51 Syphilis Incidence Following an STI Diagnosis Among Cisgender Women in Baltimore, MD, from 2009-2021

Abstract

OBJECTIVES/GOALS: The primary objective of this study is to evaluate the risk of an early syphilis diagnosis following a chlamydia, gonorrhea, or HIV diagnosis, and to determine differences by race, repeat infection, diagnosing provider and STI/HIV risk behavior among cisgender women in Baltimore, MD. METHODS/STUDY POPULATION: Public health surveillance data from 2009-2021 was used to examine the overall incidence of syphilis infections among cisgender women ages 13-50 diagnosed with a reportable STI (chlamydia, gonorrhea, or HIV) and the percentage of total infections that were early infections (primary, secondary, or early latent syphilis) in Baltimore City. Data were collected on age, race, diagnosing location (i.e., STI clinic, private provider, etc.), preceding STI diagnoses, and sexual risk behaviors. STI-specific cumulative incidence and incidence rate ratios were used to compare syphilis diagnoses among Black vs. white women, women with repeat STI diagnoses vs. one STI diagnosis, women diagnosed at a public vs. private clinic, and commercial sex workers and substance users vs. those not reporting these risk behaviors. RESULTS/ANTICIPATED RESULTS: Based on recent surveillance data, we expect approximately 79,000 chlamydia, gonorrhea, and HIV diagnoses among cisgender women between 2009-2021. We hypothesize that 3% of chlamydia, gonorrhea, and HIV diagnoses among cisgender women will be followed by a syphilis diagnosis within the study period. Extrapolating from previous studies of early syphilis in men who have sex with men in Baltimore, we expect the rate of syphilis diagnosis following STI diagnosis will be higher in Black vs. white women, women with a prior gonorrhea or HIV diagnosis vs. chlamydia diagnosis, women with repeat STI diagnoses vs. one STI diagnosis, women diagnosed at public STI clinics vs. those diagnosed by private providers, and women reporting commercial sex work and/or substance use vs. those not reporting these risk behaviors. DISCUSSION/SIGNIFICANCE: Local healthcare providers should offer syphilis screening to any woman diagnosed with a chlamydia, gonorrhea, or HIV infection. The higher rates of early syphilis diagnosis among women with repeat STI diagnoses or a prior gonorrhea or HIV diagnosis suggests regular screening is critical in these populations.