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A case-control study of syphilis among men who have sex
with men in New York City : association with HIV infection.
Sexually Transmitted Diseases 2004;31(10):581-587.
Paz-Bailey G, Meyers A, Blank S, Brown J, Rubin S, Braxton J, Zaidi A,
Schafzin J, Weigl S, Markowitz LE.
Abstract
OBJECTIVE: The objective of this study was to determine factors associated
with syphilis among men who report sex with other men in New York City. DESIGN,
SETTING AND STUDY SUBJECTS: We conducted a case-control study among 88 men
who reported sex with men in the previous year, 18 to 55 years old and diagnosed
with primary or secondary syphilis during 2001; and 176 control subjects
frequently matched by age and type of health provider. RESULTS: HIV prevalence
among syphilis cases was 48% compared with 15% among control subjects (P <0.001).
Variables associated with syphilis in a multivariate model were HIV infection
(odds ratio [OR], 7.3; 95% confidence interval [CI], 3.5-15.4), income >$30,000
per year (OR, 2.7; CI, 1.4-5.2), and barebacking (OR, 2.6; CI, 1.4-4.8).
The median time since HIV diagnosis for HIV-positive was 6 years for cases
and 7 years for control subjects (P = 0.70). Among HIV-infected participants,
syphilis cases were more likely than control subjects to report being on
antiretroviral therapy (69% vs. 44%, P = 0.05) and to report having undetectable
viral load (58% vs. 24%, P = 0.02). CONCLUSION: HIV infection was strongly
associated with syphilis in this study. High-risk behavior reported by both
cases and control subjects indicates the potential for increased HIV transmission.