Syphilis Co-Infection in HIV Population Newly Diagnosed by Rapid Testing

Background: Cook County ranked 2^nd in US syphilis cases in 2009. MSM have increased syphilis rates and highest numbers of new HIV infections. Same-day rapid HIV testing promotes immediate linkage to care.  The impact of syphilis screening concurrent with rapid HIV testing is unclear.

Objectives: Assess for syphilis co-infection in patients newly diagnosed HIV by rapid test and examine linkage to care.

Methods: Sexually Transmitted Infections (STI) walk-in clinic offered fingerstick rapid HIV testing January 2008-September 2010; RPR confirmed by TPPA with new cases verified. Preliminary reactive HIV rapid test results had confirmatory Western Blot, with results given at initial HIV clinic appointment. Descriptive analysis was performed using SAS.

Results: 12,676 had rapid HIV testing; 123 (0.97%) confirmed HIV+.  85% HIV population was male; ages ranged 15-59 (median 28); 47% of population disclosed MSM as HIV risk; 33% of MSM were ≤25 years of age. New syphilis co-infection diagnosed in 19 (15%) patients confirmed HIV+. Cases were African American (67%), Hispanic (22%) and Caucasian (11%). Mean age was 29 (SD±9); all 19 were males; 14 (74%) were MSM, associated with increased risk for syphilis compared to heterosexuals (OR= 3.1 CI=1.19 - 8.06; p<0.0125). Median CD4 count was 275; CD4 count, viral load did not have significant syphilis association. 17/19 (89%) received syphilis treatment; 2 lost to follow up. The proportion of new HIV+ patients entering care increased from 77% by end of 1^st year to 95% by 3^rd year

Conclusions: MSM HIV+ have triple risk of Syphilis co-infection compared to heterosexual males. 95% cases were ≤40 years of age. Linkage to care improved over study duration.

Implications for Programs, Policy, and Research: Linkage to care provides treatment that reduces risk of transmission of HIV, syphilis and lost to follow-up.