Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

Abstract

BackgroundSyphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru.MethodsParticipants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02).ResultsOf 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1–1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated.ConclusionsWe report a high rate of syphilis reinfection among high-risk men who have evidence of previous syphilis infection. Our findings highlight the close relationship between HIV incidence with both incident syphilis and syphilis reinfection. Further studies on syphilis reinfection are needed to understand patterns of syphilis reinfection and new strategies beyond periodic testing of high-risk individuals based on HIV status are needed.

Factors associated with syphilis infection: a cross-sectional survey among outpatients in Asikuma Odoben Brakwa District, Ghana

“…The disease can be transmitted by a pregnant woman to her unborn baby in utero [2], leading to neonatal death, blindness in the newborn and severe disability in infants [3]. Major risk factors that promote the transmission of syphilis include men having sex with men, having concurrent multiple sex partners, alcohol or drug use and engaging in unprotected sex [4].…”

Pandemias: Impactos na sociedade

“…Fatores associados à transmissão vertical e maior incidência estão relacionados, também, a menor escolaridade materna, cor da pele, menor proporção de consultas e realização de exames no período gravídico (DOMINGUES & LEAL, 2016;VALLEJO & CIFUENTES, 2015). A prevalência e o perfil epidemiológico da sífilis apareceram com mais frequência, assim como a sua forma de transmissão, os métodos de diagnósticos mais eficazes e o tratamento (PINTO, 2016;LIU, 2016;TAYLOR, 2016;MALLMA, 2016;MUTAGOMA, 2016;PARK, 2016;ALMEIDA, 2015;CUNHA, 2015;DOMINGUES, 2014;SERAFIM, 2014;SMIT, 2013;LI, 2013;JAFARI, 2013;MIRANDA, 2012;CAVALCANTE, 2012;GALATOIRE, 2012;HOLANDA, 2011;DIÉZ, 2011;GONÇALVES, 2011;CARVALHO, 2009;ISAM, 2009;SANTOS, 2009;TAYRA, 2007;CONDE-CONZÁLEZ, 2007).…”

“…Em relação a prevalência da sífilis, Mutagoma et al (2016) e Miranda et al (2012) identificaram que a maior prevalência da doença foi em pessoas de baixa escolaridade, classe média baixa, com maior índice em mulheres do que em homens, residentes em área urbana e pacientes HIV positivos. Park et al (2016) retratam em um caso coorte, que houve uma reincidência de 56% da sífilis comparando-se um grupo de homens sem tratamento e 28% em homens já tratados, enquanto a prevalência em homens infectados com o vírus HIV foi de 2,8%.…”

Contextualizing condoms: a cross-sectional study mapping intersections of locations of sexual contact, partner type, and substance use as contexts for sexual risk behavior among MSM in Peru

“…While HIV prevention programs have followed local epidemiology in targeting MSM, the prevalence of HIV among Peruvian MSM remained stable between 2002 (13.9%) and 2016 (15.2%) [1, 2]. Moreover, in studies as recent as 2016, 69–70% of MSM in Peru reported condomless anal intercourse (CAI) with one or more partners in the last 3 months [3, 4]. While a few studies worldwide have explored how the location where a sexual contact occurs influences sexual risk-taking behavior among MSM, the potential influence of different social environments on condom use by MSM in Peru has not yet been studied [5].…”