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Asking Patients About Sex Only Factor Tied in Syphilis Screening in HIV Group
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IDWeek 2014, October 8-12, 2014, Philadelphia
Mark Mascolini
Asking HIV-positive patients at an urban clinic about their sexual history emerged as the only factor independently linked to syphilis screening [1]. Twelve of 102 people (12%) tested positive for syphilis.
Syphilis incidence began to surge in the United States and Western Europe in the mid-1990s [2]. Many new cases involve men who have sex with men (MSM), and evidence indicates that 50% to 60% of US MSM with early syphilis have HIV infection [3]. Because syphilis signs and symptoms are typically innocuous or absent, the Centers for Disease Control and Prevention recommends annual syphilis screening for people with HIV, especially MSM.
To determine syphilis screening rates and factors that favor screening in an urban HIV population, researchers evaluated HIV-positive adults who made more than two visits to a Detroit infectious diseases practice from January through December 2011. They collected standard demographic data and determined whether people got screened for syphilis with an RPR assay and what the assay indicated. The investigators used logistic regression analysis to identify predictors of RPR testing.
The study focused on 173 people, 122 of them (70.5%) men, 86 (50%) MSM, and 82 (47%) heterosexual men or women. Age averaged 46.6 years (standard deviation 11.6). During the study period, 102 people (59%) had an RPR test, 93 for screening and 9 for symptoms of possible syphilis exposure.
Ninety people tested (88%) had a negative result. Among the 12 people with a positive RPR, median titer was 2 (range 2 to 512). Nine of these 12 positive tests were done for screening.
Compared with people not tested for syphilis, tested people were younger (average 45 versus 49, P = 0.022) and were more likely to have their sexual history recorded by their clinician (68.6% versus 32.4%, P < 0.001). Tested and untested people did not differ by gender, race, MSM status, history of injecting drugs, or sexual activity (about 60% in both groups were sexually active).
Logistic regression analysis singled out only one independent predictor of RPR testing: Taking a sexual history of a patient quadruped the odds of testing for syphilis (adjusted odds ratio 4.16, 95% confidence interval 2.1 to 8.2).
The Detroit investigators believe their findings indicate "an opportunity to increase syphilis screening among HIV-positive patients." They proposed that "increased emphasis on obtaining sexual history during routine care would likely result in increased appropriate syphilis screening."
References
1. Ramirez S, Szpunar S, Johnson L. Don't ask, don't test? Rates of syphilis screening among urban HIV patients. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1582.
2. Mascolini M. Slowing resurgent syphilis in people with HIV. Research Initiative, Treatment Action. 2012;17(1):5-28. http://centerforaids.org/pdfs/ritasummer2012.pdf
3. Buchacz K, Greenberg A, Onorato I, Janssen R. Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention. Sex Transm Dis. 2005;32:S73-S79.
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