O3.5 - Temporal Trends in HIV Status by Race/Ethnicity Among Reported Primary and Secondary Syphilis Cases Among Gay, Bisexual, and Other Men who have sex with Men — United States, 2011–2020

Background: Gay, bisexual, and other men who have sex with men (MSM) are disproportionately represented among both persons with HIV and reported primary and secondary (P&S) syphilis cases annually. Ulcerative syphilis lesions may double HIV transmission risk making a syndemic approach to examining trends in disease critical to inform efforts to end the HIV epidemic in the United States. Because additional differences in HIV and syphilis prevalence have been observed by race/ethnicity, we characterized trends in HIV status among P&S syphilis cases in MSM by race/ethnicity to better understand syphilis and HIV co-infection in the United States.

Methods: We reviewed 2011–2020 P&S syphilis cases among MSM reported to CDC via the National Notifiable Diseases Surveillance System from 50 states; Washington, D.C.; and Puerto Rico to determine reported HIV status (positive, negative, unknown/missing). Among the three race/ethnicity groups that represent >85% of annual P&S syphilis cases (non-Hispanic White, non-Hispanic Black, and Hispanic/Latino persons), we examined annual trends in number and proportion of cases with and without reported HIV co-infection.

Results: During 2011–2020, P&S syphilis cases increased by 80% among non-Hispanic Black MSM (3,034 in 2011 to 5,461 in 2020), 81% among non-Hispanic White MSM (3,330 to 6,043) and 147% among Hispanic/Latino MSM (1,796 to 4,441) (Figure 1). Among each race/ethnicity group, P&S syphilis case counts increased among reported HIV negative and HIV positive cases, although racial/ethnic differences in the magnitude of increase were observed. P&S syphilis cases with reported HIV nearly doubled for non-Hispanic Black and Hispanic/Latino MSM while increasing by 29% for non-Hispanic White MSM. When looking at trends in proportion of P&S syphilis cases reported with HIV co-infection, the proportion increased among non-Hispanic Black MSM (52% to 56%) but decreased among non-Hispanic White (46% to 32%) and Hispanic/Latino MSM (44% to 35%).

Conclusion: Increasing numbers of P&S syphilis cases among MSM across racial/ethnic groups and HIV status highlights the importance of prioritizing MSM for engagement in syphilis and HIV treatment and prevention services. Further investigation is needed to understand determinants of racial/ethnic disparities in trends of proportion of P&S syphilis cases reported with HIV co-infection.