Prevalence and risk factors associated with syphilis in women

Introduction Although the incidence of syphilis is generally ion; it remain s an important global public health problem, given its interaction with oth er sexually transmitted diseases (STDs). It has been shown that syphilis, d ue to the genital ulcers it produces, is a co-factor for acquiring other ST Ds, principally those of viral origin such as herpes simples type 2, hepati tis B and HIV. Many female commercial sex workers (FCSW) in Mexico have bee n found to have acquired good levels of knowledge about STD prevention. Nev ertheless, they constitute a heterogeneous group in terms of socio-economic level, health status and type of work site; these factors in turn appear t o determine their attitudes, knowledge and behavior related to acquiring an d transmitting STDs, including syphilis. This study, therefore, focused on the factors associated with Treponema pallidum infection in this group of w omen. Method Based on a sample frame of sites where female commercial sex work ta kes place within Mexico City, a sample of 807 FCSWs was selected; after pro viding informed consent, they completed a structured questionnaire. A blood sample for identifying serologic markers for STDs was collected and analyz ed according to a procedure manual for STD diagnosis. Treponema pallidum wa s diagnosed rising the RPR (Bigaux Diagnostica) screening test, and FTA - A BS (Pasteur Diagnostics) for confirmation. Results The prevalence of syphilis in this sample of FCSWs was 6.4% (52/807 ), and was higher among women who worked at street sites than among those w ho worked in massage parlors. The age of the women interviewed ranged from 17 to 58 years, with a mean of 29.2 years (SD 7.3 years); syphilis was more prevalent among women over 30 years of age. Age at first sexual intercours e ranged from 11 to 30 years, with a mean of 16 years (SD 3.1 years), which is similar to that of the general female population in Mexico. Predictive factors for T. pallidum infection, determined adjusted logistic regression, included: tupe of by work site (bar and street sites); socio-economic leve l (middle and low); age (over 30 years); duration of involvement in sex wor k (> 5 years) and number of clients per week (> 10). Conclusion In spite of some limitations regarding statistical precision, th is study shows that FCSWs are heterogeneous in terms of risk of acquiring S TDs, including syphilis; the principal differentiating factor was shown to be the type of work site. Given that it is not belonging to a risk group bu t rather participating in risky practices that leads to acquiring STDs, sit uations that facilitate riskier or safer practices (such as type of sex wor k site, for sex workers) should be taken into account when studying people' s risk level. STD prevention campaigns must also consider these factors, in addition to focusing on FCSWs and their clients and personal partners, so that all involved assume their responsibility for safer sex.