Abstract
The Centers for Disease Control and Prevention (CDC) recommends syphilis screening at least annually for sexually active men who have sex with men (MSM). The objective of this study is to assess the frequency of MSM testing for syphilis and how syphilis test results compared with results of rectal gonorrhea and chlamydia tests. In collaboration with a large US commercial laboratory, we identified men aged 15–60 years who had rectal chlamydia or gonorrhea tests during 09/01/2013–09/30/2015 as presumed MSM. We classified MSM as having current or past syphilis if during the study period they had (1) either a reactive qualitative non-treponemal test or at least a 1:1 quantitative non-treponemal test, and (2) they had a reactive treponemal test. Of 52,771 MSM, 14.3% had no syphilis testing, 4.8% had only treponemal testing (37.8% were reactive), 63.2% had only non-treponemal testing (2.0% were reactive), and 17.7% had both non-treponemal and treponemal testing (86.6% had current or past syphilis). Of those MSM who had reactive qualitative non-treponemal tests, at least 90% had no quantitative non-treponemal tests. Current or past syphilis was more common among MSM with positive rectal gonorrhea or chlamydia tests (24.1%) than MSM with negative rectal gonorrhea and chlamydia tests (13.0%, p < 0.005). Of MSM with any syphilis testing during 09/01/2013–09/30/2014, 64.8% also had annual repeat testing. Syphilis testing in general and repeat syphilis testing were frequent but suboptimal among MSM. It is important to continually monitor syphilis for MSM, especially for those MSM who had rectal chlamydia or gonorrhea infection.
Highlights
Men who have sex with men (MSM) are at high risk for HIV and other sexually transmitted diseases (STD), such as gonorrhea, chlamydia, and syphilis [1,2]
Current or past syphilis was more common among MSM with positive rectal gonorrhea or chlamydia tests (24.1%) than among MSM with negative rectal gonorrhea and chlamydia tests (13.0%, p < 0.05)
It is important for clinicians to screen all sexually active MSM for syphilis, MSM with a positive rectal chlamydia or gonorrhea test result are at elevated risk
Summary
Men who have sex with men (MSM) are at high risk for HIV and other sexually transmitted diseases (STD), such as gonorrhea, chlamydia, and syphilis [1,2]. The Centers for Disease Control and Prevention (CDC) recommends routine HIV and STD screening of all sexually active MSM [2]. Sexually active MSM should be tested at least annually: for HIV; for syphilis; for urethral gonorrhea and chlamydia if they report insertive intercourse; for rectal gonorrhea and chlamydia if they report receptive anal intercourse; and for pharyngeal gonorrhea if they report receptive oral intercourse. Previous studies have shown that chlamydia, gonorrhea, syphilis, and HIV testing is suboptimal among MSM and rectal gonorrhea, rectal chlamydia, and syphilis were associated with increased risk for HIV seroconversion among MSM [3,4,5,6,7,8,9,10,11]. The objective of this study is to assess the frequency of testing for syphilis among MSM and how syphilis test results compared with results of rectal gonorrhea and chlamydia tests
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