title: Prevalence of syphilis and associated factors in homeless people of Sao Paulo, Brazil, using a Rapid Test.
abstract: BACKGROUND
  Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis.
  
  
  OBJECTIVE
  To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population.
  
  
  METHODS
  Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference.
  
  
  RESULTS
  1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (OR(adj) 4.9; 95%CI 2.6 - 9.4), prior history of STD (OR(adj) 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (OR(adj) 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%.
  
  
  CONCLUSIONS
  The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable.
authors.affiliation: São Paulo State Department of Health, São Paulo, SP, Brazil.
authors.forename: Valdir Monteiro
authors.initials: VM
authors.lastname: Pinto
authors.affiliation: São Paulo State Department of Health, São Paulo, SP, Brazil.
authors.forename: Mariza Vono
authors.initials: MV
authors.lastname: Tancredi
authors.affiliation: São Paulo State Department of Health, São Paulo, SP, Brazil.
authors.forename: Herculano Duarte Ramos
authors.initials: HD
authors.lastname: De Alencar
authors.affiliation: São Paulo State Department of Health, São Paulo, SP, Brazil.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Camolesi
authors.affiliation: São Paulo State Department of Health, São Paulo, SP, Brazil.
authors.forename: Márcia Moreira
authors.initials: MM
authors.lastname: Holcman
authors.affiliation: Universidade Federal do Estado de São Paulo, São Paulo, SP, Brazil.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Grecco
authors.affiliation: School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Grangeiro
authors.affiliation: São Paulo State Department of Health, São Paulo, SP, Brazil.
authors.forename: Elisabete Taeko Onaga
authors.initials: ET
authors.lastname: Grecco
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D013587:Syphilis / Q000453:epidemiology*; D013588:Syphilis Serodiagnosis / Q000379:methods; D013997:Time Factors; D014504:Urban Health; D055815:Young Adult