Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA.
Sex Transm Infect. 2022 Feb;98(1):4-10. doi: 10.1136/sextrans-2020-054674. Epub 2021 Jan 6.
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.
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.
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.
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.
2014 年至 2018 年间，美国女性梅毒发病率增长了一倍以上。我们试图确定参加妇女艾滋病研究机构间（WIHS）的女性中梅毒的相关因素，以为有针对性的干预措施提供信息。
这项回顾性的横断面分析包括了 1994 年至 2015 年间参加美国多地点妇女艾滋病研究机构间（WIHS）队列的艾滋病毒感染者或有感染艾滋病毒风险的女性。在基线时进行梅毒筛查。通过阳性快速血浆反应素试验和确证性梅毒螺旋体抗体来确定感染。比较了在早期（1994-2002 年）和近期（2011-2015 年）入组的女性中，按基线梅毒状态分层的社会人口统计学和行为特征。采用向后选择（移除概率>0.2）的多变量二项式模型来分析梅毒的相关因素。
本研究包括早期队列中的 3692 名女性和近期队列中的 1182 名女性。两组的梅毒发病率分别为 7.5%和 3.7%（p<0.01）。在早期队列的调整模型中，与梅毒相关的因素包括年龄、黑人种族、低收入、丙型肝炎病毒阳性、药物使用、艾滋病毒感染和 >100 名性伴侣（均 p<0.05）。在近期队列中，年龄（调整后的患病率比值比（aPOR）0.2，95%可信区间 0.1 至 0.6 为 30-39 岁；aPOR 0.5，95%可信区间 0.2 至 1.0 为 40-49 岁与≥50 岁）、丙型肝炎病毒阳性（aPOR 2.1，95%可信区间 1.0 至 4.1）和酗酒（aPOR 2.2，95%可信区间 1.1 至 4.4）与感染相关。
梅毒筛查对艾滋病毒感染者和有感染艾滋病毒风险的女性至关重要。有针对性的预防措施应重点关注丙型肝炎病毒感染者和酗酒者。
