Article Text

Download PDFPDF
Original research
Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses
  1. Silvia Achia Nieuwenburg1,
  2. Ricardo Jamie Sprenger1,
  3. Maarten Franciscus Schim van der Loeff1,2,3,
  4. Henry John Christiaan de Vries1,3,4
  1. 1Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Internal Medicine, Amsterdam UMC, location Academic Medical Centre, Amsterdam, The Netherlands
  3. 3Amsterdam institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands
  4. 4Department of Dermatology, Amsterdam UMC location Academic Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Professor Henry John Christiaan de Vries, Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Noord-Holland, Netherlands; hdvries{at}


Objectives HIV-positive men who have sex with men (MSM) may be at a higher risk of repeat syphilis, have different clinical manifestations and have a different serological response to treatment compared with HIV-negative MSM. The objective of this study was to assess whether HIV-negative and HIV-positive MSM with infectious syphilis (primary, secondary or early latent) differed in history of previous syphilis episodes, disease stage and non-treponemal titre of initial and repeat episodes, and the titre response 6 and 12 months after treatment. Furthermore, determinants associated with an inadequate titre response after treatment were explored.

Methods This retrospective analysis used data of five longitudinal studies (four cohorts; one randomised controlled trial) conducted at the STI clinic in Amsterdam, the Netherlands. Participants were tested for syphilis and completed questionnaires on sexual risk behaviour every 3–6 months. We included data of participants with ≥1 syphilis diagnosis in 2014–2019. Pearson’s χ² test was used to compare HIV-negative and HIV-positive MSM in occurrence of previous syphilis episodes, disease stage of initial and repeat syphilis episode and non-treponemal titre treatment responses.

Results We included 355 participants with total 459 syphilis episodes. HIV-positive MSM were more likely to have a history of previous syphilis episodes compared with HIV-negative MSM (68/90 (75.6%) vs 96/265 (36.2%); p<0.001). Moreover, HIV-positive MSM with repeat syphilis were less often diagnosed with primary syphilis (7/73 (9.6%) vs 36/126 (28.6%)) and more often diagnosed with secondary syphilis (16/73 (21.9%) vs 17/126 (13.5%)) and early latent syphilis (50/73 (68.5%) vs 73/126 (57.9%)) (p=0.005). While not significantly different at 12 months, HIV-negative MSM were more likely to have an adequate titre response after 6 months compared with HIV-positive MSM (138/143 (96.5%) vs 66/74 (89.2%); p=0.032).

Conclusions In repeat syphilis, HIV infection is associated with advanced syphilis stages and with higher non-treponemal titres. HIV infection affects the serological outcome after treatment, as an adequate titre response was observed earlier in HIV-negative MSM.

  • syphilis
  • serology
  • HIV

Statistics from


  • SAN and RJS are joint first authors.

  • Handling editor Joseph D Tucker

  • SAN and RJS contributed equally.

  • Contributors SN and RJS collaborated in the production of this manuscript. RJS performed the statistical analyses. HDeV and MSvdL reviewed the manuscript multiple times before submission, and provided indispensable feedback. SN, RJS, HDeV and MSvdL were involved with choosing the main directions for data analysis and the interpretation of results.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The approval by the Medical Ethics Review Committee (METC) was obtained for the individual studies; for the current analysis, additional ethical approval was not needed.

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

  • Data availability statement No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.