HUMAN-IMMUNODEFICIENCY-VIRUS SEROPOSITIVITY IN ADOLESCENTS WITH SYPHILIS

Objective. The purpose of this study was to assess the relationship be tween syphilis and human immunodeficiency virus (HIV) infection among inner-city, minority group adolescents. Methods. From August 1989 thro ugh June 1990, serum from all positive serologic tests for syphilis, o btained from patients attending a comprehensive adolescent health cent er in an acquired immunodeficiency syndrome epicenter and its two scho ol-based clinics, were frozen without patient identifiers and were sub sequently screened for HIV by enzyme-linked immunosorbent assay with c onfirmatory Western blot for positives. In addition, a retrospective c hart review was performed for all patients with a positive serologic t est for syphilis during the study period. Results. Of the 59 specimens with a positive syphilis serologic test, 9 (15.3%) were HIV seroposit ive. Of the patients with syphilis, 57.4% were black and 42.6% were Hi spanic; 16.4% were male (mean age 18.1) and 83.6% were female (mean ag e 17.8). Only 1 subject (female) was an injection drug user; 4 of the male subjects self-identified as having had sex with other males. Of t he subjects, 27.8% had primary, 19.7% had secondary, and 52.5% had lat ent syphilis at the time of diagnosis. A prior or concurrent sexually transmitted disease was present in 90% of the males and 80% of the fem ales; gonorrhea was the most prevalent sexually transmitted disease in the males (89%) and chlamydia was most prevalent in the females (35%) . A history of chancroid and/or herpes was present in 16.4% of the sub jects. Conclusions. It is concluded that the diagnosis of syphilis in an adolescent is a risk factor for HIV infection. All sexually active adolescents should be routinely screened for syphilis, regardless of s exual practices. Those with syphilis should be specifically counseled about their increased risk for HIV infection and the importance of con sistent condom use, and they should be referred for formal HIV pretest counseling.