Syphilis among men who have sex with men attending a large HIV clinic in Trinidad

Abstract

A chart review study was conducted to determine the prevalence of syphilis and explore the associated risk factors among men who have sex with men (MSM) who attended a large HIV clinic in Trinidad during the period January–December 2019. Patients were routinely screened for syphilis annually, and demographic, clinical, and laboratory data were extracted from the medical records. Descriptive and bivariate analyses were performed, and factors significantly associated with a syphilis diagnosis were assessed using multivariate logistic regression. During the period, 218 MSM were seen, age range 19–67 years, and median age 34.0 years. The prevalence of syphilis was 41.3% (90/218), and 71.1% (64//90) of these infections were asymptomatic. Multivariate analysis using logistic regression showed that MSM living with HIV in the 30–34 years old-age group (OR, 4.32; 95% CI, 1.04–18.02), and those with a previous history of treated syphilis (OR, 10.18; 95% CI, 4.60–22.53) were more likely to be diagnosed with syphilis. The prevalence of syphilis is high among MSM attending the HIV clinic in Trinidad, and most of these infections were asymptomatic; hence, targeted and sustained interventions to reduce syphilis transmission are urgently required. Repeat episodes of syphilis may play a role in the transmission dynamics of syphilis in MSM.

Correlates of prevalent syphilis infection among men who have sex with men (MSM) living with HIV attending the HIV clinic in Trinidad

“…In this study, the prevalence of syphilis in MSM living with HIV was 28% and MSM with a previous diagnosis of syphilis were five times more likely to be diagnosed with syphilis (OR 5.16; 95% CI, 1.03–25.83). These findings are similar to a retrospective analysis in MSM living with HIV conducted at the MRFTT in 2019 which found a high prevalence of syphilis of 41.3% [ 11 ] and patients with a previous history of treated syphilis were ten times more likely to be diagnosed with syphilis [ 11 ]. Similar results were demonstrated by Roth et al in a study of a Swiss cohort of MSM living with HIV where repeat episodes of syphilis were reported [ 15 ] and this was attributed to high risk sexual behavior and the high background rate of syphilis in MSM populations [ 15 ].…”

“…In our study, most of the syphilis infections were asymptomatic (89.2%). This was also reported in the retrospective study of MSM attending the HIV Clinic in Trinidad in 2019 with 71.1% of these infections being asymptomatic [ 11 ] and by Branger et al [ 17 ] in an outpatient clinic in Amsterdam where routine syphilis screening conducted on 1,105 HIV infected patients identified 81 cases with syphilis, all among males of whom 94% were MSM with 33% of the infections being asymptomatic. A few studies have suggested that persons with past episodes of syphilis were more likely to be asymptomatic on repeat episodes [ 18 , 19 ] possibly due to the acquired immune response resulting from past infection which may attenuate the clinical manifestations of reinfection with T .…”

“…Using the traditional algorithm, a diagnosis of syphilis was made by a reactive VDRL test confirmed by a reactive TPPA. A confirmed serological test result for syphilis is indicative of the presence of treponemal antibodies but may be unable to distinguish between past and current infection, thus correlation from the history of the patient ever having a diagnosis of syphilis and subsequent treatment is important [ 11 ] and this was obtained by chart review.…”

“…a reactive VDRL and TPPA serology following a diagnosis of syphilis and after treatment there was a subsequent ≥4-fold reduction or negativity of the VDRL titres followed by a consecutive ≥4-fold titre increase with a titre of at least 8 in VDRL testing [ 11 ] suggesting syphilis re-infection.…”

“…In these studies, the prevalence of syphilis increased from 13.2% in 2012 (9) to 21.0% in 2014 [ 10 ]. A retrospective study was conducted in 2019 among MSM living with HIV attending the HIV clinic in Trinidad [ 11 ] and showed the prevalence of syphilis was 41.3%, most of these infections were asymptomatic (71.1%) and syphilis was more likely to be diagnosed among patients in the 30–34 year old age group and those who were previously treated for syphilis [ 11 ]. Stigma and discrimination still persist in T&T as relationships among members of the same sex are not readily accepted by the general population and by some health care workers [ 11 ], though in 2018, anal sex among consenting adults was decriminalized [ 12 ].…”