Background: The well-described biologic and epidemiologic associations of syphilis and HIV are particularly relevant to the military, as service members are young and at risk for sexually transmitted infections. We therefore used the results of serial serologic testing to determine the prevalence, incidence, and risk factors for incident syphilis in a cohort of HIV-infected Department of Defense beneficiaries.
Methods: Participants with a positive nontreponemal test at HIV diagnosis that was confirmed on treponemal testing were categorized as prevalent cases, and participants with an initial negative nontreponemal test who subsequently developed a confirmed positive nontreponemal test were categorized as incident cases.
Results: At HIV diagnosis, the prevalence of syphilis was 5.8% (n = 202). A total of 4239 participants contributed 27,192 person-years (PY) to the incidence analysis and 347 (8%) developed syphilis (rate, 1.3/100 PY; [1.1, 1.4]). Syphilis incidence was highest during the calendar years 2006 to 2009 (2.5/100 PY; [2.0, 2.9]). In multivariate analyses, younger age (per 10 year increase hazard ratio [HR], 0.8; [0.8–0.9]), male gender (HR, 5.6; [2.3–13.7]), non–European-American ethnicity (African-American HR, 3.2; [2.5–4.2]; Hispanic HR, 1.9; [1.2–3.0]), and history of hepatitis B (HR, 1.5; [1.2–1.9]) or gonorrhea (HR, 1.4; [1.1–1.8]) were associated with syphilis.
Conclusions: The significant burden of disease both at and after HIV diagnosis, observed in this cohort, suggests that the cost-effectiveness of extending syphilis screening to at-risk military members should be assessed. In addition, HIV-infected persons continue to acquire syphilis, emphasizing the continued importance of prevention for positive programs.
From the *Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; †School of Public Health, University of Minnesota, Minneapolis, MN; ‡San Antonio Military Medical Center, San Antonio, TX; §Walter Reed Army Medical Center, Washington, DC; ¶Naval Medical Center San Diego, San Diego, CA; and ‖Naval Medical Center Portsmouth, Portsmouth, VA
The Infectious Disease Clinical Research Program HIV Working Group included the following members: Susan Banks, RN, Irma Barahona, RN, CAPT Mary Bavaro, MD, Helen Chun, MD, Cathy Decker, MD, Lynn Eberly, PhD, Conner Eggleston, LTC Tomas Ferguson, COL Susan Fraser, MD, MAJ Joshua Hartzell, MD, MAJ Joshua Hawley, LTC Gunther Hsue, Arthur Johnson, MD, COL Mark Kortepeter, MD, MPH, Michelle Linfesty, Scott Merritt, LTC Robert O'Connell, MD, Cpt Jason Okulicz, MD, Sheila Peel, PhD, Michael Polis, MD, John Powers, MD, MAJ Roseanne Ressner, MD, ret Col Edmund Tramont, LT Tyler Warkentien, MAJ Paige Waterman, MD, Amy Weintrob, MD, Timothy Whitman, MD, and LTC Michael Zapor, MD. The authors thank William Bradley for his assistance with data acquisition.
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Some authors on this paper are military service members and/or employees of the U.S. Government. As such, this work was prepared as part of official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.
Presented in part at the 16th Conference on Retrovirus and Opportunistic Infections, Montreal, February 16–19, 2009; Abstract number 1057.
All authors have reviewed and approved this manuscript.
A.G. and A.F. had full access to all the data and take responsibility for the accuracy of the data. Study concept and design (A.G., B.A.); acquisition of the data (A.G., N.C.-C., M.L., T.L., G.W.); drafting of the manuscript (A.G., A.F., B.A., and G.M.); critical review of the manuscript (G.W., M.L., T.L., N.C.-C., and A.L.); obtaining funding (A.G., B.A.); study supervision (A.G.).
Supported by the Infectious Disease Clinical Research Program (IDCRP) (IDCRP-000-26), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.
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Correspondence: Anuradha Ganesan, MD, MPH, National Naval Medical Center, Division of Infectious Diseases, 8901 Wisconsin Ave, Bethesda, MD 20889.E-mail: Anuradha.firstname.lastname@example.org.
Received for publication September 9, 2011, and accepted January 5, 2012.