Prevalence of syphilis in female sex workers in three countryside cities of the state of Pará, Brazilian Amazon

Abstract

Background: Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy. Female sex workers (FSWs) are exposed especially to syphilis infection, and besides all the efforts to control the spread of STIs, syphilis prevalence is still rising, mainly occurring in low-income countries. This study aimed to investigate the syphilis prevalence, demographic characteristics and sexual habits among FSWs in the Amazon region of Brazil. Methods: A cross-sectional study was carried out including 184 FSWs from 3 countryside cities of the state of Pará, Amazon region of Brazil. A venereal disease research laboratory test and an indirect immunoenzyme assay to test antibodies against Treponema pallidum were used for screening syphilis infection, while sexual habits and demographic data information were collected through a semi-structured questionnaire. Data was analyzed comparing groups with/without syphilis. Poisson regression models were used to estimate the reasons of prevalence (RP). Results: The overall prevalence of syphilis was 14.1% (95% CI = 9.8-17.8). FSWs had between 15 and 56 years of age, most were unmarried (65.7%), had attended less than 8 years of formal education (64.1%), had between 10 and 20 partners per week (64.1%), and reported no previous history of STIs (76.1%) and regular use of condom (52.7%). Low level of education attending up to the primary school (RP adjusted = 3.8; 95% CI = 1.4-9.2) and high frequency of anal sex during the past year (RP adjusted = 9.3; 95% CI = 3.5-28.7) were associated with a higher prevalence of syphilis. Conclusions: A high prevalence of syphilis among FSWs in the Brazilian Amazon region was identified, showing that syphilis is more likely to be transmitted in FSW working in low-income areas, which is attributed to the low level of education. Anal intercourse was found as a risk factor associated with syphilis. Health programs focused on risk populations appear as a rational way to control syphilis spread, which is a rising problem in Brazil and in other several countries.

Human Immunodeficiency Virus (HIV) and Treponema pallidum (Syphilis) Co-infection in Uyo, Nigeria

“…Higher HIV/syphilis co-infections were observed among individuals who were married (1.9%) than singles (1.8%). This finding is however in consonance with other studies that reported a higher prevalence of HIV/syphilis co-infection in married subjects [30,38]. Again, the disparity can be attributed to the larger of married subjects, 106 as compared to 67 unmarried (singles, divorced/widow/widower) screened in this study.…”

“…Though bulk of the HIV-infected individuals had tertiary education (49.5%). This may reflect the low overall awareness of these individuals about the risks involved and measures to prevent STIs [38,39]. This finding is however in consonance with other studies that reported a higher prevalence of HIV/syphilis co-infection in subjects with low educational levels [38,[40][41].…”

“…Schooling is one of the most important variables to measure the socio-economic status and its effects on the health status of a population [38]. We found that HIV-infected individuals who had no formal education (33.3%) and those who attended up to the primary school (4.2%) showed a significantly higher prevalence of syphilis positivity compared to other educational class (secondary 1.6% and Tertiary 0.0%).…”

“…The study has shown that low educational level is an independent risk factor for syphilis infection [38]. The study by Opone et al [42] also reported low educational status as a risk factor for contracting syphilis.…”

“…This might be as a result of the nature of their work. The low sero-prevalence of HIV/syphilis co-infection among the high skill individuals might be because they are well informed of the skill and spread these infections, as they are mostly educated [30,38,[40][41].…”