Background
Syphilis is associated with increased risk of HIV acquisition and poor pregnancy outcomes, including congenital syphilis. Syphilis remains a threat to public health despite accessible screening and treatment. This study examines the prevalence of syphilis among reproductive-age (18-45 years) women with or without HIV enrolled between 2021 and 2023 in the Study of Treatment and Reproductive Outcomes (STAR), an observational cohort across six Southern U.S cities.
Methods
Demographic, medical (prior diagnosis of syphilis, presence of a rash or genital ulcerations) and obstetric data are collected as well as syphilis screening using a nontreponemal test (RPR) with treponemal test for confirmation, or the reverse sequence algorithm. Women with two different reactive tests (two treponemal or one treponemal plus one non treponemal) were categorized based on self-reported history of syphilis and RPR titer as possible: (1) recent infection (no history of syphilis, and RPR ≥1:8), (2) recent reinfection/reactivation (history of syphilis with RPR ≥1:8), (3) late latent syphilis (no history of syphilis and RPR <1:8), or (4) serofast status (history of syphilis with RPR <1:8). Cross-sectional data was examined and associations between pregnancy, HIV status, and syphilis were evaluated.
Results
A total of 785 women underwent syphilis testing. Median age was 35 years (IQR 29-40); 580 (74.2%) were non-Hispanic Black, 87 (11.1%) Hispanic, and 80 (10.2%) non-Hispanic White. Observed syphilis cases were 9 (1.5%): 2 (0.3%) recent infection, 2 (0.3%) reinfection/reactivation, and 5 (0.6%) late latent. Among 88 pregnant women, there were 2 (2.3%) syphilis cases with reinfection/reactivation. Among 461 women with HIV there were 6 syphilis cases: 2 (0.4%) had reinfection/reactivation and 4 (0.9%) late latent syphilis. There were no differences in syphilis prevalence by pregnancy (p=0.263) or HIV status (p=0.742). Overall, 14 (1.8%) women had serofast status, of those 2 were pregnant and 6 living with HIV.
Conclusions
The well-established link between syphilis and HIV underscores the importance of equitable, integrated screening and treatment programs for high-risk women of reproductive age in the Southern U.S. Despite no associations with HIV status or pregnancy, this study highlights the continuous high prevalence of syphilis, emphasizing an urgent need to address these interconnected public health challenges among reproductive age women.