{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:26:02Z","timestamp":1792531562073,"version":"4.5.0"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"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>Co-infections of syphilis and HIV have been found to exacerbate the impact on sexual and reproductive health, especially among key population groups such as Female Sex Workers (FSWs) and Transgender Individuals (TGs). The data on the prevalence and determinants of syphilis and HIV in Pakistan, particularly in Sindh province, is limited. This prospective cross-sectional study aimed to determine the seroprevalence and risk factors for HIV and syphilis infections among FSWs and TGs in different cities of Sindh, Pakistan.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 1120 participants (531 FSWs and 589 TGs) were recruited from Karachi, Sukkur, Hyderabad, and Larkana. Community-based serological testing for HIV and syphilis was performed using Abbot Bioline HIV\/syphilis Duo test kits, and sociodemographic and risk factor data were collected through questionnaires. Chi-square and logic regression were applied to determine variables associated significantly with syphilis in TGs and FSWs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>TGs exhibited higher rates of syphilis (16.29%) and syphilis-HIV (6.79%) as compared to FSWs (syphilis: 15.63%; syphilis-HIV: 0.75%). Inconsistent condom use was more common among FSWs (75.32%), and over half reported STI symptoms. Regression analysis showed that for TGs, having five years (adjusted OR: 0.52, p = 0.04) and graduate-level education (adjusted OR: 0.40, p = 0.04) was associated with a lower risk of syphilis, while an income between 30,000 and 50,000 Pakistani rupees (OR: 1.93, p = 0.028) and more than three years in profession (adjusted OR: 2.20, p = 0.04) was associated with a higher risk. For FSWs, five (OR: 0.34, p = 0.03) and ten (OR: 0.02, p = 0.02) years of education were associated with a lower risk of syphilis, whereas an income between 30,000 and 50,000 PKR (OR: 3.05, p &lt; 0.01) and self-reported HIV-negative status (OR: 3.08, p = 0.01) were associated with a higher risk of syphilis mono-infection.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In conclusion, the results of the study show higher rates of syphilis and HIV co-infection among TG compared to FSW from Sind. The study findings provide valuable insights for national health agencies and policymakers to devise data-driven strategies for preventing and controlling syphilis and HIV infections among FSW and TG populations in Sind.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0312683","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T19:16:25Z","timestamp":1737746185000},"page":"e0312683","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Analysis of seroprevalence and risk factors for syphilis and HIV among female sex workers and transgender individuals in different cities of Sindh, Pakistan"],"prefix":"10.1371","volume":"20","author":[{"given":"Sharaf A.","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Zubair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Altaf","family":"Soomro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasheed","family":"Sheikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alnara","family":"Zhamalbekova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-0902","authenticated-orcid":true,"given":"Syed Hani","family":"Abidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"issue":"1","key":"pone.0312683.ref001","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3390\/venereology1010007","article-title":"A Global Scoping Review of the Factors Associated with HIV and Syphilis Co-Infection: Findings from 40 Countries.","volume":"1","author":"IA Varshney K","year":"2022","journal-title":"Venereology"},{"issue":"5","key":"pone.0312683.ref002","first-page":"1829","article-title":"Epidemiology of HIV\/AIDS and Syphilis among High Risk Groups in Pakistan","volume":"49","author":"W. Usman","year":"2017","journal-title":"Pakistan journal of Zoology"},{"key":"pone.0312683.ref003","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s40471-018-0138-z","article-title":"An Update on the Global Epidemiology of Syphilis.","volume":"5","author":"JD Kojima NK","year":"2018","journal-title":"Curr Epidemiol Rep."},{"key":"pone.0312683.ref004","unstructured":"UNAIDS. Global HIV & AIDS statistics\u2014Fact sheet. Available from: https:\/\/www.unaids.org\/en\/resources\/fact-sheet."},{"issue":"6","key":"pone.0312683.ref005","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1080\/09540129650125380","article-title":"An assessment of the risks of syphilis and HIV infection among a sample of not-in-treatment drug users in Houston","volume":"8","author":"EW Williams ML","year":"1996","journal-title":"Texas. 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Diseases."},{"issue":"10","key":"pone.0312683.ref009","first-page":"993","article-title":"Prevalence of syphilis among antenatal clinic attendees in Karachi: imperative to begin universal screening in Pakistan.","volume":"61","author":"SA Shah","year":"2011","journal-title":"The Journal of the Pakistan Medical Association"},{"issue":"1","key":"pone.0312683.ref010","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1186\/s12879-023-08591-4","article-title":"Sexually transmitted infections and associated risk factors among the transgender population of Pakistan.","volume":"23","author":"H Javed","year":"2023","journal-title":"BMC infectious diseases."},{"key":"pone.0312683.ref011","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1136\/sti.2003.007500","article-title":"HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia.","volume":"80","author":"E Pisani","year":"2004","journal-title":"Sex Transm Infect"},{"key":"pone.0312683.ref012","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/S1473-3099(12)70315-8","article-title":"Worldwide burden of HIV in transgender women: a systematic review and meta-analysis","volume":"13","author":"SD Baral","year":"2013","journal-title":"Lancet Infect Dis"},{"key":"pone.0312683.ref013","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1186\/1471-2334-14-225","article-title":"High prevalence of HIV and syphilis and associated factors among low-fee female sex workers in mainland China: A cross-sectional study.","volume":"2614","author":"C Zhou","year":"2014","journal-title":"BMC Infect Dis"},{"key":"pone.0312683.ref014","first-page":"11","article-title":"HIV\/AIDS and syphilis screening among high risk groups","volume":"19","author":"MH Raza","year":"2015","journal-title":"Rawalpindi Med Col"},{"key":"pone.0312683.ref015","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1186\/s12889-018-5051-3","article-title":"Determinants of HIV infection among adolescent girls and young women aged 15\u201324 years in South Africa: a 2012 population-based national household survey.","volume":"18","author":"M Mabaso","year":"2018","journal-title":"BMC Public Health."},{"key":"pone.0312683.ref016","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s10461-023-04153-6","article-title":"Prevalence, Trends and Correlates of HIV, Syphilis and HCV Infection Among Chinese Local and Cross-border Migrant Female Sex Workers in the Sino-Vietnam Border Area of Guangxi, 2016\u20132021","volume":"28","author":"B Liang","year":"2024","journal-title":"AIDS Behav"},{"key":"pone.0312683.ref017","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12939-023-02068-1","article-title":"Socioeconomic inequalities in uptake of HIV testing during antenatal care: evidence from Sub-Saharan Africa.","volume":"23","author":"LK Dadzie","year":"2024","journal-title":"Int J Equity Health"},{"key":"pone.0312683.ref018","doi-asserted-by":"crossref","first-page":"1018724","DOI":"10.3389\/fpubh.2022.1018724","article-title":"Prevalence of syphilis and chlamydia trachomatis infection among female sex workers in Jiangsu, China: Results from a multicenter cross-sectional and venue-based study.","volume":"10","author":"LJ Shi L","year":"2022","journal-title":"Front Public Health."},{"key":"pone.0312683.ref019","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/1471-2334-10-198","article-title":"Mobility, risk behavior and HIV\/STI rates among female sex workers in Kaiyuan City, Yunnan Province, China.","volume":"10","author":"H Wang","year":"2010","journal-title":"BMC Infect Dis"},{"key":"pone.0312683.ref020","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s11904-021-00564-z","article-title":"The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management.","volume":"18","author":"M Ren","year":"2021","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"9839","key":"pone.0312683.ref021","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0140-6736(12)60821-6","article-title":"Global epidemiology of HIV infection in men who have sex with men","volume":"380","author":"C Beyrer","year":"2012","journal-title":"Lancet (London, England)."},{"issue":"9","key":"pone.0312683.ref022","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1080\/09540121.2018.1563284","article-title":"Greater risk for more money: the economics of negotiating condom use amongst sex workers in South Africa.","volume":"31","author":"G George","year":"2019","journal-title":"AIDS Care"},{"key":"pone.0312683.ref023","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1186\/1471-2458-12-1004","article-title":"Risks, benefits and survival strategies-views from female sex workers in Savannakhet, Laos.","volume":"12","author":"K Phrasisombath","year":"2012","journal-title":"BMC Public Health"},{"key":"pone.0312683.ref024","doi-asserted-by":"crossref","first-page":"853","DOI":"10.2147\/JMDH.S305492","article-title":"Prevalence and Predictors of Syphilis in Female Sex Workers in Eastern China: Findings from Six Consecutive Cross-Sectional Surveys.","volume":"14","author":"T Xie","year":"2021","journal-title":"J Multidiscip Healthc."},{"key":"pone.0312683.ref025","first-page":"21","author":"National Academies of Sciences E, and Medicine.","year":"2021","journal-title":"Sexually Transmitted Infections: Adopting a Sexual Health Paradigm"},{"key":"pone.0312683.ref026","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1186\/s12889-021-10762-4","article-title":"Factors associated with sexually transmitted infections among care-seeking adults in the African Cohort Study.","volume":"21","author":"M Semwogerere","year":"2021","journal-title":"BMC Public 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