Prevalência e fatores associados à sífilis entre adolescentes HSH de duas capitais brasileiras

Abstract

INTRODUCTION: Despite the significant impact on public health worldwide, sexually transmitted infections rarely gain prominence and priority in government investments. Brazil follows the global trend of an increasing incidence of acquired syphilis cases, with disproportionately high growth among key populations in various regions of the world, such as adolescent men who have sex with men (AMSM). The diagnosis of syphilis among AMSM deserves attention, considering that treponema infection increases the risk of HIV infection due to the presence of skin lesions. OBJECTIVE: To estimate the prevalence of syphilis and identify the factors associated with these outcomes among AMSM. METHODS: This was a cross-sectional, multicentric study that recruited 199 AMSM aged 15 to 19 using the Respondent-Driven Sampling (RDS) method between December 2020 and August 2022 in Fortaleza and São Paulo. Data collection involved administering a questionnaire and conducting rapid tests. Estimates were calculated using STATA® 17, considering a 95% confidence interval after data weighting in each city and merging the adolescents from the two capitals into a single database. A multivariate logistic model was developed considering variables that showed significance at the 20% level in the bivariate analysis. RESULTS: The prevalence of syphilis was 10.9% (95% CI: 6.7-17.3). Most AMSM were aged 18 to 19 (55.6%; 95% CI: 46.7-64.1), attended high school (88.0%; 95% CI: 81.7-92.3), were not working (70.8%; 95% CI: 62.0-78.4), did not have educational distortion (92.3%; 95% CI: 86.1-95.8), lived with parents or family members (91.6%; 95% CI: 85.8-95.5), considered themselves homosexual (53.7%; 95% CI: 44.9-62.4), and did not self-identify as white (74.5%; 95% CI: 66.1-81.4). There was a significant statistical association between positive syphilis results and being aged 18 to 19 (16.2%; 95% CI: 9.4-26.5), living alone or with friends (30.9%; 95% CI: 11.4-60.8), having educational distortion (40.6%; 95% CI: 16.2-70.8), receiving money for sex in the last 3 months (33.7%; 95% CI: 15.2-59.0); having had a rapid HIV test before the study (22.6%; 95% CI: 11.8-39.1); and using illicit drugs in the last 3 months (17.7%; 95% CI: 10.1 29.4). In the final logistic model, the higher chances of syphilis infection were associated with AMSM receiving money for sexual intercourse (RP 2.9; 95% CI: 1.1-7.3), having had a rapid HIV test prior to the study (RP 2.6; 95% CI: 1.0-6.7), and using illicit drugs in the 3 months prior to the study (RP 4.4; 95% CI: 1.2-15.4). CONCLUSION: The results show a high prevalence of syphilis among MSM adolescents, highlighting their high vulnerability to HIV and other STIs. This underscores the importance of developing and implementing public policies aimed at these adolescents to reduce the vulnerability of this population.