The Epidemiology of Syphilis in New York City: Historic Trends and the Current Outbreak Among Men Who Have Sex With Men, 2016

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Abstract

Background

Male primary and secondary (P&S) and early latent syphilis cases have increased markedly in New York City (NYC) after a historic nadir in 1998. The majority of cases are among men who have sex with men (MSM). We describe the epidemiology of syphilis among NYC males to provide a model of how 1 jurisdiction collects, analyzes, interprets, uses, and disseminates local data to guide programmatic activities directed at syphilis control.

Methods

We analyzed trends in reported infectious syphilis cases using routinely collected surveillance and case investigation data. Human immunodeficiency virus (HIV) coinfection status was ascertained by routine deterministic match between sexually transmitted infection and HIV surveillance registries, and self-report. We mapped diagnosing facilities to display the relative contribution of different public/private facilities. Characteristics of male syphilis cases diagnosed in public sexual health (SH) clinics were compared to those diagnosed elsewhere.

Results

During 2012 to 2016, male P&S syphilis case rates increased 81%, from 24.8 to 44.8/100,000 (1832 cases in 2016); the highest rates were among black non-Hispanic men. Overall, 87.6% (902/1030) of interviewed men in 2016 disclosed 1 or more male partner. The HIV coinfection rates are high among MSM with P&S syphilis (43.4%; 394/907 in 2016), but appear to be decreasing (from 54.1% in 2012). Maps highlight SH clinics' contribution to diagnosing P&S syphilis cases among men of color. HIV coinfection rates were lower among men with P&S syphilis diagnosed in SH clinics than among those diagnosed elsewhere (34%, SH clinics vs 49%; other settings, P < 0.0001).

Conclusions

Syphilis infections continue to increase among MSM in NYC. Novel interventions responsive to the drivers of the current outbreak are needed.

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