Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Research article

Re-emerging syphilis: a detrended correspondence analysis of the behaviour of HIV positive and negative gay men

C Philip Wheater1, Penny A Cook2*, Pete Clark2, Qutub Syed3 and Mark A Bellis2

Author Affiliations

1 Department of Environmental and Geographical Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK

2 Public Health Sector, Liverpool John Moores University, Liverpool L3 2AB, UK

3 Communicable Disease Surveillance Centre North West, Vernon Pritchard Court, 57a Upper Northgate Street, Chester CH1 4EF, UK

For all author emails, please log on.

BMC Public Health 2003, 3:34  doi:10.1186/1471-2458-3-34

Published: 29 October 2003



Recent syphilis outbreaks in the UK have raised serious concerns about the sexual health of the population. Moreover, syphilis appears more likely to facilitate HIV transmission than any other sexually transmitted infection (STI).


The sexual and other risk behaviour of a sample of HIV positive and negative gay men with and without syphilis was subjected to a detrended correspondence analysis (DCA).


A DCA plot was used to illustrate similarity of individuals in terms of their behaviours, regardless of their infection status. The majority of those with syphilis (78%; 18/23) fell into a high-risk group with more partners, and use of anonymous sex venues and drugs during sex. However, 16% of uninfected controls (8/49) and 62% of HIV positive individuals without syphilis (8/13) also fell into this high-risk group.


Using a statistical technique that is novel for this type of investigation, we demonstrate behavioural overlaps between syphilis-infected individuals in an ongoing UK outbreak and uninfected HIV positive and negative controls. Given the high-risk behaviour of a significant proportion of uninfected individuals, ongoing transmission of syphilis and HIV in this population seems likely.