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3B1 Trends in Repeat Primary and Secondary Syphilis Among NYC Men, 2000-2015

Thursday, September 22, 2016: 10:45 AM
Salon B
Ellen Klingler, MPH1, Preeti Pathela, DrPH, MPH1, Sue Blank, MD, MPH2 and Julie Schillinger, MD, MSc3, 1Bureau of Sexually Transmitted Disease Control, New York City Department of Health & Mental Hygiene, Long Island City, NY, 2Bureau of STD Control and Prevention, New York City Department of Health and Mental Hygiene, Long Island City, NY; Center for Disease Control and Prevention, Atlanta, GA, 3Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, LIC, NY; Center for Disease Control and Prevention, Atlanta, Georgia

     

Background:  Primary and secondary syphilis (P&S) cases  increased 12-fold in New York City (NYC) during 2000-2015, with 95% of cases diagnosed among men.  Men with multiple syphilis infections may represent core-group members; characterizing this group can inform intervention efforts.  

Methods:  We extracted data on treated male P&S cases reported to the NYC surveillance registry between 2000-2012.  We calculated the proportion of men who had been reinfected (>1 subsequent reported P&S diagnosis) through 2015. We generated yearly cohorts of cases and calculated proportions with reinfections occurring within three years of initial infection, and assessed  yearly changes in 3-year reinfection rates.  We compared time to first reinfection for each cohort and determined patient factors associated with reinfection.  

Results:  Overall, 14.2% (1057/7422) of men with P&S had >1 repeat diagnosis; median time to first reinfection was  33.1 months.    The proportion of cases reinfected within 3 years averaged 7.6% across cohorts, and increased from 4.3% (4/89) in 2000 to 9.6% (72/682) in 2012 (p=0.02).   Time to re-infection within 3 years (range: 16-22 months by cohort year)  was not significantly different by year (p=0.11).  Being HIV-positive versus HIV-negative/status unknown (OR 2.7; CI, 2.3-3.3), aged 20-29 years (OR 1.7; CI 1.3-2.3)  or 30-44 years(OR 1.6; CI, 1.2-2.3) versus >45 years, and diagnosed with secondary versus primary syphilis (OR 1.4; CI, 1.1-1.7) were associated with reinfection. Cases with only male partners were more likely to be reinfected; there was no difference in reinfection rate by receipt of partner services.  

Conclusions:  The proportion of P&S infections due to repeat infection has been increasing among NYC men.  The  link between HIV infection and syphilis reinfection underscores the importance of frequent syphilis screening among HIV-positive persons.  Being able to prospectively identify individuals at risk for repeat infection may be useful for targeting case management  activities, including PrEP for HIV-negative persons.

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