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Increasing Syphilis Detection Among Patients Assigned Male at Birth Screened at a Boston Community Health Center Specializing in Sexual and Gender Minority Health, 2005–2015

Hazra, Aniruddha, MD*†‡; Menza, Timothy W., MD, PhD*; Levine, Kenneth, MPH*; Grasso, Chris, MPH*; Mayer, Kenneth H., MD*†‡

Sexually Transmitted Diseases: June 2019 - Volume 46 - Issue 6 - p 375–382
doi: 10.1097/OLQ.0000000000000986
Original Studies

Background United States syphilis rates have increased to levels last seen in the 1990s. We examined syphilis epidemiology of patients attending a Boston community health center specializing in sexual and gender minority health.

Methods We performed a retrospective cohort study of all patients assigned male at birth screened with rapid plasma reagin from 2005 through 2015. We developed an algorithm to identify new infections and used repeat cross-sectional analysis to assess temporal trends in syphilis diagnoses. We also performed longitudinal analysis to calculate syphilis incidence using a Cox proportional hazards model that accounts for multiple infections over time.

Results Eighteen thousand two hundred eighty-two patients had a total of 57,080 rapid plasma reagins, 1170 (2.0%) tests met criteria for syphilis. Adjusted syphilis diagnoses increased from 1.2% to 1.9%, recurrent syphilis diagnoses increased from 0.04% to 0.3% during the study period. Black and Hispanic/Latinx patients, patients aged 35 to 44 years, gay/bisexual patients, cisgender men, and human immunodeficiency virus (HIV)-infected patients and those who became HIV-infected during the study period were more likely to test positive for syphilitic infection in repeat cross-sectional analysis. Among 6199 patients screened more than 1 time over 21,745 person-years, there were 661 new syphilis cases (3.0% annual incidence; 95% confidence interval [CI], 2.8% to 3.2%). Compared with those aged 14 to 24 years, patients 45 years or older were less likely to experience syphilis. New HIV infection was associated with increased risk of incident syphilis (adjusted hazard ratio, 2.87; 95% CI, 1.61–5.13). Virally suppressed HIV-infected patients were less likely to experience incident syphilis (adjusted hazard ratio, 0.69; 95% CI, 0.55–0.87).

Conclusions The high incidence of syphilis among patients assigned male at birth disproportionately affected young patients, black and Hispanic/Latinx patients, gay/bisexual patients, cisgender men, and those with new or chronic HIV infection. Syphilitic reinfection rates increased over time.

For patients assigned male at birth seen at a Boston clinic over a decade, we found disproportionate syphilis cases in young patients, black and Hispanic/Latinx patients, gay/bisexual patients, cisgender men, and those with new or chronic human immunodeficiency virus infection; syphilitic reinfections have significantly increased.

From the *The Fenway Institute, Fenway Health, Boston, MA;

Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; and

Harvard Medical School, Boston, MA

Conflict of Interest and Sources of Funding: None declared.

Correspondence: Aniruddha Hazra, MD, University of Chicago, Department of Medicine, 5841 S. Maryland Ave, MC5065, Chicago, IL 60637. E-mail:

Received for publication October 11, 2018, and accepted February 6, 2019.

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© Copyright 2019 American Sexually Transmitted Diseases Association