SYPHILIS IN THE HIV ATLANTA VA COHORT: RISK FACTORS AND EPIDEMIOLOGY Open Access

Dunne, Katherine Meaghan (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/ks65hd066?locale=en
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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

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