Young MSM Are at Risk for Syphilis and HIV Coinfection

Young MSM Are at Risk for Syphilis and HIV Coinfection

Emma Hitt, PhD

March 19, 2012 — There has been a dramatic increase in the rate of syphilis in young men who have sex with men (MSM), and the rate of coinfection with HIV is high.

John Su, MD, PhD, MPH, from the Division of STD Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia, discussed these findings in an oral presentation at the 2012 National STD Prevention Conference, held in Minneapolis, Minnesota.

"In this analysis, we wanted to examine syphilis [and HIV in individuals with syphilis], particularly in men who have sex with men and in subpopulations of MSM," Dr. Su told Medscape Medical News.

"The goal of my presentation was to make care providers and other health professionals aware of how syphilis and coinfection with HIV affects particular populations," he said. "Syphilis, like other genital ulcerative diseases, can increase both the risk of transmitting and of being infected with HIV," he pointed out.

From 2005 to 2010, the rates of primary and secondary syphilis in MSM 15 to 29 years of age increased substantially. According to data collected from 27 states, the rate increased in black MSM by 200% and in Hispanic MSM by 144%.

Coinfection with HIV in MSM was common; it was reported in 46% of 15- to 29-year-old MSM with primary and secondary syphilis who knew their HIV status in 2010.

In contrast, during the same period of time, rates in women increased minimally and rates of congenital syphilis did not increase.

"Clinicians need to ask all their patients about sexual partners and practices, especially MSM," said Dr. Su. "Anyone diagnosed with syphilis should be tested for HIV, and patients diagnosed with HIV should be tested for syphilis."

According to Dr. Su, the data presented do not address underlying causes. However, numerous factors, including social factors and access to care, might contribute to the increased rates of syphilis in this population.

These findings show that the increasing trend for syphilis in MSM "is becoming well established, and that black MSM are at the greatest risk for syphilis," said Kenneth H. Mayer, MD, medical research director and cochair of The Fenway Institute, in Boston, Massachusetts. "They also show that although there is a disproportionate rate of coinfection with HIV, increasing numbers of HIV-uninfected MSM are acquiring syphilis," he told Medscape Medical News.

According to Dr. Mayer, providers need to regularly screen sexually active MSM for syphilis. "HIV-uninfected MSM who develop syphilis need to be counseled carefully about their risk of acquiring HIV, and referrals to behavioral prevention interventions are indicated," he said.

The researchers and Dr. Mayer have disclosed no relevant financial relationships.

2012 National STD Prevention Conference: Abstract D5.1. Presented March 15, 2012.