Introduction Syphilis rates among MSM are increasing sharply in urban areas across the U.S. MSM with syphilis are at high risk for acquiring HIV, and may be an important subgroup to increase awareness and delivery of pre-exposure prophylaxis (PrEP). Key, however, is identifying access points to this population. Our objective was to determine health care settings where syphilis positive and HIV negative (vs. HIV positive) MSM were diagnosed to prioritise and tailor to settings for PrEP delivery. Setting: A mid-Atlantic U.S. city which has seen a 102% increase in early (primary, secondary and early latent) syphilis among MSM from 2009–2015.

Methods We analysed routinely collected public health surveillance data on MSM diagnosed with early syphilis reported to a city health department between 2009–2015. We compared diagnosing provider information by HIV status overall and in 2015 using Chi-squared tests.

Results Of the 1,495 MSM diagnosed with early syphilis between 2009–2015, the majority was aged ≥ 25 years (73%), African American (86%) and HIV co-infected (67%). Overall, 52% were diagnosed in private health care settings, and 25% were diagnosed in publically funded sexually transmitted infection (STI) clinics. Early syphilis positive/HIV negative MSM were more likely than HIV positive MSM to receive a syphilis diagnosis in STI clinics (38% vs. 19% p=<0.0001) and Emergency Departments (EDs) or Urgent Care Centres (UCC) (12% vs. 8% p<0.0001) and less likely to be diagnosed by private providers (33% vs. 61%, p<0.0001). Among the 268 MSM diagnosed with early syphilis in 2015, HIV negative MSM (n=44) were as likely as HIV positive MSM (n=224) to receive a syphilis diagnosis in STI clinics (27% vs. 16%, p=0.06), more likely to be diagnosed in EDs/UCCs (20% vs. 10%, p=0.03) and less likely to be diagnosed by private providers (36% vs. 66%, p<0.0001).

Conclusions EDs/UCCs and are important access points for MSM at high risk for HIV but sites may change over time. Efforts by the city health department to increase PrEP delivery at these sites are being initiated.