{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T22:01:25Z","timestamp":1774044085436,"version":"3.50.1"},"reference-count":30,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2019,7,17]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>There have been recent reports globally on substantial increase in syphilis diagnoses particularly among high-risk men. The aim of this study was to assess temporal trends of incident syphilis and associated risk factors among HIV-infected men in Singapore.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted retrospective cohort analysis using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. HIV-infected men with a negative syphilis result at baseline who had undergone at least one subsequent test in 2006\u20132017 were included. Factors associated with incident syphilis were investigated using Cox proportional hazards regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1069 HIV-infected men were tested for syphilis at least once following their negative baseline test during the 12-year period, and they contributed 4284 person-years of follow-up (PYFU). There were 266 cases of incident syphilis, giving an overall incidence of 6.21 per 100 PYFU (95% CI 5.49\u20137.00). The incidence of syphilis per 100 PYFU increased from 1.21 (95% CI 0.33 to 3.10) in 2010 to 26.04 (95% CI 19.97 to 33.40) in 2017. In the multivariable model, risk factors for syphilis seroconversion were: age 15\u201324 years at HIV diagnosis (adjusted HR (aHR) 1.64, 95%\u2009CI 1.05 to 2.56) versus \u226545 years, being Chinese (aHR 1.82, 95%\u2009CI 1.01 to 3.29) versus Indian and other minority ethnic groups, men having sex with men (MSM) (aHR 3.29, 95%\u2009CI 2.22 to 4.87) versus heterosexuals, and HIV diagnosis in later periods of 2009\u20132011 (aHR 1.96, 95%\u2009CI 1.41 to 2.74), 2012\u20132014 (aHR 3.96, 95%\u2009CI 2.68 to 5.83) and 2015\u20132017 (aHR 7.94, 95%\u2009CI 4.52 to 13.95) versus 2006\u20132008.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The annual incidence rate of syphilis in HIV-infected men was on the rise, and it was consistently higher among MSM than in heterosexual men. The findings supported regular screening for syphilis and enhanced behavioural interventions in Singapore.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2019-054163","type":"journal-article","created":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T21:25:17Z","timestamp":1564694717000},"page":"293-299","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Incidence of syphilis among HIV-infected men in Singapore, 2006\u20132017: temporal trends and associated risk factors"],"prefix":"10.1136","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-255X","authenticated-orcid":false,"given":"Li Wei","family":"Ang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen Seong","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oon Tek","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yee Sin","family":"Leo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"key":"2024092304052135000_96.4.293.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159309","article-title":"Syphilis trends among men who have sex with men in the United States and Western Europe: a systematic review of trend studies published between 2004 and 2015","volume":"11","author":"Abara","year":"2016","journal-title":"PLoS One"},{"key":"2024092304052135000_96.4.293.2","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.19.1.20965","article-title":"Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the treat Asia HIV observational database","volume":"19","author":"Ahn","year":"2016","journal-title":"J Int AIDS Soc"},{"key":"2024092304052135000_96.4.293.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000432449.30239.fe"},{"key":"2024092304052135000_96.4.293.4","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1080\/14787210.2018.1446828","article-title":"Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care","volume":"16","author":"Refugio","year":"2018","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2024092304052135000_96.4.293.5","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200410210-00012"},{"key":"2024092304052135000_96.4.293.6","doi-asserted-by":"publisher","DOI":"10.1086\/513427"},{"key":"2024092304052135000_96.4.293.7","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199811000-00013"},{"key":"2024092304052135000_96.4.293.8","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e318186debb"},{"key":"2024092304052135000_96.4.293.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-021544","article-title":"A retrospective study of the clinical features of new syphilis infections in an HIV-positive cohort in Alberta, Canada","volume":"8","author":"Lang","year":"2018","journal-title":"BMJ Open"},{"key":"2024092304052135000_96.4.293.10","unstructured":"Ministry of Health . Communicable diseases surveillance in Singapore 2017. Singapore: Communicable Diseases Division, Ministry of Health, 2018."},{"key":"2024092304052135000_96.4.293.11","unstructured":"Ministry of Health . Update on the HIV\/AIDS situation in Singapore 2017 (June 2018). Available: https:\/\/www.moh.gov.sg\/resources-statistics\/infectious-disease-statistics\/hiv-stats\/update-on-the-hiv-aids-situation-in-singapore-2017-(june-2018) [Accessed 15 February 2019]."},{"key":"2024092304052135000_96.4.293.12","doi-asserted-by":"crossref","first-page":"667","DOI":"10.47102\/annals-acadmedsg.V42N12p667","article-title":"Risk factors and time-trends of cytomegalovirus (CMV), syphilis, toxoplasmosis and viral hepatitis infection and seroprevalence in human immunodeficiency virus (HIV) infected patients","volume":"42","author":"Lim","year":"2013","journal-title":"Ann Acad Med Singapore"},{"key":"2024092304052135000_96.4.293.13","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/cid\/ciy348","article-title":"Risk Factors and Incidence of Syphilis in Human Immunodeficiency Virus (HIV)-Infected Persons: The HIV Outpatient Study, 1999-2015","volume":"67","author":"Novak","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2024092304052135000_96.4.293.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-015-1098-2","article-title":"High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada","volume":"15","author":"Burchell","year":"2015","journal-title":"BMC Infect Dis"},{"key":"2024092304052135000_96.4.293.15","first-page":"629","article-title":"Medical monitoring project. increased sexually transmitted disease testing among sexually active persons receiving medical care for human immunodeficiency virus infection in the United States, 2009-2013","volume":"64","author":"Mattson","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2024092304052135000_96.4.293.16","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31815b0148"},{"key":"2024092304052135000_96.4.293.17","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001718"},{"key":"2024092304052135000_96.4.293.18","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2006","volume":"55","author":"Workowski","year":"2006","journal-title":"MMWR Recomm Rep"},{"key":"2024092304052135000_96.4.293.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2007.00533.x"},{"key":"2024092304052135000_96.4.293.20","doi-asserted-by":"crossref","first-page":"602","DOI":"10.47102\/annals-acadmedsg.V41N12p602","article-title":"Human immunodeficiency virus (HIV) prevention education in Singapore: challenges for the future","volume":"41","author":"Wong","year":"2012","journal-title":"Ann Acad Med Singapore"},{"key":"2024092304052135000_96.4.293.21","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051368"},{"key":"2024092304052135000_96.4.293.22","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofv077","article-title":"Increases in Condomless sex in the Swiss HIV cohort study","volume":"2","author":"Kouyos","year":"2015","journal-title":"Open Forum Infect Dis"},{"key":"2024092304052135000_96.4.293.23","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051494"},{"key":"2024092304052135000_96.4.293.24","unstructured":"Action for AIDS . 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Available: https:\/\/afa.org.sg\/portfolio-item\/annualreport2011\/ [Accessed 15 Feb 2019]."},{"key":"2024092304052135000_96.4.293.29","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25186","article-title":"Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for treatment as prevention programme","volume":"21","author":"Phanuphak","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"2024092304052135000_96.4.293.30","article-title":"Screening for syphilis infection: recommendation statement [correction appears in Ann Fam Med 2004;2:362-5]","volume":"2","year":"2004","journal-title":"Ann Fam Med"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2019-054163","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T11:06:37Z","timestamp":1727089597000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2019-054163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,1]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,5,17]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/sextrans-2019-054163"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2019-054163","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,1]]}}}