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High numbers of HIV-positive MSM not being tested for syphilis

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July 15, 2018

Nearly one-third of sexually active HIV-positive men who have sex with men are not tested for syphilis at least annually, researchers reported in a recent study, calling the finding “concerning.”

Alex de Voux, PhD, an Epidemiologist in the CDC’s Division of STD Prevention, and colleagues sought to examine the proportion of sexually active HIV-positive men who have sex with men (MSM) currently in care who were tested for syphilis in the past 3, 6 and 12 months by their HIV care provider.

A 2017 study showed that MSM accounted for more than 60% of syphilis cases nationwide in 2015. In that study, researchers determined that the rate of primary and secondary syphilis in the United States among MSM was 106 times that of men who have sex with women only.

In the current study, the authors noted that guidelines recommend that sexually active MSM, including HIV-positive MSM, be tested at least annually for syphilis, with testing every 3 to 6 months for MSM at elevated risk, and used this timeline to evaluate the group.

De Voux and colleagues used the most recent medical record and interview data collected by the Medical Monitoring Project, a population-based HIV surveillance system, from 2013 to 2014. The data showed that 71% of all sexually active HIV-positive MSM had at least one test for syphilis in the past 12 months. In the past 6 months, only 43% had been tested, and the number dropped to 22% in the past 3 months.

Researchers also examined the frequency of testing in MSM who reported risk factors, including having condomless sex and having sex with two or more partners.

According to the study, 48% of MSM reported having condomless sex and 58% reported two or more sexual partners in the past 12 months. Among them, 75% and 77%, respectively, were tested for syphilis in the past 12 months. In each group, only 49% of patients had been tested in the past 6 months and 26% in the past 3.

De Voux said that although the findings suggest a continued trend in syphilis testing among MSM, the fact that nearly one-third of HIV-positive MSM are not being regularly tested is cause for concern.

“Screening and prompt treatment of syphilis are a core component of controlling syphilis, so it’s important to closely monitor screening rates and get the most recent data in the hands of health care providers,” de Voux told Infectious Disease News.


The researchers concluded that efforts to improve compliance with screening guidelines for high-risk HIV-positive MSM are warranted. Additional measures to ensure testing could include simple clinic-based interventions, de Voux explained, such as testing as part of routine visits, health alerts being integrated into electronic health systems or sending out patient reminders.

“A lack of timely and regular syphilis screening could be a missed opportunity to identify and treat a case of syphilis,” de Voux said. “Prompt identification and treatment of syphilis among HIV-positive individuals in particular could help to prevent serious outcomes, including an increased HIV viral load, blindness and even stroke.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

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