The high incidence of syphilis among people living with HIV (PLHIV) has emerged as a pressing public health challenge, particularly highlighted by recent findings from Hainan Province, south China. A study conducted at the Haikou Prevention and Treatment Center revealed alarming rates of syphilis seroconversion within this vulnerable population, underscoring the necessity for targeted screening and intervention strategies.
From November 2012 to December 2022, researchers assessed the syphilis incidence among 650 adults diagnosed with HIV, utilizing various serological tests, including the TRUST and TPPA, to confirm positive syphilis cases. The study found a significant rate of 23.7% syphilis among participants, predominantly men who have sex with men (MSM).
Globally, there is growing concern over the intersection of syphilis and HIV, with the World Health Organization reporting increases in syphilis cases over the years. Syphilis can lead to serious health complications if left untreated, such as neurological and cardiovascular disease. Importantly, PLHIV are at heightened risk for syphilis due to immune suppression, exacerbated by the HIV virus's ability to facilitate the transmission of sexually transmitted infections.
The research highlights key factors associated with syphilis among PLHIV. Notably, individuals diagnosed with HIV via voluntary testing were 1.918 times more likely to contract syphilis than those diagnosed through hospital testing. This finding indicates the need for enhanced preventative measures at the point of HIV diagnosis.
Also noteworthy was the finding indicating the incidence of syphilis increased sharply among those with suboptimal adherence to antiretroviral therapy (ART) and those possessing prior histories of sexually transmitted diseases before their HIV diagnosis. Over 43% of participants with such histories tested positive for syphilis, showcasing the interplay of existing health conditions and risky behaviors.
The median age of HIV diagnosis among participants was 28, emphasizing the young demographic often afflicted by both conditions. With 70.9% identifying as MSM, the study highlights the specific population groups particularly vulnerable to dual infection risks. Enhancing sexual health education and awareness at the time of HIV testing, particularly for those demonstrating characteristics of elevated risk, emerged as fundamental recommendations.
Despite the concerning results, there is room for optimism. Compared to previous studies from the area, which reported rates as low as 8.7% to 19.9%, the current 23.7% incidence signals both the urgent need for more rigorous surveillance and intervention strategies. The increase could be partly explained by longer follow-up times and improved screening practices.
Conclusions drawn from the study strongly advocate for the integration of annual syphilis screening as standard practice within HIV care, especially to identify asymptomatic cases. The findings urge public health officials to pave the way for focused and effective health education initiatives alongside improving ART prescription adherence to mitigate syphilis rates.
Preventative measures such as routine screening, patient education, and prompt treatment are fundamental to managing and reducing syphilis incidence rates among PLHIV. The community’s broader awareness of STDs and health-seeking behaviors can facilitate positive health outcomes and reduce the dual burden of HIV and syphilis.