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July 24, 1987

Does Syphilis Facilitate Sexual Acquisition of HIV?

Author Affiliations

El Paso County Health Department Colorado Springs, Colo

El Paso County Health Department Colorado Springs, Colo

JAMA. 1987;258(4):473. doi:10.1001/jama.1987.03400040071016

To the Editor.—  Minorities, especially blacks, are strikingly overrepresented in cases of the acquired immunodeficiency syndrome (AIDS) in the United States.1 In a recent Letter to the Editor, Mr Samuel and Dr Winkelstein2 reported that established risk factors (needle sharing, promiscuity, and receptive anal/genital contact) failed to explain significant differences in human immunodeficiency virus (HIV) seroprevalence between black and white patients in their cohort of homosexual/bisexual men. The authors recommended intensifying the search for factors to explain the increased susceptibility of blacks to HIV infection.Syphilis may qualify as an important factor. There is substantial indirect evidence to support the hypothesis that syphilis lesions facilitate transmission of HIV, an idea previously proposed.3 As shown in the Table, several studies3-5 have noted statistically significant differences in the proportion of HIV-infected patients bearing markers of treponemal infection, compared with their uninfected counterparts.The strength and consistency of this