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Multicenter Study
. 2022 Feb;98(1):4-10.
doi: 10.1136/sextrans-2020-054674. Epub 2021 Jan 6.

Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015)

Kristal J Aaron  1 , Ilene Brill  2 , Zenoria Causey-Pruitt  3 , Kerry Murphy  4 , Michael Augenbraun  5 , Seble Kassaye  6 , Joel E Milam  7 , Dominika Seidman  8 , Audrey L French  9 , Stephen J Gange  10 , Adaora A Adimora  11 , Anandi N Sheth  12 , Margaret A Fischl  13 , Barbara Van Der Pol  3 , Jeanne Marrazzo  3 , Mirjam-Colette Kempf  3   2   14 , Jodie Dionne-Odom  3
Affiliations
Multicenter Study

Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015)

Kristal J Aaron et al. Sex Transm Infect. 2022 Feb.

Abstract

Objective: Syphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women's Interagency HIV Study (WIHS) to inform targeted interventions.

Methods: The retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994-2002) and recent (2011-2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis.

Results: The study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p<0.01). In adjusted models for the early cohort, factors associated with syphilis included age, black race, low income, hepatitis C seropositivity, drug use, HIV infection and >100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30-39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40-49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection.

Conclusions: Syphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use.

Keywords: HIV women; epidemiology; risk factors; seroprevalence; syphilis.

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Conflict of interest statement

Competing interests: Dr. Van Der Pol receives research support, consulting fees and/or honorarium from the following: Abbott Molecular, BD Diagnostics, Binx Health, BioFire Diagnostics, Hologic, Rheonix, Roche and SpeeDx; Dr. Marrazzo receives research support and/or consulting fees from BD Diagnostics, Gilead, and BioFire Diagnostics. Dr. Adimora has received research funding from Gilead and consulting fees from Merck, Viiv, and Gilead. Dr. Sheth has received research grants from Gilead sciences unrelated to the published work. As a group, we have no other conflicts of interest to report.

Figures

Figure 1
Figure 1
Flow chart for study participants according to baseline syphilis testing and cohort. RPR, rapid plasma reagin; WIHS, Women’s Interagency HIV Study.
See this image and copyright information in PMC

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