Trends in Syphilis Screening at Time of Blood Tests for HIV Monitoring Among HIV–Positive Men, Oregon 2008–2012

BACKGROUND:   In Oregon, the incidence rate of primary and secondary (P&S) syphilis jumped from 0.4 cases per 100,000 in 1999 to 10.3 cases per 100,000 in 2013.  In 2012, 57% of reported cases were co-infected with HIV.  Current guidelines recommend syphilis screening for HIV–positive men who have sex with men (MSM) at least once per year.  In response to the outbreak, some providers started routinely testing for syphilis when drawing labs for standard HIV care.  We aimed to evaluate trends in syphilis screening, including concurrent HIV monitoring tests and syphilis serology.

METHODS:   Our sample included men interviewed as part of the Medical Monitoring Project (MMP) from 2008–2012 in Oregon.  Next, we counted the number of men with a positive syphilis test during the study period.  Participants were classified as having concurrent HIV monitoring and syphilis screening if they had an HIV related test (CD4 count or viral load) within 7 days of either a Rapid Plasma Reagin (RPR) or Veneral Disease Research Laboratory (VDRL) test.  We evaluated the trend of syphilis tests and concurrent syphilis screening and HIV monitoring tests over time using Cochran-Armitage test for trend.

RESULTS:   During 2008–2012, an average of 220 HIV–positive males living in Oregon were enrolled in the MMP. The proportion of men with a positive syphilis tests went from 1% in 2009 to 14% in 2012.  The number of syphilis tests processed increased from 121 in 2008 to 301 in 2012 among MMP participants (p < 0.0001).  Eighteen percent of all HIV testing events included a screen for syphilis in 2008 which increased to 43% in 2012 (p < 0.0001).

CONCLUSIONS:   Both syphilis screening and concurrent screening with HIV monitoring rose with syphilis incidence in Oregon.  Increasingly, Oregon medical providers are routinely screening for syphilis with HIV related testing.