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Background: Detroit has historically seen heterosexual syphilis transmission associated with drug use and commercial sex work. In late 2008 the percent of male cases that are MSM increased.
Objectives: Include analysis of this changing epidemiology by demographics, risk factors, and HIV co-infection data.
Methods: Morbidity data was captured from the Michigan Disease Surveillance System. Interview data was analyzed from the syphilis interview record. HIV data was output from Ehars based on a name and date of birth match. Data was analyzed using SAS version 9.1.
Results: Of the 83 male syphilis cases year to date in 2009, 57 are MSM, 44 are HIV+ (77%). 43 of the 57 cases are primary and secondary syphilis. This compares to just over 10% of 2007 male cases and just fewer than 40% of 2008 that were MSM. MSM males are younger and more likely to report anonymous partners. Non-MSM are more likely to have been in jail and exchange money or drugs for sex. MSM were more likely to use ecstasy and Non-MSM reported higher rates of cocaine and crack use. The most popular meeting places among MSM were the internet (28%) and bars (26%). Among those less than 25 years old at syphilis diagnosis, the average number of years from HIV to syphilis infection was 1 year (0, 4.7 years). For those over the age of 25 years, the average time to syphilis infection was 7.7 years. Conclusions: Detroit is rapidly adapting its intervention efforts to target this group. Initiatives have included a CBO meeting, a MSM strategic planning group, a MSM Town Hall meeting, MSM specific testing referrals, and site visits to HIV care providers. Implications for Programs, Policy, and/or Research: Although MSM syphilis is common in many major US cities, in other jurisdictions this example of a rapidly evolving response can be useful.