There Is No Room for Complacency: Recent Trends in Human Immunodeficiency Virus (HIV) Seroprevalence and Risk Behaviors Among Early Syphilis Cases in Los Angeles, 2005 - 2010

Background: Syphilis infection significantly increases susceptibility to HIV infection. Examining syphilis trends can offer important insights into where the HIV rates are likely to increase and provide important insights into HIV prevention planning.

Objectives: To describe recent trends in the rate of early syphilis, HIV/syphilis co-infection and associated risk behaviors in a large urban, demographically diverse environment.

Methods: We analyzed data collected on all early syphilis cases from 2005 to 2010. To see if observed trends in the rate of syphilis, HIV/syphilis co-infection and associated risk behaviors were statistically significant we computed the Cochran-Armitage test for trend and used p_trend ≤ .05 as the criterion for significance.

Results: Between 2005 and 2010, the rate of early syphilis per 100,000 residences increased from 12.5 to 15.7 and HIV prevalence among early syphilis cases remained high and stable (58.2% to 58.8%; p=0.76). The proportion of cases who reported meeting partners through the Internet (24.1% to 32.4%; p<0.01); IV drug use (4.4% to 8.7%; p<0.01); and having multiple partners (68.2% to 72.5%; p=0.04) increased significantly. The proportion of cases reporting condom use (32.3% to 33.0%; p=0.74) and meeting their sex partner at bathhouses and sex clubs (11.9% to 9.8%; p=0.16) did not change significantly.

Conclusions: A decade into the epidemics, early syphilis and the proportion infected with HIV continue to increase as have many of the risk behaviors associated with both infections.

Implications for Programs, Policy, and Research: Integrated STD and HIV prevention approaches should be multipronged and intensified. Moreover, early detection and treatment of curable STDs should become a major, explicit component of comprehensive HIV prevention programs at national, state, and local levels. Whether this can best be achieved through improvements to existing interventions or by developing new cost-effective approaches requires further research.