title: The high risk of an HIV diagnosis following a diagnosis of syphilis: a population-level analysis of New York City men.
abstract: BACKGROUND
  Epidemiologic studies have shown that syphilis is associated with risk for human immunodeficiency virus (HIV) infection. We used population-level syphilis and HIV data to quantify HIV incidence among men following primary or secondary (P&S) syphilis diagnoses and identify the highest-risk subgroups for intensified prevention, such as pre-exposure prophylaxis with antiretroviral medications.
  
  
  METHODS
  Male cases reported to the New York City HIV/AIDS and Sexually Transmitted Disease (STD) surveillance registries were matched using a deterministic algorithm. We measured HIV incidence following P&S syphilis diagnosed between 2000 and June 2010 and identified risk factors for HIV infection using Cox proportional hazards models.
  
  
  RESULTS
  Of 2805 men with syphilis contributing 11 714 person-years of follow-up, 423 (15.1%) acquired HIV; annual incidence was 3.61% (95% confidence interval [CI], 3.27%, 3.97%). HIV incidence was high among: men who have sex with men (MSM) (5.56%, 95% CI, 5.02%-6.13%); males with secondary compared with primary syphilis (4.10% vs 2.64%, P < .0001); and males diagnosed with another bacterial STD after syphilis (7.89%, 95% CI, 6.62%-9.24%).
  
  
  CONCLUSIONS
  HIV incidence among men diagnosed with syphilis is high; one in 20 MSM were diagnosed with HIV within a year. Our data have implications for syphilis and HIV screening and may be useful for further targeting HIV-negative populations for pre-exposure prophylaxis.
authors: Bureau of Sexually Transmitted Disease Control.
authors: Preeti
authors: P
authors: Pathela
authors: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York.
authors: Sarah L
authors: SL
authors: Braunstein
authors: Bureau of Sexually Transmitted Disease Control Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Susan
authors: S
authors: Blank
authors: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York.
authors: Colin
authors: C
authors: Shepard
authors: Bureau of Sexually Transmitted Disease Control Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Julia A
authors: JA
authors: Schillinger
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D013587:Syphilis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
keywords: HIV incidence; syphilis