Factors Associated With Syphilis Transmission and Acquisition Among Men Who Have Sex With Men: Protocol for a Multisite Egocentric Network Study

Abstract

Background In the United States, the rates of primary and secondary syphilis have increased more rapidly among men who have sex with men (MSM) than among any other subpopulation. Rising syphilis rates among MSM reflect changes in both individual behaviors and the role of sexual networks (eg, persons linked directly or indirectly by sexual contact) in the spread of the infection. Decades of research examined how sexual networks influence sexually transmitted infections (STIs) among MSM; however, few longitudinal data sources focusing on syphilis have collected network characteristics. The Centers for Disease Control and Prevention, in collaboration with 3 sites, enrolled a prospective cohort of MSM in 3 US cities to longitudinally study sexual behaviors and STIs, including HIV, for up to 24 months. Objective The Network Epidemiology of Syphilis Transmission (NEST) study aimed to collect data on the factors related to syphilis transmission and acquisition among MSM. Methods The NEST study was a prospective cohort study that enrolled 748 MSM in Baltimore, Maryland; Chicago, Illinois; and Columbus, Ohio. NEST recruitment used a combination of convenience sampling, venue-based recruitment, and respondent-driven sampling approaches. At quarterly visits, participants completed a behavioral questionnaire and were tested for syphilis, HIV, gonorrhea, and chlamydia. The participants also provided a list of their sexual partners and described their 3 most recent partners in greater detail. Results The NEST participants were enrolled in the study from July 2018 to December 2021. At baseline, the mean age of the participants was 31.5 (SD 9.1) years. More than half (396/727. 54.5%) of the participants were non-Hispanic Black, 29.8% (217/727) were non-Hispanic White, and 8.8% (64/727) were Hispanic or Latino. Multiple recruitment strategies across the 3 study locations, including respondent-driven sampling, clinic referrals, flyers, and social media advertisements, strengthened NEST participation. Upon the completion of follow-up visits in March 2022, the mean number of visits per participant was 5.1 (SD 3.2; range 1-9) in Baltimore, 2.2 (SD 1.6; range 1-8) in Chicago, and 7.2 (SD 2.9; range 1-9) in Columbus. Using a community-based participatory research approach, site-specific staff were able to draw upon collaborations with local communities to address stigma concerning STIs, particularly syphilis, among potential NEST participants. Community-led efforts also provided a forum for staff to describe the NEST study objectives and plans for research dissemination to the target audience. Strategies to bolster data collection during the COVID-19 pandemic included telehealth visits (all sites) and adaptation to self-collection of STI specimens (Baltimore only). Conclusions Data from NEST will be used to address important questions regarding individual and partnership-based sexual risk behaviors among MSM, with the goal of informing interventions to prevent syphilis in high-burden areas. International Registered Report Identifier (IRRID) RR1-10.2196/40095

Positive and Negative Social Consequences of Participating in a Sexual‐Network Study

“…T he Network Epidemiology of Syphilis Transmission (NEST) Study was a multisite longitudinal sexual health study that followed men who have sex with men (MSM) over two years in three U.S. cities: Columbus, Ohio; Baltimore, Maryland; and Chicago, Illinois. 6 The current analysis is restricted to Columbus participants. Eligible men were adults aged 18 or older who reported anal or oral sex with a man in the past six months; lived, worked, or received medical care within an hour of Columbus, Ohio; and reported male sex assigned at birth and male gender identity.…”

“…T he Network Epidemiology of Syphilis Transmission (NEST) Study was a multisite longitudinal sexual health study that followed men who have sex with men (MSM) over two years in three U.S. cities: Columbus, Ohio; Baltimore, Maryland; and Chicago, Illinois 6 . The current analysis is restricted to Columbus participants.…”

Advancing Syphilis Research: Exploring New Frontiers in Immunology and Pharmacological Interventions

“…Primary healthcare providers are well-positioned to address various health needs of their patients, including sexual health. By including syphilis services in routine health check-ups and screenings, primary healthcare providers can offer comprehensive care and encourage regular testing for sexually transmitted infections, including syphilis [108][109][110].…”

Advancing Syphilis Research: Exploring New Frontiers in Immunology and Pharmacological Interventions

“…These groups often face higher rates of syphilis transmission due to various factors, including social stigma, discrimination, and limited access to healthcare services. Tailored interventions for MSM and transgender individuals involve community engagement and peer-led initiatives to create safe spaces for discussions about sexual health and promote regular testing and treatment-seeking behavior [67].…”

“…Partner notification and contact tracing are essential in these cases to identify undiagnosed cases and interrupt the transmission chain. Utilizing technology and community health workers can enhance the effectiveness of partner notification efforts and facilitate timely testing and treatment for those at risk [11,67].…”