Background: Over half of Primary & Secondary (P&S) syphilis diagnoses in Texas occur in Men who have Sex with Men (MSM), and 35% of diagnoses are in MSM Living with HIV (LWH). Several explanations have been posited for the high burden of P&S syphilis in MSM LWH, including serosorting and increases in condomless sex and drug use. Differences in Partner Services’ outcomes for P&S syphilis in MSM LWH compared to HIV-negative MSM have not been explored as a possible factor.
Methods: The study population included MSM ≥13 years diagnosed with P&S syphilis and reported to Texas’ STD Surveillance System between January 1, 2010 and December 31, 2014. MSM with an HIV diagnosis date ≥30 days before their syphilis diagnosis, determined through a match to Texas’ HIV Surveillance system, were classified as LWH. Partner Services data was obtained from Texas’ STD*MIS system. Partner Services outcome measures were compared between MSM LWH and HIV-negative MSM using logistic regression and Student’s t-test.
Results: A total of 2,422 HIV- MSM and 1,335 MSM LWH were initiated for P&S syphilis partner services during the study period. Compared to HIV-negative MSM, MSM LWH were more likely to refuse partner services, (OR 3.2, p<0.01) and not name any partners when they did agree to partner services (OR 1.7 p<0.001). HIV-negative MSM named more partners compared to MSM LWH (mean 2.1 vs. 1.4, p<0.01) and a lower proportion of partners named by MSM LWH were successfully located, tested, and treated when clinically or epidemiologically indicated (mean 53%, vs. 62% p<0.01).
Conclusions: Inadequate partner services for P&S syphilis in MSM LWH may result in missed opportunities for testing and treatment among sexual contacts, which could allow propagation of syphilis in this population. Further investigation is needed to determine why partner services outcomes in MSM LWH are suboptimal compared with HIV-negative MSM.