April is STD Awareness Month, and this year’s theme is Syphilis Strikes Back. This week’s post highlights the impact of syphilis on gay, bisexual, and other men who have sex with men (MSM).
As noted in the first blog post of the series, syphilis is a bacterial infection that is primarily spread through sexual contact. MSM experience a disproportionately high risk of acquiring and transmitting syphilis. In 2015, CDC reported that for male cases of new primary and secondary syphilis (P&S – the most transmissible stages of infection) in which the sex of the sex partner was known, 81.7% of cases were among MSM. Further, the skin sores caused by syphilis place MSM at an increased risk of transmitting and acquiring HIV infection. Among MSM testing positive for syphilis, where HIV-status was also reported, 51.2% of syphilis cases among MSM in 2015 were also HIV-positive. The increasing rates of P&S syphilis and increased risk of HIV infection experienced by MSM are exacerbated by significant rates of reinfection among those previously treated for syphilis.
The dramatic increase in syphilis cases among MSM draws attention to the need for accessible syphilis screening and treatment for those testing positive for syphilis. LHDs are taking a number of approaches to address syphilis at the local level, including collecting enhanced surveillance data on syphilis to tailor testing and treatment access, and offering testing in novel settings and through nontraditional approaches. One approach to increasing access to testing and treatment for syphilis among MSM is leveraging strategic partnerships. Multnomah County (OR) has utilized partnerships with community-based organizations (CBOs) to provided STD testing services among the jurisdiction’s gay and bisexual men and transgender communities. These partnerships allow the LHD to leverage the CBOs’ community knowledge and relationships, as well as its infrastructure, to provide more direct access to testing and treatment among at-risk populations.
LHDs are also using innovative surveillance approaches to better understand how syphilis is spreading among MSM communities. For example, Pima County (AZ) collected information on the usage of dating and hook-up smartphone apps and websites among its STD clinic patients, and determined that in 2014, 53% of MSM testing positive for P&S syphilis used a dating or hook-up app to find sexual partners. Salt Lake County (UT) has conducted extensive interviews with individuals testing positive for syphilis and with their partners, which revealed close-knit sexual networks and the growing popularity of MSM sex parties. This on-the-ground knowledge spurred Salt Lake County to develop partnerships with the party hosts, opening the door for the LHD to provide rapid HIV testing and pre-exposure prophylaxis (PrEP) education at the events, with rapid syphilis testing to be incorporated in the near future.
In order to identify effective practices to support the work of LHDs in leveraging strategic partnerships and providing syphilis testing and linkage to treatment for at-risk populations in nontraditional settings, NACCHO is implementing a project supported by CDC’s Division of STD Prevention that aims to assess optimal uses for rapid syphilis testing in nonclinical settings. This project will be discussed in detail in the final post of the series, while next week’s blog will explore the growing impact of syphilis on women of childbearing age and newborns (congenital syphilis), as well as novel approaches LHDs are taking to address syphilis in these populations. The next post will be available on April 21, and as reminder, throughout the month of April check out CDC’s resources on syphilis, participate in CDC’s Syphilis Strikes Back Thunderclap, and use sample STD Awareness Month tweets and Facebook posts on your social media accounts.