Background In British Columbia, Canada, syphilis is at record-high rates, with over 80% of cases in 2017 seen in gay, bisexual, and other men who have sex with men (GBM). The epidemic is of particular concern for those living with HIV, since syphilis may lead to more serious complications in this population. We sought to inductively explore syphilis-related knowledge, and attitudes around biomedical prevention options for syphilis in an age of HIV pre-exposure prophylaxis (PrEP), with the goal of informing effective strategies to address the syphilis epidemic.

Methods We conducted in-depth, one-on-one interviews with a heterogeneous sample of GBM in Vancouver, including men living with HIV and/or with a history of syphilis. Our interviews focused on participants’ knowledge around syphilis and perceptions regarding syphilis PrEP. Interviews were audio-recorded, transcribed verbatim, and analyzed using Grounded Theory.

Results Twenty-five GBM were interviewed (64% white; median age: 43 years). Four overarching themes emerged regarding men’s views about syphilis. First, syphilis-related knowledge differed according to HIV and syphilis serostatus. Second, competing ideas emerged regarding men’s concerns about syphilis. While our participants expressed concern about getting syphilis, they also described the importance of sexual intimacy and pleasure. Third, many participants said that syphilis was not perceived to be particularly alarming; preventing HIV infection remained a primary concern for many. Finally, although syphilis PrEP was appealing to some, participants were concerned about antibiotic resistance, cost, and side effects.

Conclusion Concern for syphilis appeared low among GBM. Our participants tended to organize their safer sex strategies around HIV, not syphilis. Although syphilis-related knowledge was relatively high among GBM living with HIV and those with a prior syphilis diagnosis, this knowledge did not appear to be associated with safer sexual practices, such as increased condom use. This work highlights the importance of examining other potential acceptable prevention solutions, such as syphilis PrEP.

Disclosure No significant relationships.