High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India.
Open accessAbstract
BACKGROUND: Recent syphilis outbreaks have raised concern regarding the potential enhancement of HIV transmission. The incidence of syphilis and its association with HIV-1 infection rates among a cohort of sexually transmitted infection (STI) clinic attendees was investigated. METHODS: 2732 HIV-1 seronegative patients attending three STI and one gynaecology clinic, were enrolled from 1993-2000 in an ongoing prospective cohort study of acute HIV-1 infection in Pune, India. At screening and quarterly follow up visits, participants underwent HIV-1 risk reduction counselling, risk behaviour assessment and HIV/STI screening that included testing for serological evidence of syphilis by RPR with TPHA confirmation. Patients with genital ulcers were screened with dark field microscopy. RESULTS: Among 2324 participants who were HIV-1 and RPR seronegative at baseline, 172 participants were found to have clinical or laboratory evidence of syphilis during follow up (5.4 per 100 person years, 95% CI 4.8 to 6.5 per 100 person years). Independent predictors of syphilis acquisition based on a Cox proportional hazards model included age less than 20 years, lack of formal education, earlier calendar year of follow up, and recent HIV-1 infection. Based on a median follow up time of 11 months, the incidence of HIV-1 was 5.8 per 100 person years (95% CI 5.0 to 6.6 per 100 person years). Using a Cox proportional hazards model to adjust for known HIV risk factors, the adjusted hazard ratio of HIV-1 infection associated with incident syphilis was 4.44 (95% CI 2.96 to 6.65; p<0.001). CONCLUSIONS: A high incidence rate of syphilis was observed among STI clinic attendees. The elevated risk of HIV-1 infection that was observed among participants with incident syphilis supports the hypothesis that syphilis enhances the sexual transmission of HIV-1 and highlights the importance of early diagnosis and treatment of syphilis.
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Other STIs also might significantly increase the risk for HIV infection.
“Importantly, other STIs also might significantly increase the risk for HIV infection (197–199).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [199]
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Sexually Transmitted Infections Treatment Guidelines, 2021
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- Authors
- Reynolds, S. J., Risbud, A. R., Shepherd, M. E., Rompalo, A. M., Ghate, M. V., Godbole, S. V., Joshi, S. N., Divekar, A. D., Gangakhedkar, R. R., Bollinger, R. C., & Mehendale, S. M.
- Affiliations
- National AIDS Research Institute (IN)
- Johns Hopkins University (US)
- Corresponding author
- Reynolds, S J
- Venue
- Sexually Transmitted Infections
- Publisher
- BMJ
- Published
- 2006-03-30
- Volume
- 82
- Issue
- 2
- Pages
- 121-126
- ISSN
- 0007-134X (ISSN-L)
- 1368-4973
- PMC
- PMC2564682
- OpenAlex
- W2125704778
- Cited by
- 95
- References
- 50
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 4 · 2014: 4 · 2013: 6 · 2012: 9
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Sexually Transmitted Infections (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (5r01ai041369-04, n01ai035173-037)
- National Institute of Allergy and Infectious Diseases (AI01633, AI-35173, K24AI001633, AI41369, N01-AI-035173)
- Fogarty International Center (5 D43 TW00010-AITRP, D43TW000010)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
- Keywords
- syphilis, HIV-1 transmission, syphilis incidence, HIV incidence, HIV-syphilis coinfection, STI clinic attendees, genital ulcers, Pune
- MeSH terms
- Adult, Aged, Disease Outbreaks, Female, Humans, India, Male, Middle Aged, Prospective Studies, Risk Factors, Syphilis, HIV-1, HIV Infections, Incidence
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