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Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

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dc.contributor.author Park, Hayoung
dc.contributor.author Konda, Kelika-A.
dc.contributor.author Roberts, Chelsea-P.
dc.contributor.author Maguina, Jorge-L.
dc.contributor.author Leon, Segundo-R.
dc.contributor.author Clark, Jesse-L.
dc.contributor.author Coates, Thomas-J.
dc.contributor.author Caceres, Carlos-F.
dc.contributor.author Klausner, Jeffrey-D.
dc.date.accessioned 2019-02-06T14:45:57Z
dc.date.available 2019-02-06T14:45:57Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5136
dc.description.abstract BACKGROUND: Syphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru. METHODS: Participants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02). RESULTS: Of 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1-1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated. CONCLUSIONS: We report a high rate of syphilis reinfection among high-risk men who have evidence of previous syphilis infection. Our findings highlight the close relationship between HIV incidence with both incident syphilis and syphilis reinfection. Further studies on syphilis reinfection are needed to understand patterns of syphilis reinfection and new strategies beyond periodic testing of high-risk individuals based on HIV status are needed. en_US
dc.language.iso eng
dc.publisher PLoS
dc.relation.ispartof urn:issn:1932-6203
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adult en_US
dc.subject Cohort Studies en_US
dc.subject Humans en_US
dc.subject Incidence en_US
dc.subject Longitudinal Studies en_US
dc.subject Male en_US
dc.subject Models, Statistical en_US
dc.subject Peru/epidemiology en_US
dc.subject Risk Factors en_US
dc.subject Syphilis/epidemiology en_US
dc.subject Young Adult en_US
dc.title Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0162156
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.02


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