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Background: Fenway Health (FH) is the largest healthcare center for men who have sex with men (MSM) in New England. Between 2005 and 2010, the annual number of syphilis cases at FH rose by over 50% (from 72 cases in 2005 to 108 cases in 2010). This increase has disproportionately affected men, particularly MSM. The syphilis epidemic among MSM has been accompanied with another less researched phenomenon – repeat syphilis infections.
Objectives: To investigate syphilis re-infection cases within male patients at FH and to identify risk factors associated with repeat syphilis infections
Methods: A retrospective review of all syphilis tests on men from October 2005 to October 2010 at FH. Any patient successfully treated for syphilis and found to become seroreactive after becoming seronegative or have a new four-fold increase of nontreponemal titers was defined as a reinfection. Multivariate analysis identified factors associated with syphilis re-infection.
Results: From 10/2005 to 10/2010, 8479 men were tested for syphilis, 3954 men were screened more than once. MSM accounted for 82% all tests (n = 5970) and 97% of all syphilis infections (n = 418). We identified 74 cases of repeat syphilis infections; 99% of these cases were MSM and 87% were HIV infected. Of those patients who HIV seroconverted during the study period (n = 517), 4% had repeat syphilis infections. Of those patients co-infected with HIV and syphilis (n = 51), 18% had repeat syphilis infections.
Conclusions: At Fenway Health, HIV-infected MSM were at significantly higher risk for syphilis re-infection. Conversely, syphilis re-infection is highly associated with HIV seroconversion.
Implications for Programs, Policy, and Research: Recurrent syphilis infections present a challenge for sexual health promotion and disease prevention for MSM. By understanding the patients highest at risk for reinfection, health care providers can implement additional interventions for this specific patient population.