Refocusing Health Promotion for Syphilis Prevention: Results of a Case-Control Study of Men Who Have Sex With Men on England's South Coast

The authors set out to investigate factors associated with recent syphilis diagnosis and to recommend approaches to improve prevention. "Prevention interventions have had little impact on syphilis outbreaks among men who have sex with men (MSM) and diagnosis rates continue to rise rapidly," they noted.

The method of investigation was a case-control study of MSM accessing care at genitourinary medicine (GUM) and HIV outpatient clinics. All participants completed the same anonymous questionnaire regarding demographics, lifestyle, sexual behavior and partnerships. Those testing positive for early syphilis, either through laboratory or microscopy results, were designated as cases; controls were those testing negative.

In the study, 50 cases and 108 controls returned questionnaires. The investigators found syphilis diagnosis was significantly associated with STD history, recent use of recreational drugs, receptive anal sex practices (but not insertive ones), and a higher number of oral sex partners (but not specific oral sex practices). There were no overall differences between HIV-positive and HIV-negative or untested MSM in reporting sexual behaviors or partnership combinations. Sixty-eight percent of the MSM reported using public sex venues; however, this was not significantly associated with syphilis diagnosis.

The authors pointed out that many of the same key behavioral and partnership risk factors for syphilis are also risk factors for HIV, indicating "the need for integrated strategies that tackle the two infections together. Simplified procedures for syphilis screening should be available in GUM clinical settings, along with targeted community outreach prevention interventions," they concluded.

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