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Clinical factors associated with syphilis concordance in men in sexual partnerships: a cross-sectional couples study
  1. Janet M Towns1,2,
  2. Sarah Huffam1,2,
  3. Eric P F Chow1,2,
  4. Ian Denham1,
  5. Lei Zhang1,2,3,4,
  6. Andrea Ryan1,
  7. Clare Elizabeth Bellhouse1,2,
  8. Melanie Bissessor1,
  9. Catriona S Bradshaw1,2,
  10. Tiffany Phillips1,
  11. Stephen Graves5,
  12. Christopher K Fairley1,2,
  13. Marcus Y Chen1,2
  1. 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Faculty of Medicine, Nursing and Health Sciences, Monash University Central Clinical School, Melbourne, Victoria, Australia
  3. 3 Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Research Center for Public Health, Tsinghua University, Beijing, China
  5. 5 Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Australia
  1. Correspondence to Dr Janet M Towns, Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia; jtowns{at}


Background Syphilis infections continue to increase among men who have sex with men (MSM) in many countries, with rates often higher among HIV-positive MSM. There is limited understanding of the risk and determinants of syphilis transmission between men. We aimed to examine the concordance of early syphilis infection between male sexual partners and clinical factors associated with transmission.

Methods Men attending Melbourne Sexual Health Centre with their male partners, where at least one was diagnosed with early syphilis, were identified from linkage of partner records between March 2011 and April 2016. Early latent syphilis was defined as a new asymptomatic syphilis presentation of less than 2 years’ duration. Associations between concordance and potential risk factors were examined using Fisher’s exact test.

Results Among 43 couples (86 men) identified, there were 13 couples (26 men) where both were diagnosed with early syphilis, representing a concordance rate of 30.2% (95% CI 17.2% to 46.1%). Among the 13 concordant couples, 5 men had primary syphilis (4 penile, 1 anal), 11 secondary syphilis (8 generalised rash, 3 penile, 2 anal, 1 oral lesion) and 10 early latent infections. Concordance was higher among couples where at least one partner had secondary syphilis compared with couples where neither partner had secondary syphilis (53% (9/17) vs 15% (4/26), P=0.016). Furthermore, concordance was higher among couples where one was HIV positive compared with couples where both were HIV negative (62% (5/8) vs 23% (8/35), P=0.042).

Conclusions There was an overall concordance rate of 30%. Higher concordance rates for early syphilis infection between male sexual partners were associated with HIV and secondary syphilis.

  • HIV
  • syphilis
  • gay men

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  • Handling editor Jackie A Cassell

  • Contributors CKF conceived the idea for the study. MYC and SH developed the concept and planned the study. SH, MB, CSB and AR performed data collection and analysis. JMT, ID, MYC and SG provided clinical advice. EPFC and LZ provided statistical advice. JMT wrote the first draft and took responsibility for the manuscript. All authors contributed to the writing and review of the manuscript and have approved the final manuscript.

  • Funding EPFC is supported by the National Health and Medical Research Council (NHMRC) Early Career Fellowships (No 1091226). JMT is supported by the Australasian Chapter of Sexual Health Medicine (Royal Australasian College of Physicians) Research Entry Grant.

  • Competing interests EPFC reports grants from the National Health and Medical Research Council (NHMRC) and grants from Merck & Co, outside the submitted work.

  • Ethics approval Alfred Health Human Ethics Research Committee (project number: 108-15).

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