Monitoring syphilis serology in blood donors: Is there utility as a surrogate marker of early transfusion transmissible infection behavioral risk?

Abstract

Background: In Canada the time deferral for gay, bisexual, and other men who have sex with men (gbMSM) was progressively shortened (lifetime, 5 years, 1 year, 3 months). Here we describe trends in syphilis rates (a potential sexual risk marker) and risk behaviors from blood donors in the past 12 years. Study Design and Methods: Syphilis positivity in 10,288,322 whole blood donations (January 1, 2010–September 10, 2022) and gbMSM deferral time periods, donation status, age, and sex were analyzed with logistic regression. Overall, 26.9% syphilis positive and 42.2% controls (matched 1:4) participated in risk factor interviews analyzed by logistic regression. Results: Syphilis rates were higher in first-time donors (OR 27.0, 95% CI 22.1–33.0), in males (OR 2.3, 1.9–2.8) and with the 3-month deferral (OR 3.4, 2.6–4.3) during which the increase was greater for first-time males (p.05). Among first-time donors, histories of intravenous drug use (OR 11.7, 2.0–69.5), male-to-male sex 7.8 (2.0–30.2) and birth in a high prevalence country (OR 7.6, 4.4–13.0) predicted syphilis positivity; among repeat donors, history of male-to-male sex (OR 33.5, CI 3.5–317.0). All but 1 gbMSM syphilis-positive donors were noncompliant with the gbMSM deferral. About a quarter of first-time interviewed case donors had history of syphilis; 44% were born in a high-prevalence country. Conclusion: Rising syphilis rates in donors correlates with the general population epidemic. Recent infection rates rose similarly in males and females. GbMSM history may contribute to donor syphilis rates but shortening time deferrals appears unrelated.