Syphilis Testing and Diagnosis Among People With Human Immunodeficiency Virus (HIV) Engaged in Care at 4 US Clinical Sites, 2014-2018

Abstract

Background Despite rising rates of syphilis among people with HIV (PWH) in the United States, there is no optimal syphilis screening frequency or prioritization. Methods We reviewed records of all PWH in care between January 1, 2014 and November 16, 2018 from four sites in the CFAR Network of Integrated Clinical Systems Cohort (CNICS; N=8455). We calculated rates of syphilis testing and incident syphilis and used Cox proportional hazards models modified for recurrent events to examine demographic and clinical predictors of testing and diagnosis. Results Participants contributed 29568 person-years of follow-up. The rate of syphilis testing was 118 tests per 100 person-years (95%CI: 117-119). The rate of incident syphilis was 4.7 cases per 100 person-years (95%CI: 4.5-5.0). Syphilis diagnosis rates were highest among younger cisgender MSM and transgender women, Hispanic individuals, people who inject drugs, and those with detectable HIV RNA, rectal infections, and hepatitis C. Conclusion We identified PWH who may benefit from more frequent syphilis testing and interventions for syphilis prevention.

High syphilis prevalence and incidence in people living with HIV and Preexposure Prophylaxis users: A retrospective review in the French Dat’AIDS cohort

“…Incidence rate was 3.77 cases per 100 person-years for infection, and 6.47 cases per 100 person-years for re-infection, confirming that syphilis occurs more frequently in previously infected subjects, and reflecting the lack of prevention measures. As a comparison, a recent study found a comparable incidence rate of syphilis of 4,7 per 100 person-years in a cohort of PLWH from the United States [ 21 ]. However, unlike ours, this study found higher rates among younger MSM and those with detectable HIV viral load.…”

Anatomic Site–Specific Gonorrhea and Chlamydia Testing and Incidence Among People With HIV Engaged in Care at 4 US Clinical Centers, 2014–2018

“…This finding suggests that PWH who practice condomless insertive sex may be more likely to transmit HIV in the setting of both STI-related genital inflammation and detectable plasma HIV RNA compared with those with a suppressed viral load. We also found that an incident syphilis diagnosis in PWH was strongly associated with detectable HIV RNA, raising concerns that urogenital GC/CT and syphilis could potentiate onward HIV transmission [ 11 ]. While mathematical modeling studies have assessed the contribution of GC/CT to HIV transmission [ 10 ], future modeling studies of HIV transmission should incorporate the effects of both site-specific GC/CT and syphilis.…”

“…We previously reported on the criteria used to assess syphilis diagnoses in a clinical cohort [ 11 , 28 ].…”

“…Men who have sex with men (MSM) experience extragenital infections at rates greater than urogenital infections [ 7 ], and among cisgender women with extragenital exposures, the prevalence of rectal GC may be greater than that of urogenital GC [ 8 ]. Correlates of incident GC and/or CT (GC/CT) infections likely differ by anatomic site, and infections at different anatomic sites may have differential implications for GC/CT transmission and the transmission of HIV [ 9 , 10 ] and other sexually transmitted infections (STIs), like syphilis [ 11 ] and hepatitis C virus (HCV) [ 12 ]. For example, anogenital infections are more likely to potentiate HIV transmission than pharyngeal infections.…”

Estimating the Proportion of People Living With HIV Who May Benefit From the Reverse Algorithm for the Diagnosis of Incident Syphilis

“…2,3 Recent studies found syphilis to be common among women with HIV, particularly young women, Black and Hispanic women of all ages, women who inject drugs, and women with hepatitis C virus. 4,5 Syphilis screening using the traditional or reverse algorithm is an important intervention to address the rising rates of syphilis among PLWH. Although the reverse algorithm may diagnose syphilis earlier than the traditional algorithm, 6 it cannot be used to detect a new Treponema pallidum infection among those with a history of syphilis and is inefficient and not cost-effective in populations with a high prevalence of prior syphilis.…”