High incidence of syphilis in HIV-positive homosexual men: data from two community-based cohort studies
Fengyi Jin A E , Garrett P. Prestage A , Iryna Zablotska B , Patrick Rawstorne B , John Imrie B , Susan C. Kippax B , Basil Donovan A C , David J. Templeton A D , John M. Kaldor A and Andrew E. Grulich AA National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2010, Australia.
B National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia.
C Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia.
D RPA Sexual Health, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
E Corresponding author. Email: jjin@nchecr.unsw.edu.au
Sexual Health 6(4) 281-284 https://doi.org/10.1071/SH09060
Submitted: 29 May 2009 Accepted: 21 September 2009 Published: 13 November 2009
Abstract
Background: Syphilis has re-emerged and become established in gay communities in most developed countries since the late 1990s. HIV infected men have been disproportionately affected by this endemic, but it is unclear whether this is due to behavioural or biological reasons. We report incidence and risk factors for syphilis in two community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia. Methods: Participants were recruited using similar community-based strategies in both cohorts and underwent annual face-to-face interviews. Syphilis screening was offered to all consenting participants at annual visits. Results: In the HIV-negative cohort, 21 men seroconverted to syphilis and one man had a syphilis re-infection during 2001–07, an incidence of 0.49 per 100 person-years (95% CI: 0.31–0.74). In the HIV-positive cohort during 2005–07, eight men seroconverted and one man had a syphilis re-infection, giving an incidence of 3.62 per 100 person-years (95% CI: 1.67–6.48). All nine reported a recent CD4 count of more than 350 cells µL–1. Syphilis incidence was significantly higher in the HIV-positive cohort after adjustment for age (hazard ratio (HR) = 9.20, 95% CI: 3.63–23.31). Unprotected anal intercourse (UAI) with HIV-positive partners was significantly associated with incident syphilis in both cohorts (HR = 4.45, 95% CI: 1.37–14.45 in HIV-negative; HR = 8.67, 95% CI: 1.03–72.76 in HIV-positive). Conclusion: Syphilis incidence was almost 10-fold higher in HIV-positive than in HIV-negative homosexual men, and it was not related to a CD4 count below 350 µL–1. UAI with HIV positive partners was of particular importance in the transmission of syphilis.
Additional keywords: homosexuality, incidence, male, risk factor.
Acknowledgements
The authors thank all the participants, the dedicated pH and HIM study team and the participating doctors and clinics.
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