title: Frequent screening for syphilis as part of HIV monitoring increases the detection of early asymptomatic syphilis among HIV-positive homosexual men.
abstract: BACKGROUND
  Syphilis continues to be a significant public health problem among HIV-positive men who have sex with men (MSM) internationally. This study aimed to determine whether the routine inclusion of syphilis serology with every blood test performed as part of HIV monitoring increases the detection of early asymptomatic syphilis among HIV-positive MSM.
  
  
  METHODS
  We examined the effect of this intervention, implemented in January 2007, on the detection of early asymptomatic syphilis among HIV-positive MSM attending the Melbourne Sexual Health Centre, Australia, and compared this with the previous clinic policy of annual syphilis screening.
  
  
  RESULTS
  In the 18 months before and after the intervention, the median number of syphilis tests performed per man per year was 1 and 2, respectively. The proportion of MSM diagnosed with early syphilis who were asymptomatic was 21% (3 of 14) and 85% (41 of 48) for the 2 respective periods (P = 0.006). The time between the midpoint since last syphilis serology and diagnosis of syphilis was a median of 107 days (range 9-362) and 45 days (range 23-325) for the 2 periods, respectively (P = 0.018).
  
  
  CONCLUSIONS
  The inclusion of routine syphilis serology with every blood test performed as part of HIV monitoring in HIV-positive MSM resulted in a large increase in the proportion of men diagnosed with early asymptomatic syphilis. This simple intervention probably also decreased the duration of infectiousness, enhancing syphilis control while also reducing morbidity.
authors.affiliation: Melbourne Sexual Health Centre, Victoria, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bissessor
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.forename: David
authors.initials: D
authors.lastname: Leslie
authors.forename: Kerri
authors.initials: K
authors.lastname: Howley
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine; D042241:Early Diagnosis; D015658:HIV Infections / Q000150:complications / Q000628:therapy*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology; D013588:Syphilis Serodiagnosis / Q000706:statistics & numerical data; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult