Background Although syphilis remains a central public health problem, disease estimates for men who have sex with men (MSM) and transwomen (TW) in the Americas are incomplete. The purpose of this study was to compare the syphilis epidemics of North America (NA) and Latin America/Caribbean (LAC).
Methods We conducted a systematic review of ten databases for studies of syphilis in MSM/TW in the Americas between 1980–2017. Regional and country-specific prevalences were calculated from 2000–17 using 3 analytic frameworks: 1) All MSM/TW; 2) MSM/TW with versus without HIV; and 3) MSM and TW separately. Pooled prevalence estimates were calculated utilizing random effects meta-analysis.
Results 167 studies (NA=84, LAC=83) representing 368,587 subjects were included. Almost no data was available from LAC prior to 2000 and only 8% of studies from either region reported stage of infection (Primary, Secondary, Latent). For syphilis diagnosis, 42% of studies used RPR, 24% used VDRL, and 18% used FTA-Abs. From 2000–2017, syphilis prevalence among MSM/TW in NA was 6.6% (95% CI: 5.7–7.4%) and 13.3% (95% CI: 11.7–14.9%) in LAC. For TW alone, prevalence was 7.1% (95% CI: 2.3–11.9%) in NA and 31.7% (95% CI: 19.1–44.4%) in LAC. Among MSM/TW with HIV in NA, prevalence was 10.5% (95% CI: 7.4–13.3%) versus 4.0% (95% CI: 1.8–6.1%) in those without HIV. In LAC, syphilis was diagnosed in 15.1% (95% CI: 0–30.3%) of MSM/TW with HIV and 12.9% (95% CI: 9.5–16.2%) without HIV.
Conclusion From 2000–2017, the burden of syphilis in MSM/TW was greater in LAC than NA. Prevalence estimates were higher in certain subgroups, including TW in LAC and MSM/TW with HIV in NA, though these data were limited. Our results suggest a need for additional data on syphilis epidemiology with stratification by key subgroups, classification by stage of disease, and uniform diagnostic criteria to target public health strategies in the Americas.
Disclosure No significant relationships.
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