{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:58:05Z","timestamp":1782979085548,"version":"3.54.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T00:00:00Z","timestamp":1647475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["U2GGH001226"],"award-info":[{"award-number":["U2GGH001226"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Ulcerative STIs, including syphilis, increase the risk for HIV acquisition and transmission due to the presence of ulcers\/chancres that serve as a point-of-entry and exit for HIV. In Zimbabwe, diagnosis of syphilis often occurs in pregnant women who seek ANC services where syphilis testing is offered, and among men and women who seek health care for STIs. Zimbabwe\u2019s national syphilis estimates are based on these diagnosed cases, with little information available about the prevalence of untreated syphilis among the general population. This analysis uses data from ZIMPHIA (2015\u20132016) to describe factors associated with active syphilis among men and women ages 15 years and older.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>ZIMPHIA collected blood specimens for HIV and syphilis testing from 22,501 consenting individuals (ages 15 years and older). Household HIV testing used the national HIV rapid-testing algorithm with HIV-positive results confirmed at satellite laboratories using Geenius HIV-1\/2 rapid test (Bio-rad, Hercules, California, USA). Point-of-care non-Treponemal and Treponemal syphilis testing was performed using Chembio\u2019s Dual-Path Platform Syphilis Screen &amp; Confirm Assay. Factors associated with active syphilis were explored using multiple variable, weighted logistic regression and were stratified by gender.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The likelihood of active syphilis in HIV-positive females was 3.7 times greater in HIV-positive females than HIV-negative females (aOR: 3.7, 95% CI 2.3\u20135.9). Among males odds of having active syphilis was 5 times higher among those that engaged in transactional sex than those who did not have sex or transactional sex (aOR: 5.3, 95% CI 1.9\u201314.7), and 6 times higher if HIV positive versus negative (aOR: 5.9, 95% CI 3.0\u201312.0). Urban residence, province, education (highest attended), marital status, number of sex partners, consistency of condom use, pregnancy status (females), and circumcision status (males) were not significant in the adjusted model for either females or males.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conculsion<\/jats:title>\n<jats:p>HIV status was found to be the only factor associated with active syphilis in both females and males. Given the persistent link between HIV and active syphilis, it is prudent to link individuals\u2019 diagnoses and treatments, as recommended by the WHO. Enhanced integration of STI and HIV services in health delivery points such as ANC, reproductive services, or male circumcision clinics, combined with consistent, targeted outreach to high-risk populations and their partners, may assist the MOHCC to eliminate active syphilis in Zimbabwe.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0261057","type":"journal-article","created":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T18:11:14Z","timestamp":1647540674000},"page":"e0261057","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Factors associated with active syphilis among men and women aged 15 years and older in the Zimbabwe Population-based HIV Impact Assessment (2015\u20132016)"],"prefix":"10.1371","volume":"17","author":[{"given":"Leala","family":"Ruangtragool","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Silver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Machiha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lovemore","family":"Gwanzura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avi","family":"Hakim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Lupoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9077-4429","authenticated-orcid":true,"given":"Godfrey","family":"Musuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hetal","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Mugurungi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Tippett Barr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0811-3064","authenticated-orcid":true,"given":"John H.","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,17]]},"reference":[{"issue":"4","key":"pone.0261057.ref001","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.idc.2013.08.005","article-title":"Syphilis in the modern era: an update for physicians","volume":"27","author":"SE Cohen","year":"2013","journal-title":"Infect Dis Clin North Am"},{"issue":"3","key":"pone.0261057.ref002","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2471\/BLT.12.107623","article-title":"Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis","volume":"91","author":"GB Gomez","year":"2013","journal-title":"Bull World Health Organ"},{"key":"pone.0261057.ref003","author":"World Health Organization","year":"2012","journal-title":"Global incidence and prevalence of selected curable sexually transmitted infections\u20142008"},{"issue":"1","key":"pone.0261057.ref004","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ejim.2008.04.002","article-title":"Syphilis and HIV co-infection","volume":"20","author":"G Karp","year":"2009","journal-title":"European journal of internal medicine"},{"issue":"1","key":"pone.0261057.ref005","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s12879-017-2201-7","article-title":"The immunological response to syphilis differs by HIV status; 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