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Original research
Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women’s Interagency HIV Study (1994–2015)
  1. Kristal J Aaron1,
  2. Ilene Brill2,
  3. Zenoria Causey-Pruitt1,
  4. Kerry Murphy3,
  5. Michael Augenbraun4,
  6. Seble Kassaye5,
  7. Joel E Milam6,
  8. Dominika Seidman7,
  9. Audrey L French8,
  10. Stephen J Gange9,
  11. Adaora A Adimora10,
  12. Anandi N Sheth11,
  13. Margaret A Fischl12,
  14. Barbara Van Der Pol1,
  15. Jeanne Marrazzo1,
  16. Mirjam-Colette Kempf1,2,13,
  17. Jodie Dionne-Odom1
  1. 1Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA
  3. 3Department of Medicine/Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
  4. 4Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
  5. 5Department of Medicine/Division of Infectious Diseases, Georgetown University, Washington, DC, USA
  6. 6Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
  7. 7Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, and Bixby Center for Global Reproductive Health, San Francisco, California, USA
  8. 8Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, Illinois, USA
  9. 9Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
  10. 10School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  11. 11Department of Medicine/Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
  12. 12Department of Medicine/Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
  13. 13Department of Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Kristal J Aaron, Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; kjaaron{at}


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.

  • syphilis
  • HIV women
  • risk factors
  • epidemiology
  • seroprevalence

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  • Handling editor Claudia S Estcourt

  • Presented at This work was presented, in part, at the STI & HIV 2019 World Congress meeting in Vancouver, Canada on 16 July 2019.

  • Contributors The authors’ responsibilities were as follows: KJA: conceived of and designed the study, analysed and interpreted the data, wrote and critically reviewed and edited the manuscript; JD-O: conceived of and designed the study, interpreted the data, wrote and critically reviewed the manuscript; IB: created data set, assisted with data interpretation, critically reviewed the manuscript and assisted with the writing of the manuscript; ZC-P and M-CK: interpreted the data, critically reviewed the manuscript and assisted with the writing of the manuscript; BVDP and JM: assisted with study design and critically reviewed the manuscript; KM, MA, SK, JEM, DS, ALF, SJG, AAA, ANS and MAF: critically reviewed the manuscript.

  • Funding MWCCS (principal investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01- HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01- HL146240; Connie Wofsy Women’s HIV Study, Northern California CRS (Bradley Aouizerat, Phyllis Tien and Jennifer Price), U01-HL146242; Los Angeles CRS (Roger Detels), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01- HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung and Blood Institute (NHLBI), with additional cofunding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development, National Institute On Aging, National Institute Of Dental & Craniofacial Research, National Institute Of Allergy And Infectious Diseases, National Institute Of Neurological Disorders And Stroke, National Institute Of Mental Health, National Institute On Drug Abuse, National Institute Of Nursing Research, National Cancer Institute, National Institute on Alcohol Abuse and Alcoholism, National Institute on Deafness and Other Communication Disorders, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Minority Health and Health Disparities and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research. MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR) and P30-AI-027767 (UAB CFAR). Project support was also provided by 1K23HD090993 (Jodie Dionne-Odom).

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval This study received institutional review board approval from the University of Alabama at Birmingham (IRB-300001349).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no additional unpublished data available. Readers should contact KJA with any inquiries.

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