Persistently elevated risk of syphilis among HIV-positive men receiving care in a status-neutral setting: A retrospective analysis.

BACKGROUND
Over the past decade, the incidence of primary and secondary syphilis has increased dramatically in the United States and western Europe. Men living with HIV and those at risk of HIV infection experience disproportionately high rates of early syphilis [ES]. We compared the odds of ES among HIV-positive and HIV-negative men participating in a status-neutral comprehensive HIV prevention and treatment program [CHP].


METHODS
We conducted a retrospective analysis of men aged 18-65 years with ≥ one CHP visit and ≥ two rapid plasma reagin [RPR] tests performed between January 1, 2018, and December 31, 2021. ES was defined as newly reactive RPR with a minimum titer of ≥1:4 or a ≥ four-fold increase in the RPR titer. Multiple logistic regression analyses were performed to determine predictors of ES.


RESULTS
A total of 2490 men met the inclusion criteria, of whom 1426 (57·3%) were HIV-positive and 1064 (42·7%) were HIV-negative. Of the 393 men with ES, 284 (72·3%) were HIV-positive and 109 (27·7%) were HIV-negative. HIV-positive men had higher adjusted odds of ES (aOR 2·86, 95% CI 2·45, 3·27) than HIV-negative men did. Chlamydia or gonorrhea [CTGC] infection did not differ according to HIV status (aOR 0·93, 95% CI 0·82, 1·04).


CONCLUSIONS
In our status-neutral care setting, HIV-positive status was associated with significantly higher odds of ES, but not CTGC. Our findings emphasize the vulnerability of HIV-positive men to syphilis in an era of effective HIV biomedical prevention.