Background:
Increases in sexually transmitted diseases STDs have been identified among men who have sex with men (MSM) in the past decade. Unlike other metropolitan areas, there appears to be an increase in syphilis but a decrease in gonorrhea and chlamydia among MSM identified through Whitman-Walker Clinic, a non-profit community-based health organization serving the Washington, D.C. metropolitan region.

Objective:
To identify risk factors for high-titer syphilis among MSM attending Whitman-Walker Clinic.

Method:
As part of CDC's MSM Prevalence Monitoring Project, MSM tested for syphilis at Whitman-Walker Clinic between January 2001-December 2004 were selected. Multivariate logistic regression was utilized to assess the association between risk factors and high-titer syphilis, controlling for year of diagnosis.

Result:
Among 6,307 MSM tested, 182 (2.9%) were diagnosed with high-titer syphilis. Black race (OR=5.4 [2.7-10.9]), history of STDs (OR=2.7 [1.3-5.4]), abnormal clinical signs (OR=2.0 [1.0-4.0]), previous (OR=7.8 [2.1-28.9]) or new HIV positive result (OR=6.8 [3.2-14.5]), and declining to answer a question regarding vaginal sex in the last 30 days (OR=3.9 [1.7-8.7]) were strongly associated with an increased risk of high-titer syphilis. Drug use, including methamphetamine, marijuana, cocaine, heroin, poppers, and intravenous drug use, was not associated with high-titer syphilis in a multivariate model.

Conclusion:
HIV infection, black race, declining to answer a question regarding vaginal sex, history of STDs and abnormal clinical signs at examination were associated with an increased risk of high-titer syphilis infection among MSM tested at Whitman-Walker Clinic.

Implications:
Syphilis prevention efforts should target HIV infected individuals and those with a history of other STDs.