A Case–Control Study of Syphilis Among Men Who Have Sex With Men in New York City
Gabriela Paz‐Baileya b c✉, Andrea Meyersd e, Susan Blankb d e✉, James Brownb d e✉, Steve R. Rubinb d e✉, Jim R. Braxtonb✉, Akbar A. Zaidib✉, Josh Schafzinb✉, Susan Weiglf, Laurie E. Markowitzb✉
- aDivision of STD Prevention, NCHSTP, Centers for Disease Control and Prevention, Mail stop E-04, 1600 Clifton Road, Atlanta, GA 30333, USA. gpbz@cdc.gov
- bDivision of STD Prevention and the †Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
- cEpidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
- dThe New York City Department of Health and Mental Hygiene STD Control Program, New York, New York
- eThe New York City Department of Health and Mental Hygiene STD Control Program, New York, New York; and
- fCallen-Lorde Community Health Center, New York, New York
- ✉Corresponding author
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Abstract
OBJECTIVE: The objective of this study was to determine factors associated with syphilis among men who report sex with other men in New York City. DESIGN, SETTING AND STUDY SUBJECTS: We conducted a case-control study among 88 men who reported sex with men in the previous year, 18 to 55 years old and diagnosed with primary or secondary syphilis during 2001; and 176 control subjects frequently matched by age and type of health provider. RESULTS: HIV prevalence among syphilis cases was 48% compared with 15% among control subjects (P <0.001). Variables associated with syphilis in a multivariate model were HIV infection (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.5-15.4), income >$30,000 per year (OR, 2.7; CI, 1.4-5.2), and barebacking (OR, 2.6; CI, 1.4-4.8). The median time since HIV diagnosis for HIV-positive was 6 years for cases and 7 years for control subjects (P = 0.70). Among HIV-infected participants, syphilis cases were more likely than control subjects to report being on antiretroviral therapy (69% vs. 44%, P = 0.05) and to report having undetectable viral load (58% vs. 24%, P = 0.02). CONCLUSION: HIV infection was strongly associated with syphilis in this study. High-risk behavior reported by both cases and control subjects indicates the potential for increased HIV transmission.