HIV DIAGNOSIS FOLLOWING A SYPHILIS, GONORRHEA, OR REPEAT DIAGNOSIS AMONG MALES INCLUDING NON-MSM: WHAT IS THE INCIDENCE?

BACKGROUND: The release of the first drug for HIV pre-exposure prophylaxis (PrEP) in 2012 marked the beginning of a new era of HIV prevention. Although PrEP is highly efficacious, identifying and ultimately increasing uptake among the highest risk male subgroups remains a challenge.

METHODS: Public health surveillance data from 2009-2016 was used to evaluate the risk of an HIV diagnosis following a syphilis (i.e. primary, secondary, or early latent), gonorrhea, and repeat diagnosis among urban males including MSM and non-MSM in Baltimore City.

RESULTS: Of the 1,531 males with 898 syphilis diagnoses and 1,243 gonorrhea diagnoses, 6.8% (n=104) were subsequently diagnosed with HIV. Within two years, one in ten syphilis or gonorrhea diagnoses were followed by an HIV diagnosis among MSM, and one in fifty syphilis or gonorrhea diagnoses were followed by an HIV diagnosis among non-MSM. Among non-MSM with gonorrhea, the rate of HIV incidence was 5.36 (95% CI: 2.37-12.14) times higher in those with (vs. without) a subsequent syphilis and/or gonorrhea diagnosis.

CONCLUSIONS: Local healthcare providers should offer PrEP to MSM diagnosed with syphilis or gonorrhea and to non-MSM with a previous gonorrhea diagnosis at time of a syphilis or gonorrhea diagnosis. The high proportion and short time to an HIV diagnosis among MSM after a syphilis or gonorrhea diagnosis suggests immediate PrEP initiation.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.