Childhood sexual abuse, alcohol problem scores, and race are associated with syphilis incidence in a prospective cohort of young sexual and gender minority adults assigned male at birth

Background: Syphilis rates in the United States have dramatically increased in recent years and are high among young men who have sex with men and transgender women. Yet, few studies have examined a wide-range of risk factors for syphilis incidence prospectively in young sexual and gender minority (YSGM) populations in the U.S. One framework which may have utility in understanding syphilis risk factors is syndemics, which focuses on co-morbid factors and their mutual influence. The current analysis examines demographic, comorbid health and socio-structural risk factors for syphilis in YSGM assigned male at birth including applying a syndemic framework.

Methods: Participants were part of a Chicago-based prospective cohort called RADAR (n = 738). All participants were YSGM. Syphilis cases were identified by serologic screening with a reverse-sequence testing algorithm. Risk factors included demographics, indicators of sexual risk, mental health, substance use, and violence victimization. Syndemic component score was calculated by adding the number of syndemic conditions. Analyses included multivariable logistic regressions.

Results: In multivariable predictive modeling, Black identity, childhood sexual abuse and alcohol problems predicted incident syphilis. Though roughly 37% of participants were indicated as having at least 2 syndemic conditions, the syndemic component did not predict syphilis incidence.

Conclusions: Syphilis incidence is high in this sample of YSGM. Additional research is needed to better understand mechanisms driving associations between childhood sexual abuse and syphilis incidence as well as to develop interventions improve testing and treatment among Black YSGM, YSGM who experience childhood sexual abuse, and YSGM who experience alcohol problems.