title: Low viral suppression and high HIV diagnosis rate among men who have sex with men with syphilis--Baltimore, Maryland.
abstract: BACKGROUND
  The burden of syphilis and HIV among gay, bisexual, and other men who have sex with men (MSM) in Baltimore, Maryland, is substantial. Syphilis and HIV surveillance data were analyzed to characterize MSM with syphilis, including those with repeat infection and HIV coinfection, to strengthen prevention efforts.
  
  
  METHODS
  MSM 15 years or older from Baltimore City or County diagnosed as having early syphilis in 2010 to 2011 were included. Those previously treated for syphilis in 2007 to 2011 were considered to have repeat syphilis infection. HIV surveillance data were used to identify HIV coinfection and assess viral suppression. For MSM not diagnosed as having HIV at or before their syphilis diagnosis, annual HIV diagnosis rates were estimated, using Baltimore City data.
  
  
  RESULTS
  Of 460 MSM with early syphilis in 2010 or 2011, 92 (20%) had repeat infection; 55% of MSM with a single diagnosis and 86% with repeat infection were HIV coinfected. Among MSM diagnosed as having HIV, viral suppression was low (25%, or 46% of those with a viral load reported). Among Baltimore City MSM without a prior HIV diagnosis, estimated annual HIV diagnosis rates were high (5% for those with 1 syphilis diagnosis, 23% for those with repeat infection).
  
  
  CONCLUSIONS
  Baltimore-area MSM with syphilis, particularly those with repeat infection, represent a unique population for whom coinfection with HIV is high. Increasing frequency of syphilis and HIV testing among Baltimore area MSM with a syphilis diagnosis and prioritizing HIV-infected MSM with syphilis in efforts to achieve viral suppression may improve outcomes locally for both infections.
authors.affiliation: From the *Division of HIV/AIDS Prevention and †Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; ‡Maryland Department of Health and Mental Hygiene, Baltimore, MD; §Division of STD Prevention and ¶CDC Experience Applied Epidemiology Fellowship, Atlanta, GA; and **Baltimore County Department of Health and Human Services, Towson, MD.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Cooley
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Pearl
authors.forename: Colin
authors.initials: C
authors.lastname: Flynn
authors.forename: Christine
authors.initials: C
authors.lastname: Ross
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hart-Cooper
authors.forename: Kim
authors.initials: K
authors.lastname: Elmore
authors.forename: David
authors.initials: D
authors.lastname: Blythe
authors.forename: James
authors.initials: J
authors.lastname: Morgan
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Oster
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D001727:Bisexuality / Q000706:statistics & numerical data*; D060085:Coinfection / Q000453:epidemiology*; D017280:Condoms / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening; D055502:Secondary Prevention; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology*; D013587:Syphilis / Q000453:epidemiology* / Q000276:immunology