title: Syphilis infection, sexual practices and bisexual behaviour among men who have sex with men and transgender women: a cross-sectional study.
abstract: OBJECTIVE
  Men who have sex with men (MSM) and transgender women (TW) are highly vulnerable groups to sexually transmitted infections (STIs). This study aims to assess the prevalence of syphilis infection, sexual behaviour and identify factors associated with syphilis in MSM and TW in Campo Grande, Central Brazil.
  
  
  METHODS
  Between 2009 and 2011, 430 MSM/TW participants were interviewed and tested for syphilis. Univariable and multivariable regression analyses were done to assess associations with syphilis infection.
  
  
  RESULTS
  A total of 430 MSM/TW (278 MSM and 152 TW) were included in the study. The overall prevalence of lifetime syphilis and active syphilis was 34.7% (26.3% among MSM; 50.0% among TW) and 17.5% (12.3% among MSM; 27.0% among TW), respectively (p<0.001). In multivariable regression analysis, being 20-24 years and ≥30 years, having engaged in a variety of sexual practices and with a history of genital/anal ulcer in the last 12 months were associated with lifetime syphilis infection in the MSM group. Among TW participants, being ≥30 years of age, having more than 10 male sexual partners in last week and being infected with HIV were associated with lifetime syphilis. Factors associated with active syphilis among MSM were massage parlour/sauna recruitment and alcohol consumption at least once a week. Having sex with female partners in the past 12 months was predictive for active syphilis among TW.
  
  
  CONCLUSIONS
  The prevalence of syphilis infection and risk sexual behaviour were high in the two samples, especially among TW. High levels of bisexual behaviours and low rates of consistent condom use indicate potential HIV/STIs transmission into the heterosexual population. This finding indicates the need and urgency for implementing more effective integrated programmes targeting MSM/TW for the prevention of syphilis and other STIs.
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Fernanda Rodas Pires
authors.initials: FR
authors.lastname: Fernandes
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Priscila Brunini
authors.initials: PB
authors.lastname: Zanini
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Grazielli Rocha
authors.initials: GR
authors.lastname: Rezende
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Lisie Souza
authors.initials: LS
authors.lastname: Castro
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Larissa Melo
authors.initials: LM
authors.lastname: Bandeira
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Marco Antônio
authors.initials: MA
authors.lastname: Puga
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Tayana Serpa Ortiz
authors.initials: TS
authors.lastname: Tanaka
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Ludiele Souza
authors.identifier: http://orcid.org/0000-0002-1717-0562
authors.initials: LS
authors.lastname: Castro
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
authors.forename: Lívia Garcia
authors.initials: LG
authors.lastname: Bertolacci-Rocha
authors.affiliation: School of Nursing, Federal University of Goias, Goiânia, GO, Brazil.
authors.forename: Sheila Araújo
authors.initials: SA
authors.lastname: Teles
authors.affiliation: Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil Laboratory of Molecular Virology, Oswaldo Cruz Foundation, Mato Grosso do Sul, Brazil.
authors.forename: Ana Rita Coimbra
authors.initials: AR
authors.lastname: Motta-Castro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D018451:Homosexuality, Male; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D013223:Statistics as Topic; D013587:Syphilis / Q000453:epidemiology*; D063106:Transgender Persons; D055815:Young Adult
keywords: EPIDEMIOLOGY (GENERAL); MEN; SEXUAL BEHAVIOUR; SYPHILIS; TRANSSEXUAL