Program Schedule

Rising Incidence of Syphilis Among Rural HIV+ Men Despite Systematic, Point of Care Prevention Counseling

Session: Oral Abstract Session: HIV Related Inflammation, Complications and Comorbidities
Friday, October 10, 2014: 11:15 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: Syphilis incidence has been increasing in men with HIV infection despite the implementation of routine clinic-based HIV prevention efforts.  We observed an increase in syphilis diagnoses among our HIV+ cohort during the same time period that we introduced a “Preventions with Positives” initiative.  Patients’ risk profiles were closely examined to better understand the epidemiology of syphilis in our cohort of rural HIV-infected men in an effort to plan more effective prevention strategies.

Methods: We performed a retrospective cohort study to identify risk factors associated with incident syphilis diagnoses in a cohort of HIV+ men mostly living in rural south central Pennsylvania from 2008 to mid-2013.  During this same time period we introduced a succinct, formalized risk behavior screening protocol tied to transmission reduction education delivered at the point of care.  Patients’ demographic, clinical, psychosocial and risk behavioral characteristics were examined.  A multivariate logistic regression model was performed to identify factors associated with syphilis.

Results: Between 2003 and 2007 we diagnosed a total of 15 syphilis cases, all men.   Without significant changes in our population or syphilis screening practice, a total of 51 new syphilis infections were diagnosed among 702 HIV+ men during the study period (5 patients were diagnosed with 2 or more episodes).  The number of syphilis cases paradoxically increased from 5 cases in 2008 to 17 cases in 2012 in the face of our ongoing prevention counseling.  Younger age (<35 years) (adjusted odds ratio [aOR]=2.99), a higher educational attainment (aOR=4.30), and perception that partner may have sex with other people (aOR=2.85) were significantly associated with syphilis. Additionally, non-injection drug use was related to syphilis diagnosis in HIV+ men who have sex with men (aOR=2.61). 

Conclusion: Some HIV+ men, especially younger, well-educated men or those who perceived that their partners may have sex with other people, continue to have high-risk behaviors that may facilitate HIV transmission and increase their own risks of acquiring new STDs.  Routine clinic-based risk-reduction counseling may not have long-term effects in reducing high-risk behaviors.  New approaches are needed to prevent safer sex fatigue in HIV+ men.

Poonam Mathur, MD1, John Zurlo, MD2, Patsi Albright, CRNP, Ph.D2, Tonya Crook, MD2, Cynthia Whitener, MD2 and Ping Du, MD, PhD3, (1)Medicine, Hershey Medical Center, Hershey, PA, (2)Medicine/Infectious Diseases, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, (3)Medicine/Public Health Sciences, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA


P. Mathur, None

J. Zurlo, None

P. Albright, None

T. Crook, None

C. Whitener, None

P. Du, None

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