High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada

Ann N Burchell, Vanessa G Allen, Sandra L Gardner, Veronika Moravan, Darrell H S Tan, Ramandip Grewal, Janet Raboud, Ahmed M Bayoumi, Rupert Kaul, Tony Mazzulli, Frank McGee, Sean B Rourke, OHTN Cohort Study Team, Adrian Betts, Anita C Benoit, Les Bowman, Tracey Conway, Patrick Cupido, Tony Di Pede, Brian Finch, Michael J Hamilton, Brian Huskins, Rick Kennedy, Ken King, Nathan Lachowsky, Joanne Lindsay, Shari Margolese, John McTavish, Colleen Price, Lori Stoltz, Darien Taylor, Rosie Thein, Ahmed Bayoumi, Evan Collins, Curtis Cooper, Clemon George, Troy Grennan, Claire Kendall, Greg Robinson, Ann N Burchell, Vanessa G Allen, Sandra L Gardner, Veronika Moravan, Darrell H S Tan, Ramandip Grewal, Janet Raboud, Ahmed M Bayoumi, Rupert Kaul, Tony Mazzulli, Frank McGee, Sean B Rourke, OHTN Cohort Study Team, Adrian Betts, Anita C Benoit, Les Bowman, Tracey Conway, Patrick Cupido, Tony Di Pede, Brian Finch, Michael J Hamilton, Brian Huskins, Rick Kennedy, Ken King, Nathan Lachowsky, Joanne Lindsay, Shari Margolese, John McTavish, Colleen Price, Lori Stoltz, Darien Taylor, Rosie Thein, Ahmed Bayoumi, Evan Collins, Curtis Cooper, Clemon George, Troy Grennan, Claire Kendall, Greg Robinson

Abstract

Background: The re-emergence of syphilis among HIV-positive gay and other men who have sex with men (MSM) requires vigilance. We estimated incidence of and risk factors for first and subsequent syphilis diagnoses among MSM in HIV care in Ontario, Canada.

Methods: We analyzed data from 2,280 MSM under follow-up from 2006 to 2010 in the Ontario HIV Treatment Network Cohort Study (OCS), a multi-site clinical cohort. We obtained syphilis serology results via record linkage with the provincial public health laboratory. Rates were calculated using Poisson regression.

Results: First syphilis diagnoses occurred at a rate of 2.0 per 100 person-years (95 % CI 1.7, 2.4; 121 cases) whereas the re-diagnosis rate was 7.5 per 100 person-years (95 % CI 6.3, 8.8; 136 cases). We observed higher rates over time and among men who were aged <30 years, receiving care in the two largest urban centers, or had a previous syphilis diagnosis. Syphilis diagnosis was less common among Indigenous men, men with higher CD4 cell counts, and, for first diagnoses only, among men with less than high school education.

Conclusions: Compared to reported cases in the general male population, incidence of a new syphilis diagnosis was over 300 times greater among HIV-positive MSM but year-to-year changes reflected provincial trends. Re-diagnosis was common, suggesting treatment failure or re-infection. Novel syphilis control efforts are needed among HIV-positive MSM.

Figures

Fig. 1
Fig. 1
Rate of new syphilis diagnoses among HIV-positive MSM, OHTN Cohort Study, 2006–2010. Re-diagnosis defined as a four-fold rise in RPR titre. See text for details

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