Background: The number of early syphilis (ES) cases diagnosed in King County, Washington MSM increased dramatically in 2015. We describe changes in the MSM population diagnosed with ES to identify potential contributors to the increase.
Methods: We analyzed case report data for 1787 MSM diagnosed with ES (primary, secondary, and early latent) in King County, Washington, 2010-2015, and compared 2014 vs. 2015 cases using chi-square statistics. We used HIV surveillance data to determine if HIV-infected cases were virally suppressed at syphilis diagnosis.
Results: From 2010-14, the number of MSM diagnosed with ES varied from 250 to 313 (mean 278), with no clear trend; 61% of cases occurred in HIV-infected MSM (range 58-66%), with a rising proportion occurring in HIV-uninfected men (p=<0.01). Total ES diagnoses in MSM increased by 59% from 2014 (n=250) to 2015 (n=397). Comparing 2014 and 2015, we observed declines in the percentage of cases occurring in MSM who had a prior HIV diagnosis (58 vs. 49%, p=0.02), used methamphetamine (19% vs. 9%, p<0.01), and had a history of syphilis (39% vs. 31%, p=0.05). Both the percentage of HIV-uninfected MSM who reported using PrEP at time of ES diagnosis (8% vs. 18%, p<0.01) and the percentage of HIV-infected MSM who were virally suppressed in the 12 months prior to ES diagnosis (47% vs. 66%, p<0.01) increased. Age, race/ethnicity, syphilis stage, and number of sex partners in last year did not significantly change from 2014 to 2015.
Conclusions: The rate of ES in King County rose sharply in 2015 as the infection increasingly affected MSM who were HIV-uninfected, denied methamphetamine use, and had no history of syphilis. This rise was also associated with increases in PrEP use and HIV viral suppression, suggesting that the syphilis epidemic is spreading into a population that was traditionally at lower risk for ES.