Background During the early 2000s, reports of the re-emergence of syphilis among men who have with men (MSM) in the USA described a high prevalence of HIV coinfection in different localities, often among middle-aged men. Since 2001, syphilis has increased among men in younger age groups. Here, we present a description of HIV coinfection among MSM of different races and ethnicities with primary and secondary syphilis across multiple states during 2009.

Methods We reviewed data reported to CDC from states in the USA that reported HIV coinfection status for at least 70% of cases of primary and secondary (P&S) syphilis during 2009. These data originated from P&S syphilis patient interviews and included census region, sex, sex of sex partner, race, ethnicity, and HIV infection status. Prevalence of coinfection was calculated using coinfected patients as the numerator, and all P&S syphilis patients who were asked about their HIV status as the denominator.

Results 34 states and Washington, DC from all regions of the USA met inclusion criteria, accounting for 82% of all P&S syphilis in the USA during 2009 and 77% of estimated HIV diagnoses during 2008. Of 6501 men who had sex with men (MSM) in the past 12  months with P&S syphilis, 6346 (98%) were asked about HIV status—53% were coinfected with HIV, 38% were not coinfected, 1% refused to disclose their status, and 8% did not know their status. Across all regions, prevalence of HIV coinfection among MSM with P&S syphilis was high (51–55%, depending on region). Black MSM with P&S syphilis were younger than other MSM with P&S syphilis—39% of black MSM with P&S syphilis were under 25 years old (Hispanic MSM—25%, white MSM—12%, other MSM—22%) (see Abstract P1-S2.40 Table 1). Compared to 15−19-year old and 20−24-year old MSM with P&S syphilis of other races and ethnicities, black MSM were more likely to be HIV coinfected (RR 15−19-year old =2.2, p<0.001; RR 20−24-year old =1.8, p<0.001). Prevalence of HIV coinfection increased with age; black MSM with P&S syphilis reached the highest prevalence of HIV coinfection at an earlier age than MSM with P&S syphilis of other races and ethnicities.

Conclusion Regardless of race, ethnicity or region, MSM with P&S syphilis had high rates of HIV coinfection. Interventions at young ages are urgently needed to prevent HIV and P&S syphilis among MSM.