Background: Recently, rapid treponemal antibody tests have been approved and used in the United States. These tests are not recommended for persons previously treated for syphilis. This investigation aims to measure how many new syphilis cases are occurring among persons who previously had syphilis and, therefore, would not have been eligible for rapid-test screening.
Methods: All reported syphilis cases in Florida aged 18 years or greater from January 1, 2012, through December 31, 2014, were extracted from Florida’s sexually transmitted disease (STD) surveillance system. All cases with a previously reported syphilis diagnosis ascertained through previous cases in the database before the current infection and after January 1, 2000, were determined to be a reinfection. All infections prior to January 1, 2000, and all infections reported less than 60 days after an infection were excluded. Novel syphilis infections and syphilis reinfections were compared across demographic and STD-related risks using odds ratios and survival curves.
Results: The percent of reported infections that was due to reinfections increased each year from 17.2% (n=755) in 2012 to 21.7% (n=1,283) in 2014. The odds of being reinfected were higher for males [compared to females] (odds ratio (OR) 4.99; 95% confidence interval (CI) 4.21–5.93), gay or bisexual men who have sex with men (GBMSM) [compared to men not known to be GBMSM] (OR 9.09; 95% CI 7.59–10.88), and HIV-infected individuals [compared to individuals not known to HIV infected] (OR 9.04 95% CI 8.20–9.98). Among individuals with reinfections, the median time between infections was significantly shorter for GBMSM individuals (917 days) by nearly 1.5 years than non-GBMSM individuals (1,437 days).
Conclusions: We identified a higher odds of reinfection among men, especially GBMSM. Routine screening for syphilis among GBMSM, especially those with prior syphilis infections, is critical.