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High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy?
  1. Nicolò Girometti1,2,
  2. Angela Gutierrez2,
  3. Nneka Nwokolo2,
  4. Alan McOwan2,
  5. Gary Whitlock2
  1. 1Infectious Diseases Unit, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
  2. 2Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Nicolò Girometti, Chelsea & Westminster Hospital NHS Foundation Trust, 56 Dean Street, London W1D 6AQ, UK; nicogir{at}hotmail.it

Abstract

Objectives HIV pre-exposure prophylaxis (PrEP) is becoming a pivotal strategy for HIV prevention. Understanding the impact of risk factors for HIV transmission to identify those at highest risk would favour the implementation of PrEP, currently limited by costs. In this service evaluation, we estimated the incidence of bacterial STIs in men who have sex with men (MSM) diagnosed with early syphilis attending a London sexual health clinic according to their HIV status. In addition, we estimated the incidence of HIV infection in HIV-negative MSM, following a diagnosis of early syphilis.

Methods We undertook a retrospective case note review of all MSM patients diagnosed with early syphilis between January and June 2014. A number of sexual health screens and diagnoses of chlamydia, gonorrhoea and HIV were prospectively analysed following the syphilis diagnosis.

Results 206 MSM were diagnosed with early syphilis. 110 (53%) were HIV-negative at baseline, 96 (47%) were HIV-positive. Only age (37 vs 32 years, p=0.0005) was significantly different according to HIV status of MSM at baseline. In HIV-negative versus HIV-positive MSM, incidence of rectal chlamydia infection at follow-up was 27 cases vs 50/100 person-years of follow-up (PYFU) (p=0.0039), 33 vs 66/100 PYFU (p=0.0044) for rectal gonorrhoea and 10 vs 26/100 PYFU (p=0.0044) for syphilis reinfection, respectively. Total follow-up for 110 HIV-negative MSM was 144 person-years. HIV incidence was 8.3/100 PYFU (CI 4.2 to 14).

Conclusions A diagnosis of early syphilis carries a high risk of consequent HIV seroconversion and should warrant prioritised access to prevention measures such as PrEP and regular STI screening to prevent HIV transmission.

  • PREVENTION
  • HIV
  • SYPHILIS
  • GAY MEN

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Footnotes

  • These data were previously presented at the BASHH conference, Oxford 10–12 July 2016.

  • Sex Transm Infect 2016;92(Suppl 1):P172.

  • Handling editor Jackie A Cassell

  • Contributors NG and GW contributed to ideation, data collection, writing and analysis of this study. AG contributed with data collection. NN and AMcO contributed with the analysis and editing.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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