Syphilis Screening and Diagnosis Among Men Who Have Sex with Men, 2008-2014, 20 U.S. Cities

Background: Men who have sex with men (MSM) account for 61% of reported primary and secondary syphilis cases in the United States. Routine annual screening for syphilis is indicated for all sexually active MSM.

Methods: We assessed self-reported syphilis testing and diagnoses trends among MSM using National HIV Behavioral Surveillance data from 2008, 2011, and 2014. Participants reported their health and risk behaviors, including syphilis screening and diagnosis, in the past 12 months. We calculated percentages of syphilis screening and diagnosis by selected characteristics for each year. Trends were assessed using Poisson regression models with robust standard errors. Analysis of syphilis diagnosis was limited to participants who reported syphilis screening.

Results: Analysis included data from 30,062 MSM (2014: n=10,369; 2011: n=9,819; 2008: n=9,874). Overall, 47% of MSM interviewed in 2014 reported syphilis screening, a significant increase (p<0.01) from 39% in 2011 and 37% in 2008. In 2014, syphilis screening was most commonly reported by MSM who were aged 25-29 (55%), HIV-positive (65%), and had >10 sexual partners in the past 12 months (65%). The largest increases in syphilis screening between 2008 and 2014 were among MSM aged 30-39 years (37% to 51%) and MSM who reported 6-10 or >10 sex partners (42% to 55%, 48% to 65%, respectively). Diagnoses of syphilis increased from 9% in 2008 to 11% in 2014 (p<0.01). Notable increases in syphilis diagnosis were observed among MSM who were aged 25-29 (6% to 10%), black (9% to 14%), HIV-positive (15% to 21%), and reported >10 sexual partners (11% to 17%).     

Conclusions: Despite the recommendation for at least annual screening among all sexually active MSM, less than ½ of MSM reported recent syphilis screening in 2014. While screening among MSM increased, more work is needed, especially given increases in syphilis diagnosis among those screened from 2008 to 2014.