Increasing Syphilis Prevalence Among MSM Across India Despite Improvements in the HIV Care Continuum

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Syphilis rates are rising globally, particularly among men who have sex with men (MSM).
• Data on syphilis trends in low- and middle-income countries, including India, are limited.
• Understanding these trends is crucial for effective public health interventions.

Purpose of the Study:

• To characterize changes in syphilis prevalence among MSM in 10 Indian cities from 2012 to 2024.
• To identify correlates of syphilis infection in this population.
• To inform strategies for improving syphilis detection and control.

Main Methods:

• Respondent-driven sampling (RDS) surveys were conducted in 2012-2013, 2016-2017, and 2023-2024.
• Participants were men aged 18+ reporting sex with men in the past 12 months.
• Syphilis was diagnosed using rapid plasma regain (RPR) and Treponema pallidum hemagglutination (TPHA) tests; HIV status was also assessed.

Main Results:

• Syphilis prevalence increased significantly over the study period, from 2.9% to 15.6%.
• Nearly 50% of participants reported recent condomless anal sex.
• Factors associated with syphilis included living with HIV, multiple recent male partners, prior syphilis diagnosis, and anogenital ulceration.

Conclusions:

• A dramatic rise in syphilis prevalence among urban Indian MSM was observed over ten years.
• Concurrently, HIV viral load suppression improved, suggesting potential disconnects in sexual health services.
• Barriers to syphilis testing persist, indicating a need for enhanced screening strategies, possibly using dual HIV/syphilis rapid tests.