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Geographic Correlates of Primary and Secondary Syphilis among MSM in the United States
  • Published Date:
    February 05 2019
  • Source:
    Ann Epidemiol. 32:14-19.e1
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Public Access Version Available on: April 01, 2020 information icon
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  • Description:

    Primary and secondary (P&S) syphilis in men who have sex with men (MSM) has been increasing; however, there is a lack of research on geographic factors associated with MSM P&S syphilis.


    We used multiple data sources to examine associations between social and environmental factors and MSM P&S syphilis rates at the state- and county-level in 2014 and 2015, separately. General linear models were used for state-level analyses and hurdle models were used for county-level models. Bivariate analyses (P<0.25) were used to select variables for adjusted models.


    In 2014 and 2015 state models, a higher percentage of impoverished persons (2014 β=1.24; 95%CI=0.28–2.20; 2015 β=1.19; 95%CI=0.42–1.97) was significantly associated with higher MSM P&S syphilis rates. In the 2015 county model, policies related to sexual orientation (marriage, housing, hate crimes) were significant correlates of MSM P&S syphilis rates (P<0.05).


    Our state-level findings that poverty is associated with MSM P&S syphilis are consistent with research at the individual-level across different subpopulations and various STDs. Our findings also suggest that more research is needed to further evaluate potential associations between policies and STDs. Geographic-level interventions to address these determinants may help curtail the rising syphilis rates and their sequelae in MSM.

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