HIV Co-Infection Common With Syphilis among MSM

Published: August 16, 2011

People recently infected with syphilis are also likely to be co-infected with HIV, with men who have sex with men hardest hit, a CDC researcher reported.

More than a third of people being treated for syphilis — some 36% — were also HIV-positive, according to John Su, MD, PhD, of the Centers for Disease Control and Prevention in Atlanta.

But that rate rose to 53% among men who have sex with men, compared with 9% among men who have sex only with women, and 5% among women, Su reported at the 2011 National HIV Prevention Conference in Atlanta.

The findings underscore an "urgent need" to increase HIV and syphilis prevention efforts, Su told reporters.

The analysis is the first national-level look at HIV-syphilis co-infection and it comes in the wake of a study, also by Su and colleagues, showing a startling increase in syphilis incidence among young black men who have sex with men.

That study found that from 2005 through 2008, the rate of primary and secondary syphilis rose by a factor of 2.67 among black men, ages 20 through 24, who have sex with men, Su said.

The co-infection data comes from information supplied by 34 states and the District of Columbia, which are areas that had HIV data for at least 70% of reported syphilis cases. Taken together, the study regions accounted for 82% of syphilis cases reported in 2009.

Of 11,499 patients with primary and secondary syphilis, Su reported, 11,043 (or 96%) were asked about their HIV status. Of those, 36% also had HIV, 49% did not, 1% would not disclose their status, and 15% did not know.

Co-infection rates were higher among men who have sex with men, but also varied with race and ethnicity within that group, Su and colleagues found. Specifically, the rate among black men was 59% compared with 49% among Hispanics and 50% among whites — differences that were significant at P<0.001.

Racial and ethnic disparities were even greater among young men who have sex with men, ages 15 through 19: 35% of blacks were co-infected compared with 22% of whites and 11% of Hispanics, Su and colleagues found.

While they were rarer overall, cases of co-infection among heterosexual men and women also showed that blacks were hardest hit: 68% of the 176 co-infected men who had sex only with women were black, as were 72% of the 72 women who had both diseases.

The CDC’s latest HIV incidence data showed that the virus is roughly stable at about 50,00 infections a year. However, young black men who have sex with men, ages 13 through 29, had a 48% increase in new HIV infections between 2006 and 2009.

Taken together, the findings illustrate a need for greater efforts to reach the groups at greatest risk, according to Kevin Fenton, MD, PhD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

"We cannot allow the health of a new generation of gay and bisexual to be lost to essentially preventable diseases," Fenton said.

At this meeting, the CDC is also rolling out a new ad campaign — dubbed "Testing Makes Us Stronger" — aimed at encouraging HIV testing among black men who have sex with men.

Testing is a "critical" part of reducing the infection rate, according to Richard Wolitski, PhD, of the CDC, because people who know their HIV status can take steps to prevent passing the virus on.

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