High Prevalence of Treponema pallidum Infection in Brazilian Prisoners

Abstract

The number of new syphilis cases in Brazil has risen alarmingly in recent years. However, there is limited data regarding syphilis prevalence in the Brazilian prison population. To facilitate the development of effective interventions, a cross-sectional study was undertaken to determine the prevalence of infection, active syphilis, and associated risk factors among Brazilian prisoners. We administered a questionnaire to a population-based sample of prisoners from 12 prisons in Central-West Brazil and collected sera for syphilis testing, from January to December 2013. Univariable and multivariable regression analyses were performed to assess associations with active syphilis. We recruited 3,363 prisoners (men: 84.6%; women: 15.4%). The overall lifetime and active syphilis prevalences were 10.5% (9.4% among men; 17% among women, < 0.001) and 3.8% (2% among men; 9% among women, < 0.001), respectively. The variables associated with active syphilis in men prisoners were homosexual preference, history of sexually transmitted infections, and human immunodeficiency virus status. Among women, the factors were sex with intravenous drug users, genital ulcer disease, and previous incarceration. Despite the high prevalence of active syphilis, 88.5% reported unawareness of their serological status and 67% reported unprotected sexual practices. Women had the highest rates of infection, including them in a high-risk group for the development of syphilis during pregnancy. Thus, implementing screening programs to enable continuous measures of control and prevention of infection in the prison environment, mainly in women institutions, is important to prevent severe forms of this disease and congenital infections.

Screening for HBV, HCV, HIV and syphilis infections among bacteriologically confirmed tuberculosis prisoners: An urgent action required

“…pallidum were serially diluted to quantify Venereal Disease Research Laboratory (VDRL) titers and to determine whether the disease is active. As recommended by the Brazilian Ministry of Health, participants were considered to have active syphilis when they presented VDRL titers equal or superior to 1/8 plus treponemal test positive [18]. All positive and indeterminate specimens for antibodies against HIV-1/2 by ECL were confirmed by Western blot assay (Novopath HIV-I, Immunoblot, BioRad).…”

Treatment Outcomes of Brazilian Inmates with Treponema pallidum and Human Immunodeficiency Virus Infection: A Prospective Cohort Study

“…The incidence of STIs is higher in inmates than in the general population; therefore, prisons require sentinel STI surveillance. [9][10][11]21,22 Although a few studies have assessed the prevalence of STIs in these environments, 11,23 this study, to our knowledge, is the first to describe the incidence of STIs and treatment outcomes among vulnerable populations, such as inmates. The evaluation of treatment using the VDRL test showed that only 26% of the inmates received effective treatment of syphilis.…”

“…27,28 Data regarding the incidence of STIs in vulnerable populations are limited. Although a high prevalence rate of syphilis and HIV in inmates has been described, 11,23 a low rate of syphilis and HIV incidence (0.55%) was recognized, indicating low transmission of these infections during 1 year of imprisonment. 11 Although this result remains underexplored in most studies, it reinforces the importance of STI screening during prison admission, which would bring the level of early detection and treatment up to par with many developed countries.…”

Health morbidity in Brazilian prisons: a time trends study from national databases

“…It is important to highlight that the number of syphilis cases among adults in Brazil has been consistently increasing, mainly in the vulnerable population, since 201023. The situation is not different among prisoners in the country, who present even a higher rate of the infection 24. Prisons are known to be high-risk settings for the spread of sexually transmitted infections (STIs).…”