Background Syphilis rates are increasing globally among men who have sex with men (MSM). Repeat infections within core groups could contribute to ongoing transmission of syphilis. The aim of this study was to measure the frequency and to explore predictors of repeat infectious syphilis infection among MSM attending Sexual Health Centres (SHCs) in the Netherlands.
Methods We analysed national SHC surveillance data between July 2014 and December 2019. A unique identifier enabled individual level analysis of repeat consultations and infections. Infectious syphilis (syphilis) included primary, secondary and early latent syphilis diagnoses. Repeat infection was defined as having two syphilis diagnoses during the study period. Multivariable logistic regression analyses were used to explore predictors of repeat syphilis infection. MSM with at least one syphilis diagnosis and one following consultation were included. Age, education level, ethnicity, HIV infection, having symptoms related to syphilis/HIV, being notified for STI, prior STI, condom use and number of partners at first infectious syphilis diagnosis were included in the analysis.
Results There were 184,621 consultations registered among 41,210 MSM who tested repeatedly. Among 3,504 MSM, 4,282 syphilis infections were diagnosed. At first syphilis diagnosis median age was 39 (IQR: 29–49), 32.4% was known HIV positive and 41.4% had 10 or more partners in the past 6 months. Repeat infection occurred in 647 MSM (18.5%; median time to repeat infection: 468 days (IQR: 287–808)). Being HIV positive (aOR: 2.02 [95% CI: 1.69–2.42]) and being notified for STI (aOR: 1.21 [95% CI: 1.01–1.46]) were statistically significant predictors of repeat infection.
Conclusion This study showed that repeat infection was common and that HIV infection and being notified for STI at first syphilis diagnosis were predictors of repeat infection among MSM who tested repeatedly. Preventive strategies, including adequate partner management, for repeat syphilis are needed, especially for HIV-positive MSM.
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