Earlier Detection of Latent Syphilis: Every 3 Month Screening with MSM and HIV

BACKGROUND: Since this data was last presented, there has been a continued resurgence of syphilis despite increasing screening efforts, especially neurosyphilis and ocular syphilis. High-risk populations include men who have sex with men (MSM) and those infected with HIV. In 2015, based on data from an older Australian study and a recent Canadian study, the screening recommendation changed from yearly to every 3–6 months. We determined that high-risk patients should be screened even more frequently, at least every 3 months, to identify patients earlier in the disease course and prevent the development of symptomatic syphilis. METHODS: A retrospective chart review of the HIV Clinic Care Registry at the Jerry L. Pettis Memorial VA Medical Center (JLP VAMC) was conducted from 2002 to 2016. Patients were classified according the stage of syphilis, epidemiologic characteristics, and HIV control. In 2004, screening with RPR was changed from yearly to every 3 months. RESULTS: From 2002 to 2016, among HIV-infected men, there were 155 cases of syphilis diagnosed in 126 individuals. Of the subset before the intervention in 2004, 62.5% (5) were symptomatic at the time of diagnosis. After increasing the screening to every 3 months, only 41.6% (62) had symptomatic infection. The majority of subjects were MSM (81%) and Caucasian (71%). Sixty-nine percent of patients who developed infection had a history of prior infection. As many as 54.8% of patients had a viral load <50 copies/mL and 57.1% had CD4 counts of over 400. There were 27 cases of neurosyphilis, with 33% having ocular involvement. Among patients with neurosyphilis, 19% had an RPR in 3 months, and 31% had not had an RPR in 6 months. Primary and secondary syphilis incidence rates in San Bernardino compared with San Bernardino in 2015 were 8.4 and 389 per 100,000 respectively. CONCLUSION: This study showed a significant decrease in the amount of symptomatic syphilis with every 3-month screening compared with yearly screening. This is important for preventing progression to neurosyphilis, especially ocular involvement, given a large proportion of patients develop disease within 3–6 months. To prevent the morbidity associated with symptomatic and neurosyphilis, screening in high-risk populations of MSM, especially with HIV, should be increased to every 3 months. DISCLOSURES: All authors: No reported disclosures.