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AIDS Patient Care STDS. 2008 Dec;22(12):955-63. doi: 10.1089/apc.2008.0077.

Endemic early syphilis among young newly diagnosed HIV-positive men in a southeastern U.S. state.

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Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA.


An epidemic of HIV infections among college students who are primarily men who have sex with men (MSM) have been reported from North Carolina, a state with one of the highest syphilis rates in the southeastern United States. We assessed the proportion of early syphilis coinfections among young HIV-infected individuals statewide and associated risk factors. From January 2002 to July 2006, chart abstractions were performed from North Carolina surveillance records for newly diagnosed HIV-positive men 18-30 years of age reported between 2000-2005, and a subset of women in the same age group. Bivariable and multivariable analyses were conducted to assess early syphilis risk factors among HIV-infected persons. During the 6-year period, there were 1460 HIV-positive men aged 18-30 years reported in North Carolina; 90 (6.2%) were coinfected with early syphilis without a significant change over time. Data were available for 551 HIV-positive women diagnosed from 2002-2005; only 6 (1.1%) were coinfected. Fifty-five percent of coinfected men were diagnosed with both infections on the same date of evaluation. Young HIV-infected men who are black (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI], 1.3, 4.1), MSM (aOR 3.8; 95% CI, 1.8, 7.8), or reported sex with both genders (aOR 5.1; 95% CI, 2.2, 11.5), or anonymous sex (aOR 2.1; 95% CI, 1.3, 3.3) were more likely to have early syphilis. Although male coinfections have not increased over time, early syphilis has become endemic among young HIV-positive men statewide, emphasizing the need to provide screening for both infections among high-risk individuals.

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