when the diagnosis was primary or secondary only, HIV raised the risk 65% (AOR 1.65, 95% CI 1.14 to 2.37).
Repeat syphilis did not differ between men who reported 1 sex partner and those who reported none, 2 to 4, or 5 to 9. Hispanics and Asians did not differ from whites in repeat syphilis rate. And the repeat syphilis rate did not rise significantly over the study period.
The researchers suggested the heightened rate of repeat syphilis in HIV-positive gay men could be explained by serosorting (having sex with a partner known to have the same HIV status), having sex in a network with high syphilis prevalence, increased biologic susceptibility to syphilis in men with HIV, or other factors.
"Racial disparities in risk for repeat syphilis infection are concerning," the investigators concluded. "Understanding factors driving this disparity may inform combination HIV and syphilis prevention efforts for black men who have sex with men."
They proposed that repeated syphilis infection "may be contributing to ongoing syphilis transmission and to our unsuccessful syphilis elimination efforts to date."
Reference
1. Cohen S, Chew Ng R, Katz K, et al. Repeat syphilis among MSM in California, 2002 to 2006: implications for syphilis elimination efforts. 18th Conference on Retroviruses and Opportunistic Infections. February 27-March 2, 2011. Boston. Abstract 981.
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