TP 171 Recent Syphilis Infection Among High-Risk Men Who Have Sex with Men (MSM) in Lima, Peru

Tuesday, June 10, 2014
Exhibit Hall
Hayoung Park, BA, UCLA Program in Global Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, Jeffrey Klausner, MD, MPH, Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine and Fielding School of Public Health, Los Angeles, CA, Kelika A Konda, PhD, Department of Medicine Division of Infectious Diseases, UCLA, Lima, Peru, Carlos F Caceres, MD, MPH, PhD, Universidad Peruana Cayetano Heredia, Lima, Peru, Brandon Brown, MPH, PhD, UC Irvine Program in Public Health, Irvine, CA, Gino Mauricio Calvo Moreno, BS, Epicentro, Lima, Peru, Segundo Leon, ME&ID, Global Health Department, University of Washington, Laboratory of Sexual Health, LID, UPCH, Lima, 31, Peru and Silver K Vargas Rivera, BS, Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru

Background:  Syphilis prevalence continues to be high among at-risk populations such as men who have sex with men (MSM).  In low and middle-income countries, syphilis remains a neglected epidemic with a lack of effective prevention strategies.

Methods:  PICASSO is a clinic-based study of MSM in Lima, Peru that includes behavioral surveys and syphilis testing with rapid plasma reagin (RPR) titers (BD Macro-Vue RPR, Becton-Dickinson, NJ) and Treponema pallidum Particle Agglutination (Serodia TP-PA, Fujirebio Inc, Japan).  Participants with recent syphilis infection (RPR titer ≥1:16) were compared to participants with non-reactive titers. Participants with RPR titers 1:1-1:8 were excluded. Age in years was analyzed as a continuous variable. HIV perceived risk was self-reported on a 4-point scale. Factors associated with recent syphilis were explored using Poisson regression to compute risk ratios (RR).

Results:  The frequency of recent syphilis infection was 26/171 (15.2%). More individuals with recent syphilis infection were HIV-infected; 6/26 (23.0%) compared to 18/91 (19.8%) participants with nonreactive RPR titers (RR 1.16, p = 0.711).   Recent syphilis infection was associated with younger age (RR 0.95, p =0.016) and higher self-perceived risk of HIV (RR 1.33, p =0.06).  Insertive anal sex was associated with a lower relative risk of recent syphilis infection (RR 0.25, p = 0.05) compared to receptive or versatile. Other sexual behaviors, substance use and alcohol use were not associated with recent syphilis infection.

Conclusions: Recent syphilis infection was common in the clinic-based sample of high-risk MSM. Frequent syphilis and HIV co-infection suggest an integrated strategy is necessary for prevention and treatment efforts. Our findings suggest that patterns of syphilis transmission are only partially explained by current measures of behavioral risk.