Abstract
BackgroundSyphilis 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.MethodsA 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).ResultsThe 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.ConclusionsA 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.
Highlights
Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy
The prevalence of syphilis was high (14.1%), which was 65% higher than a recent study that evaluated a similar population of Female sex workers (FSWs) from 12 Brazilian cities (8.5%) [16], and 3.5 higher than the prevalence found in the city of Botucatu (4%), southeast Brazil [17] using rapid qualitative test and enzyme-linked immunosorbent assay (ELISA). These results indicate the disparity on syphilis prevalence among FSWs in Brazil, as well as the need for syphilis control and preventive measures in marginalized populations, such as the observed in this Amazon region and other populations worldwide
Our results suggest that anal intercourse increases the risk of human immunodeficiency virus (HIV) acquisition and from T. pallidum, and the same infection mechanism can be applied to men who have sex with men and heterosexuals [14, 23, 24]
Summary
Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy. Brazil has an important emerging economy and the largest territorial area in South America, the population still live in a wide gap of socioeconomic inequality This combination of large territorial area (with several remote areas) and economic inequality creates a big challenge to governments to provide social inclusion, access to appropriate education and healthcare [1]. These characteristics are seen in other emerging countries such as Russia, India, China and South Africa (BRICS group), that represent over 3.1 billion people, or about 41% of the world population. Many factors are associated with higher risks of acquiring an STI, such as syphilis, and female sex workers (FSWs) are exposed to them, limited information is available on this group of people often discriminated by many societies
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