Patients living with HIV who had had their sexual history taken were four times more likely to be tested for syphilis than those who had no such history documented, according to a study presented at IDWeek 2014.
The U.S. Centers for Disease Control recommend annually screening HIV-positive patients, in particular men who have sex with men (MSM), for syphilis. The HIV Medicine Association (HIVMA) and the Infectious Diseases Society of America (IDSA), on the other hand, advocate for an initial syphilis screening of HIV-positive patients and re-screenings for those who engage in high-risk sexual activities.
The study evaluated the frequency of syphilis testing in an urban setting, the Infectious Diseases clinic of St. John Hospital and Medical Center in Detroit, Mich., during 2011. It also sought to determine which demographic or care-related characteristics increase the likelihood that HIV-positive patients are tested for syphilis.
The clinic treated 220 HIV-positive patients during 2011, 173 of whom were seen more than twice during the year and were included in this study. The mean age of study participants was 46.6, more than two thirds (122, 70.5%) were male and the majority (115, 66.5%) were African American. Almost half (86, 49.7%) of patients in the study identified as MSM.
More than half of the patients (102, 59%) were tested for syphilis. The vast majority (93, 91.2%) of these Rapid Plasma Reagin (RPR) tests were scheduled screenings, while nine (8.8%) of the tests were performed in response to a patient's symptoms or because the patient had been exposed to syphilis. Ninety of these RPR tests were negative, while 12 patients tested positive for syphilis. Three quarters (9) of these positive tests had been performed as scheduled screenings.
Those given an RPR test were somewhat younger (mean age 45 years) than those not tested (mean age 49 years, P = .022), but most other demographic characteristics -- including gender, race, sexual orientation and history of injection drug use -- were similar between the two groups.
The one statistically significant difference between those tested and those not tested was the fact that those who had had their sexual history taken were four times as likely to be tested for syphilis as those who did not have their history taken. Health care providers obtained the sexual history of 68.6% of those tested, but only did so for 32.4% of those not tested (P < .0001). However, study authors cautioned that, "Some patients may have had a sexual history obtained but not documented."
Overall, "Increased emphasis on obtaining sexual history during routine care would likely result in increased appropriate syphilis screening," the researchers concluded.