CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1156 Prevalence of Syphilis and HIV/Syphilis Coinfection in an Inner-City Emergency Department Joanne Hunt 1 , Oliver Laeyendecker 2 , Bhakti Hansoti 3 , Reinaldo Fernandez 3 , Richard E. Rothman 3 , Thomas C. Quinn 2 , Yu-Hsiang Hsieh 3 1 National Institutes of Health, Bethesda, MD, USA, 2 National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Syphilis has had a resurgence in the United States. Untreated syphilis infections have detrimental health effects, and improved screening procedures are needed to control the epidemic. We performed a retrospective, deidentified cross-sectional analysis of individuals attending the Johns Hopkins Emergency Department (JHHED) to determine the prevalence of syphilis and HIV, as well as the socio-demographic characteristics associated with presumed active infection (PAI) of syphilis. Methods: Remnant serum samples from 1951 unique patients attending the JHHED in Baltimore, between January and February 2022 were collected. Demographic variables were extracted from the electronic medical record, and personal identifiers were removed prior to sample testing. Testing was performed with the CAPTIA Syphilis T-Palladium, Sure-Vue RPR, and Serodia TP-PA treponemal and non-treponemal assays. PAI was classified by positive treponemal serology and a RPR non-treponemal titer ≥ 1:8. "Not Presumed Active Infection" (NPAI) was classified by positive treponemal serology, and no high RPR titer. "True Negative" patients had a nonreactive initial serology. Patient HIV status was determined with the BioRad HIV ½+O ELISA and the BioRad Geenius HIV ½ assays. Fisher's exact and Wilcoxon rank-sum tests were performed to determine the sociodemographic factors associated with PAI. Results: Among 1951 samples tested, 1.2% (23/1951) had PAI, 4.1% (80/1951) had NPAI, and 4.5% (87/1951) were living with HIV. Of the 103 treponemal positive samples, 17.4% (18/103) were living with HIV. Prevalence of positive treponemal serology was higher in men (6.7%) than women (3.0%), and was differential by race (Hispanic 7.8%, non-Hispanic black 6.9%, non-Hispanic white 2.2%). Patients with PAI were significantly younger than those without (median: 35 [IQR: 29-48]; median: 47 [IQR: 32,62], p=0.019). Six of nine women with PAI were in childbearing age. Though PAI was higher among people living with HIV than those not (5.8% vs 1.0%, respectively, p=0.003), the majority of PAI 78.3% (18/23) were found in HIV-negative people. In comparison to those who reported having a primary care provider (PCP), patients who did not had 5.7-time higher odds of having PAI (OR, 5.7 [95% CI: 2.1-15.5]). Conclusion: One in 20 ED patients had positive treponemal serology for syphilis and several were also living with HIV. Updated screening protocols to include populations most recently infected are imperative to mitigate the resurgence of syphilis nationally. 1157 Jarisch-Herxheimer Reaction in Patients With Syphilis With or Without Prior Antibiotic Prophylaxis Samuel Lazzarin , Andrea Poloni, Giorgia Carrozzo, Giacomo Pozza, Chiara Fusetti, Francesco Caruso, Serena Reato, Maddalena Matone, Andrea Giacomelli, Maria Vittoria Cossu, Andrea Gori, Giuliano Rizzardini, Spinello Antinori, Davide Moschese Luigi Sacco Hospital, Milan, Italy Background: Jarisch-Herxheimer reaction (JHR) is a transient clinical phenomenon that may occur within 24 hours after penicillin treatment in individuals with syphilis infection. JHR incidence ranges from 9 to 31%, reaching 56% in early syphilis when proactively investigated. Aim of our study is to determine the incidence of proactively investigated JHR in individuals with or without prior antibiotic prophylaxis. Methods: We enrolled consecutive patients diagnosed with syphilis from April to September 2023 undergoing penicillin treatment. Twenty-four hours after receiving the first penicillin dose, a phone call was made by a healthcare professional to assess symptoms referable to JHR and the exposure to antibiotics (active against Treponema pallidum) before penicillin administration. JHR was defined, after excluding other possible causes, by the presence of at least one of: fever, chills, new or worsening rash, headache and myalgias. Individuals were categorized as exposed or not to antibiotics before penicillin if they received at least a 48-hours course of antibiotics in the 7 days before the first penicillin dose. Results: Ninety-five individuals were enrolled, with a median age of 41 years (IQR 33-50), including 93 (98%) males and 78 (82%) people living with HIV, of whom 61 (78%) with an HIV-RNA <50 cp/mL. Seventy patients (74%) were MSM, 14 (15%) transgender women and 11 (11%) heterosexuals. The

distribution of syphilis stages was: 5% primary, 12% secondary, 41% early latent, 41% late latent and 1% neurosyphilis. Previous penicillin treatment was reported in 50 patients (53%). Median RPR titer at diagnosis was 1:8 (IQR 1:2 1:16). We identified 71 patients (75%) with a study-defined antibiotic exposure: 67 (94%) amoxicillin and 4 (6%) doxycycline. The median cumulative dose of amoxicillin was 9.5 g (IQR 6-12 g) and doxycycline 1200 mg (IQR 950-1400 mg). Six patients [incidence 6.3% (95% CI 2.3-13.7%)] developed JHR, with fever being the most common clinical manifestation (4 in the antibiotic exposed and 2 in the antibiotic unexposed group). Among the subset of 55 patients with early syphilis (58%), 4 [incidence 7.3% (95% CI 1.1-10.2%)] had JHR (2 in the antibiotic exposed and 2 in the antibiotic unexposed group). Conclusion: The observed overall low incidence of JHR, even lower in the early syphilis group (which accounted for a higher proportion of cases when compared to previous studies), could be attributable to antibiotic prophylaxis, although a relatively low RPR titer might also play a role. 1158 Increasing Syphilis Prevalence Among MSM Across India Despite Improvements in the HIV Care Continuum Matthew M. Hamill 1 , Mihili P Gunaratne 2 , Allison M. McFall 2 , Hussain Syed Iqbal 3 , Canjeevaram K. Vasudevan 3 , Santhanam Anand 3 , Sunil Suhas Solomon 1 , Shruti H. Mehta 2 , Aylur K. Srikrishnan 3 , David D. Celentano 2 , Gregory M. Lucas 1 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: Syphilis rates have increased in men who sex with men (MSM) in high income countries. Infectious syphilis is associated with HIV acquisition in MSM. Nationally representative syphilis prevalence data from MSM in low and-middle income settings are lacking. We evaluated changes over 5 years in syphilis and high titer (HT) RPR prevalence across 10 Indian cities. Methods: As part of a cluster-randomized trial to evaluate integrated HIV prevention, testing, and treatment services, respondent-driven sampling (RDS) accrued samples of MSM (n=1000/city) in 10 Indian cities between 2012 2013 and again in 2016-2017. Participants underwent serological testing for syphilis (RPR). Additional testing was performed on RPR-positive stored sera to determine titers (high ≥ 1:8, low <1:8). The integrated services intervention did not have a statistically significant effect on syphilis prevalence. We evaluated associations with HT prevalence from 2016-17 using RDS-weighted multivariable multilevel multinomial regression models stratified by HIV status. Results: 9984 and 9991 MSM were sampled in 2012-2013 and 2016-2017, respectively. During this time, HIV prevalence increased from 7.4% to 15.3% with improvements across the HIV care continuum (33.4% vs 59.1% viral suppression). At the same time, syphilis prevalence increased in all cities; the median prevalence increase from 2013 to 2017 was 4.7% (range: 1.6 - 7.5%) with increase in HT (2.7% [1.2 - 4.8%]) accounting for more of the overall increase than low titer (1.6% [1.3 - 2.2%) (Fig 1). Of 9991 MSM with lab confirmed syphilis, only 3.2% reported a prior diagnosis. Among MSM living with HIV, significant correlates of HT (vs. negative) included being older, HIV viral load >1000 copies/ml, and reporting running out of money in the prior 12 months. Among MSM without HIV, correlates of HT included being older, having prior gonorrhea or chlamydia diagnoses and any STI symptom. Regardless of HIV status, kothi identity (prefer receptive anal sex) and recent condom use with male partners was associated with higher HT prevalence. Conclusion: Syphilis prevalence increased within all 10 cities in 5-years. Associations with HT suggests targeted interventions like STI-PEP are needed. Of concern, HT was associated with viremia in men living with HIV suggesting a greater likelihood of HIV transmission to sex partners not on HIV PrEP. Augmented adherence support and early syphilis treatment is required.

Poster Abstracts

CROI 2024 377