Syphilis and HIV Co-Infection in Wisconsin 2014
This report details reported syphilis cases with and without HIV co-infection in Wisconsin for the year 2014. It includes proportions by sex, age group, and race/ethnicity, highlighting a high proportion of HIV co-infections among men and insights into the demographics affected.
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REPORTED SYPHILIS CASES WITH AND WITHOUT HIV CO-INFECTION*, WISCONSIN 2014 Created by the State of Wisconsin STD Control Section DEPARTMENT OF HEALTH SERVICES Division of Public Health Bureau of Communicable Diseases STD Control Section P-01097(08/2015) *All syphilis cases are diagnosed for the current year of the report; however, the co-infected cases are those with a new or pre-existing HIV diagnosis.
Reported syphilis cases with and without HIV co-infection, Wisconsin 2014 Proportion of syphilis vs. syphilis/HIV co-infected cases Syphilis Cases with and without HIV Co-Infection Syphilis-Only 178 Syphilis- HIV 36% Syphilis-HIV 101 Syphilis- Only 64% TOTAL Cases 279 Syphilis in Wisconsin has a high proportion of co-infection with HIV. The first year in which the number of co-infections of syphilis and HIV reached more than one hundred (101 cases was 2014, and only 2014 syphilis cases are presented in this report. The HIV infection cases in this report that are co-infected with syphilis may or may not have occurred in 2014. Some people who were co-infected may have found out about their HIV diagnosis at the same time as their syphilis diagnosis, while others had a pre- existing HIV diagnosis for years and became recently infected with syphilis.
Reported syphilis cases by sex in Wisconsin, 2014 300 250 200 150 CASES 100 50 0 Male 100 144 244 Female 0 33 33 Transgender 1 1 2 Syph/HIV Syphilis-Only Syphilis Most syphilis cases in Wisconsin occur among men. Out of the 279 total syphilis case, 244 of them occurred among men, 33 occurred among women, and 2 cases were transgender. Of the syphilis-only cases, 144 occurred among men, 33 occurred among women and 1 case was transgender. However, the cases of syphilis/HIV co-infection show an even greater proportion of men being infected (100 men and 1 transgendered). This unusually high proportion of men being infected is an indication of a high number of men having sex with men (MSM).
Proportion of syphilis cases that are HIV co-infected to syphilis-only cases within each age group 60 80.0% 70.0% 50 60.0% 40 50.0% 30 40.0% 30.0% 20 20.0% 10 10.0% 0 0.0% Age Group 10-14 0 1 0.0% 15-19 1 11 8.3% 20-24 22 48 31.4% 25-29 24 35 40.7% 30-34 11 29 27.5% 35-39 9 19 32.1% 40-44 10 7 58.8% 45-49 14 7 66.7% 50+ 10 21 32.3% Syph/HIV Syphilis-Only Proportion There is a variety of proportions in syphilis cases to the number of syphilis/HIV co-infect cases by age groups. The age groups on the bottom row of the chart are Centers for Disease Control and Prevention (CDC) recommended age group distributions. More than half of the syphilis cases between the ages of 4o and 49 were co-infected with HIV (58.8% and 66.7%).
Reported syphilis-only and syphilis/HIV co-infections by race/ethnicity in Wisconsin Proportion of syphilis-only cases in Wisconsin, 2014 Proportion of syphilis/HIV co-infected cases in Wisconsin, 2014 Proportion of race/ethnicity in Wisconsin, 2013 0% 1% 0% 3% 1% 1% 2% 3% 0% 0% White 7% White 7% Afr. Amer. 6% White Afr. Amer. 16% Hispanic 36% 32% Hispanic Hispanic Amer. Indian Afr. Amer. Amer. Indian Asian/Pac. Is. Amer. Indian Asian/Pac. Is. 83% 42% Other (Mult.) 60% Asian/Pac. Is. Other (Mult.) Unknown Unknown A majority of the syphilis-only and syphilis/HIV co-infected cases were among African Americans. African Americans made up 60% of the syphilis/HIV co-infected cases and 42% of the syphilis-only cases in Wisconsin, while only 32% and 36% were White, respectively. However, African Americans only make up 7% of the population in Wisconsin compared to 83% White. This racial disparity primarily occurs in the southeastern part of Wisconsin, specifically in Milwaukee. The 2013 census data was the most recent data available.
Reported cases of syphilis-only, syphilis/HIV co-infections and total syphilis cases for the five regions of Wisconsin, 2014 250 200 150 CASES 100 50 0 Northeastern 6 13 19 Northern 0 1 1 Southeastern 82 109 191 Southern 12 37 49 Western 1 18 19 Syphilis/HIV Syphilis Only Total Syphilis The largest number of cases in Wisconsin among the five regions occurred in the southeastern region. The southeastern region had 191 total cases of syphilis, which was 68.5% of all the syphilis cases in Wisconsin. This region also had 82 cases of syphilis/HIV co-infections, which was 81.2% of all the syphilis/HIV co-infections in Wisconsin. However, the southeastern region currently makes up only 36.9% of the population in Wisconsin.
Syphilis stages among syphilis/HIV co-infections, Wisconsin 2014 Syphilis stages among syphilis cases, Wisconsin 2014 4% Primary syphilis Primary syphilis 8% 21% Secondary syphilis 35% Secondary syphilis Early latent syphilis Late syphilis 36% 22% Early latent syphilis Late syphilis 40% 34% Early syphilis, or people infected with syphilis less than one year, occur among the primary stage, the secondary stage and the early latent stage. Late syphilis occurs after one year of being infected. For people who are HIV positive, it is better to be diagnosed with early syphilis rather than late syphilis. People who are HIV positive and have late syphilis are usually required to have a central spinal fluid test to rule out neurosyphilis. Thirty-five percent (35 out of 101) of the syphilis/HIV co-infections were diagnosed late latent. Unfortunately, people who are co-infected with syphilis/HIV who are not in care or find out about their co-infections at the same time are more likely to be in the late stage of syphilis. The Wisconsin STD Section, per the CDC, recommends that all HIV positive patients receive an annual syphilis test to prevent late latent syphilis.
Syphilis and syphilis/HIV co-infections among men who have sex with men in Wisconsin, 2014 Reported Syphilis Cases in Wisconsin, 2014 (n=279) Reported Syphilis/HIV co- infected cases in Wisconsin, 2014 (n=101) Men who have sex w/men (MSM) Non-MSM Men who have sex w/men (MSM) Non-MSM 34% 66% 100% One of the largest risk factors for syphilis and syphilis/HIV co-infections is men who have sex with men (MSM). This includes not only people that identify as gay, but also others that identify as bi-sexual, or straight, as well as some transgender. This is a self-reported risk factor, which means that these individuals were interviewed and reported themselves as MSM either to a provider or to a disease intervention specialist (DIS). In 2014, among all the syphilis cases, 183 of the 279 cases reported that they were MSM, which makes up 66% of the syphilis cases in Wisconsin. However, all 101 syphilis/HIV co-infected cases in Wisconsin for 2014 reported being MSM.
Reported syphilis/HIV co-infection, syphilis-only and total syphilis cases in Wisconsin, 2010 - 2014 300 250 200 CASES 150 100 50 0 2010 38 64 102 2011 46 148 194 2012 67 172 239 2013 71 176 247 2014 101 178 279 Syphilis/HIV Syphilis-Only Total Syphilis Over the years there has been a steady increase in the number of syphilis-only, syphilis/HIV co-infected, and total syphilis cases. In 2010, the total number of syphilis cases was 102 and the number of syphilis/HIV cases was 38. In four years, the number of syphilis cases has risen to 279 for a 274% increase and the number of syphilis/HIV co- infected cases has risen to 101 for a 266% increase. There are now almost as many syphilis/HIV cases in 2014 as there were total syphilis cases for 2010.
Questions? Please Contact: Brandon Kufalk, Public Health Educator State of Wisconsin STD Control Section Phone 608-261-6390 or email Brandon.Kufalk@wisconsin.gov Note: All population data was queried using Wisconsin Interactive Statistics on Health (WISH) which can be found at: https://www.dhs.wisconsin.gov/wish/index.htm
