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The role of main partnerships in shaping HIV transmission dynamics among men who have sex with men (MSM) has gained recognition in recent studies, but there is little evidence that existing definitions of partnership type are accurate or have consistent meaning for all men. Using data collected from 2011 to 2013 on 693 partnerships described by 193 Black and White MSM in Atlanta, GA, partnership attributes and risk behaviors were examined and compared by race, stratified in two ways: (1) by commonly used definitions of partnerships as "main" or "casual" and (2) by a new data-driven partnership typology identified through latent class analysis (LCA). Racial differences were analyzed using chi-square, Fisher's exact, and Wilcoxon-Mann-Whitney tests. Black participants were less likely to report condomless anal sex (CAS) within partnerships they labeled as main, yet they were also less likely to describe these partnerships as "primary" on a parallel question. In contrast, within strata defined by the LCA-derived typology, most partnership attributes were comparable and the likelihood of CAS was equivalent by race. These findings suggest that classification of partnerships as main or casual does not accurately capture the partnership patterns of MSM, resulting in differential misclassification by race. Future studies and interventions should refine and utilize more evidence-based typologies.

Background: Most reported primary and secondary (P&S) syphilis cases in the United States were among men who have sex with men (MSM) during 2010-2018. Because MSM are a minority population, this indicates a disproportionate burden of P&S syphilis among MSM. However, the magnitude of the disparity has not been quantified using populationstandardized metrics such as rates. We compared rates of P&S syphilis between MSM, men who have sex with women only (MSW), and women who have sex with men (WSM) using new population estimates for 2018. Methods: We used national case-based surveillance data on P&S syphilis reported through the National Notifiable Diseases Surveillance System for 2018, the most recent year that MSM population denominators were available. We limited our analysis to states with at least 70% complete reporting of sex of sex partners to reduce bias from missing data. Data were restricted to persons aged 18 years and older and were summarized by state, sex, and sex of sex partner(s). We calculated rates by dividing case counts by population estimates from previously published research, then calculated rate ratios (RRs) comparing MSM to MSW, MSM to WSM, and MSW to WSM for all eligible states, separately and combined. Results: RRs were calculated for 37 states with sufficiently complete data. Among those states, RRs comparing MSM to MSW ranged from 40.5 (Oklahoma) to 365.1 (New Hampshire), with an overall RR of 85.9. RRs comparing MSM to WSM were greater but followed a similar geographic pattern, ranging from 50.4 (Oklahoma) to 684.5 (New Hampshire), with an overall RR of 120.0. Finally, RRs comparing MSW and WSM indicated greater similarity between them than between either group and MSM, ranging from 0.6 (Illinois) to 2.1 (Indiana), with an overall RR of 1.4. Conclusion: This study quantified the disproportionate burden of P&S syphilis among MSM in the United States, with rates among MSM being at least 40 times those of either MSW or WSM across all states analyzed. These findings highlight the importance of targeted health interventions for syphilis as well as the necessity of population estimates for examining health disparities among sexual minority populations. [ABSTRACT FROM AUTHOR]

Background: Gay, bisexual, and other men who have sex with men (MSM) are disproportionately represented among both persons with HIV and reported primary and secondary (P&S) syphilis cases annually. Ulcerative syphilis lesions may double HIV transmission risk making a syndemic approach to examining trends in disease critical to inform efforts to end the HIV epidemic in the United States. Because additional differences in HIV and syphilis prevalence have been observed by race/ethnicity, we characterized trends in HIV status among P&S syphilis cases in MSM by race/ethnicity to better understand syphilis and HIV co-infection in the United States. Methods: We reviewed 2011--2020 P&S syphilis cases among MSM reported to CDC via the National Notifiable Diseases Surveillance System from 50 states; Washington, D.C.; and Puerto Rico to determine reported HIV status (positive, negative, unknown/missing). Among the three race/ethnicity groups that represent >85% of annual P&S syphilis cases (non-Hispanic White, non-Hispanic Black, and Hispanic/Latino persons), we examined annual trends in number and proportion of cases with and without reported HIV co-infection. Results: During 2011--2020, P&S syphilis cases increased by 80% among non-Hispanic Black MSM (3,034 in 2011 to 5,461 in 2020), 81% among non- Hispanic White MSM (3,330 to 6,043) and 147% among Hispanic/Latino MSM (1,796 to 4,441) (Figure 1). Among each race/ethnicity group, P&S syphilis case counts increased among reported HIV negative and HIV positive cases, although racial/ethnic differences in the magnitude of increase were observed. P&S syphilis cases with reported HIV nearly doubled for non-Hispanic Black and Hispanic/Latino MSM while increasing by 29% for non-Hispanic White MSM. When looking at trends in proportion of P&S syphilis cases reported with HIV co-infection, the proportion increased among non- Hispanic Black MSM (52% to 56%) but decreased among non-Hispanic White (46% to 32%) and Hispanic/Latino MSM (44% to 35%). Conclusion: Increasing numbers of P&S syphilis cases among MSM across racial/ethnic groups and HIV status highlights the importance of prioritizing MSM for engagement in syphilis and HIV treatment and prevention services. Further investigation is needed to understand determinants of racial/ethnic disparities in trends of proportion of P&S syphilis cases reported with HIV co-infection. [ABSTRACT FROM AUTHOR]

Background: To describe changes in reported sexually transmitted diseases (STDs) during the U.S. coronavirus disease 2019 pandemic, we compared the weekly number of reported nationally notifiable STDs in 2020 to 2019.Methods: We reviewed cases of chlamydia, gonorrhea, and primary & secondary (P&S) syphilis reported to the U.S. National Notifiable Disease Surveillance System in 2020. For each STD, we compare the number of 2020 cases reported for a given Morbidity and Mortality Weekly Report (MMWR) week to the number of 2019 cases reported in the same week, expressing 2020 cases as a percentage of 2019 cases. We also calculated the percent difference between 2020 and 2019 cumulative case totals as of MMWR week 50 (week of December 9).Results: During MMWR weeks 1-11 (week of December 29, 2019-March 11, 2020), the weekly number of cases of STDs reported in 2020 as a percentage of the cases in the same week in 2019 were similar. However, 2020 numbers were much lower than 2019 numbers in week 15 (week of April 8; chlamydia, 49.8%; gonorrhea, 71.2%; and P&S syphilis, 63.7%). As of week 50, the 2020 cumulative totals compared to 2019 were 14.0% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for P&S syphilis.Conclusion: During March-April 2020, national case reporting for STDs dramatically decreased compared to 2019. However, resurgence in reported gonorrhea and syphilis cases later in the year suggest STD reporting may have increased during 2020, underscoring the importance of continued STD prevention and care activities. [ABSTRACT FROM AUTHOR]