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Evidence of heterosexual bridging among syphilis-positive men who have sex with men
  1. S D Cunningham1,
  2. G Olthoff2,
  3. P Burnett2,
  4. A M Rompalo3,
  5. J M Ellen4
  1. 1Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Sexually Transmitted Disease Prevention Program, Baltimore City Health Department, Baltimore, Maryland, USA
  3. 3Department of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to:
 Shayna D Cunningham
 Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2700 Lighthouse Point, East Suite 210, Baltimore, Maryland 21224, USA; scunning{at}


Objective: To explore whether heterosexual bridging among syphilis-positive men who have sex with men (MSM) contributes to increased infection rates among adolescent women in Baltimore City, Maryland.

Methods: Interview data for patients with primary, secondary and early-latent syphilis from January 2001 to July 2005 were linked with their corresponding field records for named exposed contacts to assess prevalence of male bisexual activity and risk profiles of potential male bisexual bridgers and their female sex partners.

Results: None of the women with syphilis reported having known heterosexual relationships with a bisexual man. However, 3.9% and 11.0% of the male sex partners of adolescent females and women aged >25 years with syphilis, respectively, self-reported as MSM or named male sex partners. Likewise, 10.3% of syphilis-positive MSM named female sex partners and 3.0% of syphilis-positive men who did not self-identify as MSM named both male and female sex partners.

Conclusions: Sexual network links exist between syphilis-positive MSM and heterosexual women, but the extent of bisexual behaviour among men is not detectable by self-identification and disclosure to female sex partners.

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  • Funding: This work was supported by the Centers for Disease Control Syphilis Elimination funding for the Baltimore City Health Department and NIAID RO-1 AI45724.

  • Competing interests: None.

  • Contributors: SDC was responsible for the analysis and writing. GO and PB helped compile the data and assisted with writing. AMR and JME developed the project and contributed to the analysis and writing.

    Ethical approval: The authors collected data during routine public health activities of disease control and analysed data for programme evaluation. This activity was therefore designated as public health practice and non-research. In accordance with the Code of Federal Regulations, Title 45, Part 46, The Public Service Act, human subjects review is not required for public health non-research activities.