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Rates of Primary and Secondary Syphilis Among White and Black Non-Hispanic Men Who Have Sex With Men, United States, 2014

Grey, Jeremy A. PhD*; Bernstein, Kyle T. PhD, ScM; Sullivan, Patrick S. DVM, PhD*; Kidd, Sarah E. MD, MPH; Gift, Thomas L. PhD; Hall, Eric W. MPH*; Hankin-Wei, Abigail MD; Weinstock, Hillard S. MD, MPH; Rosenberg, Eli S. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1, 2017 - Volume 76 - Issue 3 - p e65–e73
doi: 10.1097/QAI.0000000000001508

Background: Men who have sex with men (MSM) in the United States experience an approximately 100-fold greater rate of primary and secondary (P&S) syphilis diagnoses compared with men who have sex with women only. As in the general population, racial/ethnic disparities in P&S syphilis diagnosis rates may exist among MSM, but MSM-specific P&S syphilis rates by race/ethnicity are unavailable. We enhanced a published modeling approach to estimate area-level MSM populations by race/ethnicity and provide the first estimates of P&S syphilis among black and white non-Hispanic MSM.

Methods: We used data from the American Community Survey (ACS), published findings from the National Health and Nutrition Examination Survey (NHANES), and national syphilis surveillance data to estimate state-level rates of P&S syphilis diagnoses among MSM, overall and for black and white non-Hispanic MSM. We also used variability around ACS and NHANES estimates to calculate 95% confidence intervals for each rate.

Results: Among 11,359 cases of P&S syphilis among MSM with known race/ethnicity in 2014, 72.5% were among white (40.3%) or black (32.2%) MSM. The national rate of P&S syphilis diagnosis was 168.4/100,000 for white MSM and 583.9/100,000 for black MSM. Regional rates for black MSM ranged from 602.0/100,000 (South) to 521.5/100,000 (Midwest) and were consistently higher than those for white MSM.

Conclusions: Although white MSM accounted for more P&S syphilis diagnoses than black MSM in 2014, when evaluating diagnoses based on rate per 100,000, black MSM had consistently and markedly higher rates than white MSM, with the highest impacted states located in the US South.

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*Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA;

Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and

Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.

Correspondence to: Jeremy A. Grey, PhD, 1600 Clifton Road, MS E63, Atlanta, GA 30329-4027 (e-mail:

This effort was supported by Cooperative Agreement Number 5U38PS004646 by the National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, as part of the NCHHSTP Epidemiologic and Economic Modeling Cooperative Agreement.

The authors have conflicts of interest to disclose.

The findings and conclusions in this manuscript are those of the authors and do not necessarily represent views of the Centers for Disease Control and Prevention.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March 21, 2017

Accepted July 07, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.