Does Syphilis Facilitate Sexual Acquisition of HIV?

To the Editor.— Minorities, especially blacks, are strikingly overrepresented in cases of the acquired immunodeficiency syndrome (AIDS) in the United States.¹In a recent Letter to the Editor, Mr Samuel and Dr Winkelstein²reported 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.³As shown in the Table, several studies³⁻⁵have 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