Abstract
Background: Despite the availability of effective treatment,
syphilis continues to be a significant
public health problem in the United States, particularly among
HIV-positive individuals. This
analysis seeks to determine whether there are specific risk factors
for syphilis infection among HIV-
positive individuals and to describe the distribution of syphilis
stages within that population.
Methods: We performed a retrospective matched case-control
study of members of the HIV
Atlanta VA Cohort Study (HAVACS) from 2006-2010, comparing
demographic, clinical and
laboratory data of HIV-positive individuals with at least one
episode of syphilis during the study
period to those with no documented syphilis during that period. We
performed a similar comparison
of individuals with repeat syphilis infection to those with a
single episode of syphilis during the study
period. Additionally, a descriptive analysis of syphilis stages
within the cohort was performed.
Results: The only significant differences in cases and
controls were age and HIV risk factor. On
average, cases were younger than controls (p<0.0001) and were
more likely to be men who have sex
with men (MSM) (p<0.0001). There were no significant differences
between repeat and single
episode syphilis cases in any of the study variables. 40.8% of
syphilis episodes among HIV-positive
individuals at the Atlanta VA between 2006 and 2010 were in the
early latent stage.
Conclusions: HIV-positive veterans who are younger and MSM
are more likely to become infected
with syphilis. A high proportion of syphilis cases among
HIV-positive individuals at the Atlanta VA
Medical Center (VAMC) between 2006 and 2010 were in the early
latent stage. These findings
emphasize the need for increased surveillance of latent disease and
intensified counseling of high
risk, HIV-positive individuals.
Table of Contents
TABLE OF CONTENTS
CHAPTER I: BACKGROUND/LITERATURE
REVIEW
................................................................................
1
Introduction............................................................................................................................
..
1
Epidemiology of Syphilis in the
US
..................................................................................................
2
Syphilis and
HIV
.........................................................................................................................
3
Syphilis
Screening......................................................................................................................
4
Treatment of
Syphilis.................................................................................................................
.
6
Syphilis Staging and Clinical
Presentation.......................................................................................
.
6
CHAPTER II:
MANUSCRIPT
............................................................................................................
9
ABSTRACT
................................................................................................................................
9
INTRODUCTION.........................................................................................................................
10
METHODS................................................................................................................................
10
Study
Population
.......................................................................................................................
10
Study
Design...........................................................................................................................
.
11
Variables.................................................................................................................................
.
11
Analysis..................................................................................................................................
.
12
RESULTS
..................................................................................................................................
12
DISCUSSION
.............................................................................................................................
14
TABLES...................................................................................................................................
.
16
FIGURES
...................................................................................................................................
21
REFERENCES............................................................................................................................
.
22
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS AND POSSIBLE
FUTURE DIRECTIONS................... 24
Summary................................................................................................................................
.
24
Public Health
Implications...........................................................................................................
.
24
Possible Future
Directions..........................................................................................................
.
25
APPENDIX
................................................................................................................................
26
About this Master's Thesis
Rights statement
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