Getting to the Bottom of It: Sexual Positioning and Stage of Syphilis at Diagnosis, and Implications for Syphilis Screening

Author:

Cornelisse Vincent J12,Chow Eric P F12,Latimer Rosie L12,Towns Janet12,Chen Marcus12,Bradshaw Catriona S12,Fairley Christopher K12

Affiliation:

1. Melbourne Sexual Health Centre, Carlton, Victoria, Australia

2. Central Clinical School, Monash University, Melbourne, Victoria, Australia

Abstract

AbstractBackgroundSyphilis control among men who have sex with men (MSM) would be improved if we could increase the proportion of cases who present for treatment at the primary stage rather than at a later stage, as this would reduce their duration of infectivity. We hypothesized that MSM who practiced receptive anal intercourse were more likely to present with secondary syphilis, compared to MSM who did not practice receptive anal intercourse.MethodsIn this retrospective analysis of MSM diagnosed with primary or secondary syphilis at Melbourne Sexual Health Centre between 2008 and 2017, we analyzed associations between the stage of syphilis (primary vs secondary) and behavioral data collected by computer-assisted self-interviews.ResultsThere were 559 MSM diagnosed with primary (n = 338) or secondary (n = 221) syphilis. Of these, 134 (24%) men reported not practicing receptive anal sex. In multivariable logistic regression analysis, MSM were more likely to present with secondary rather than primary syphilis if they reported practicing receptive anal intercourse (adjusted odds ratio 3.90; P < .001) after adjusting for age, human immunodeficiency virus status, and condom use. MSM with primary syphilis who did not practice receptive anal intercourse almost always (92%) had their primary syphilis lesion on their penis.ConclusionsThe finding that MSM who practiced receptive anal intercourse more commonly presented with secondary syphilis—and hence, had undetected syphilis during the primary stage—implies that anorectal syphilis chancres are less noticeable than penile chancres. These men may need additional strategies to improve early detection of anorectal chancres, to reduce their duration of infectivity and, hence, reduce onward transmission.Men who practiced receptive anal intercourse (AI) were more likely to present with secondary syphilis, compared to men who exclusively practiced insertive AI. Hence, men who practice receptive AI may need additional strategies to detect anal chancres, to reduce transmission.

Funder

National Health and Medical Research Council

Australian Government’s Department of Education and Training

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Reference11 articles.

1. Syphilis trends among men who have sex with men in the United States and Western Europe: a systematic review of trend studies published between 2004 and 2015. [Review];Abara,2016

2. Increasing trends of syphilis among men who have sex with men in high income countries;Read;Sex Health,2015

3. Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. Update April 2018;Wright;J Virus Erad,2018

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