Risk factors for syphilis in women: case-control study

Macêdo, Vilma Costa de; Lira, Pedro Israel Cabral de; Frias, Paulo Germano de; Romaguera, Luciana Maria Delgado; Caires, Silvana de Fátima Ferreira; Ximenes, Ricardo Arraes de Alencar

doi:10.11606/S1518-8787.2017051007066

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Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.11606/S1518-8787.2017051007066 copy

Risk factors for syphilis in women: case-control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals.

METHODS

This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained.

RESULTS

The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors.

CONCLUSIONS

Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability.

Pregnant Women; Syphilis Serodiagnosis; Risk Factors; Socioeconomic Factors; Maternal-Child Health Services; Case-Control Studies

Variable	Total		Case	Control	OR	95%CI	p

	n = 561	%	n = 239	n = 322
Level 1 – Demographic characteristics
Household income per capita (MW)							0.236
> 1.0	50	8.9	20	30	1.00
1.0–0.50	133	23.7	58	75	1.16	0.59–2.24
0.5–0.25	222	39.6	85	137	0.93	0.49–1.74
≤ 0.25	156	27.8	76	80	1.42	0.74–2.72
Socio-economic class							0.033
B1 + B2 + C1	153	27.3	54	99	1.00
C2	263	46.9	112	151	1.36	0.90–2.05
D + E	145	25.8	73	72	1.85	1.16–2.95
Education level							< 0.001
High school and university (C/I)	158	28.2	45	113	1.00
Basic education (C)	195	34.8	79	116	1.71	1.09–2.67
Basic education (I)/Illiterate	208	37.1	115	93	3.10	1.99–4.82
Work							0.931
Yes	147	26.2	63	84	1.00
No	290	51.7	125	165	1.01	0.67–1.50
Has never worked	124	22.1	51	73	0.93	0.57–1.51
Situation of current job							0.234
Formal contract	82	14.6	30	52	1.00
Other	479	85.6	209	270	1.34	0.82–2.17
Access to the Internet							< 0.001
Yes	437	77.9	168	269	1.00
No	124	22.1	71	53	2.14	1.43–3.21
Access to telephone							0.001
Yes	513	91.4	207	306	1.00
No	48	8.6	32	16	2.95	1.58–5.52
Age group (years)							0.365
≥ 30	133	23.7	56	77	1.00
25–29	113	20.1	42	71	0.81	0.48–1.36
20–24	159	28.3	76	83	1.25	0.79–2.00
≤ 19	156	27.8	65	91	0.98	0.61–1.57
Marital status							0.005
Married	51	9.1	14	37	1.00
Common-law marriage	350	62.4	142	208	1.80	0.94–3.45
Single/Divorced/Widow	160	28.5	83	77	2.84	1.43–5.67
Race (self-reported)							0.200
White	97	17.3	36	61	1.00
Non-white	467	82.7	203	261	1.31	0.84–2.06

Variable	Total		Case	Control	OR	95%CI	p

	n = 561	%	n = 239	n = 322
Level 2 – Behavioral characteristics
Religion							0.044
No religion	208	37.1	92	116	1.00
Catholic	177	31.6	85	92	1.16	0.77–1.74
Evangelical	176	31.4	62	114	0.68	0.45–1.03
Age in the 1st sexual intercourse (years)							0.002
≥ 18	114	20.3	34	80	1.00
≤ 17	447	79.7	205	242	1.99	1.28–3.10
Age in the 1st pregnancy (years)							< 0.001
≥ 18	302	53.8	108	194	1.00
≤ 17	259	46.2	131	128	1.83	1.31–2.57
Number of pregnancies (previous + current)							0.002
1	187	33.3	62	125	1.00
2–3	256	45.6	115	141	1.64	1.11–2.43
≥ 4	118	21.0	62	56	2.23	1.39–3.58
Number of sex partnersa							< 0.001
1	434	77.4	161	273	1.00
2	75	13.4	40	35	1.93	1.18–3.17
≥ 3	52	9.3	38	14	4.60	2.42–8.75
Condom use							0.338
Always	60	10.7	29	31	1.00
Sometimes	186	33.2	84	102	0.88	0.49–1.57
No	315	56.1	126	189	0.71	0.40–1.24
Age at which started smoking (years)							< 0.001
Does not smoke	449	80.0	166	283	1.00
≥ 18	19	3.4	9	10	1.53	0.61–3.85
≤ 17	93	16.6	64	64	3.76	2.33–6.07
Age at which started drinking (years)							0.144
Does not drink	453	80.7	187	266	1.00
≥ 18	30	5.3	11	19	0.82	0.38–1.77
≤ 17	78	13.9	41	37	1.57	0.97–2.55
Age at which started using drugs (years)							< 0.001
Does not use	480	85.6	181	299	1.00
≥ 18	19	3.4	10	9	1.83	0.73–4.60
≤ 17	62	11.1	48	14	5.66	3.03–10.56
Current partner uses drugs							< 0.001
No	454	80.9	176	278	1.00
Yes	107	19.1	63	44	2.26	1.47–3.47
Suffers discriminationa							0.731
No	435	77.5	187	248	1.00
Yes	126	22.5	52	74	0.93	0.62–1.39
Watches television							0.426
Everyday	483	86.1	209	274	1.00
Sometimes a week	78	13.9	30	48	0.81	0.50–1.33
Listens to the radio							0.499
Everyday	224	39.9	102	122	1.00
Sometimes a week	217	38.7	87	130	0.24	0.54–1.16
Never	120	21.4	50	70	0.49	0.54–1.33
Access to informationb							0.140
Has improved	396	70.6	160	236	1.00
Has remained the same	145	25.8	67	78	1.26	0.86–1.85
Has worsened	20	3.6	12	8	2.21	0.88–5.53
Situation of conflictb							0.070
No	434	77.4	176	258	1.00
Yes	127	22.6	63	64	1.44	0.97–2.14

Variable	Total		Case	Control	OR	95%CI	p

	n = 561 %		n = 239	n = 322
Level 3 – Clinical, obstetric, and health care history in prenatal care and maternity hospital
History of previous abortion							0.001
No	406	72.4	155	251	1.00
Yes	155	27.6	84	71	1.91	1.31–2.78
History of previous STI							< 0.001
No	434	77.4	135	300	1.00
Yes	127	22.6	105	22	10.68	6.46–17.66
Gestational age when prenatal care began (trimester)							< 0.001
First	323	57.6	112	211	1.00
Second	149	26.6	68	81	1.58	1.06-2.34
Third	17	3.0	11	6	3.45	1.24-9.58
No prenatal care	72	12.8	48	24	3.76	2.19-6.47
Number of appointments in prenatal care							< 0.001
≥ 7	217	38.7	67	150	1.00
6–4	178	31.7	66	112	1.31	0.86–2.00
3–1	94	16.8	58	44	3.60	2.17–5.98
No prenatal care	72	12.8	48	24	4.47	2.53–7.90
Place of prenatal care							< 0.001
FHP	273	48.7	109	164	1.00
Other	216	38.5	82	134	0.92	0.63–1.32
No prenatal care	72	12.8	48	24	3.00	1.74–5.19
Received prenatal card in the 1st appointment							< 0.001
Yes	454	80.9	178	276	1.00
No	35	6.2	13	22	0.91	0.45–1.86
No prenatal care	72	12.8	48	24	3.10	1.83–5.24
Exams were requested in the 1st prenatal appointment							< 0.001
Yes	463	82.5	176	287	1.00
No	26	4.6	15	11	2.22	0.99–4.95
No prenatal care	72	12.8	48	24	3.26	1.93–5.51
Participated in the group of pregnant women*							< 0.001
Yes	103	18.4	38	65	1.00
No	386	68.8	153	233	1.12	0.71–1.76
No prenatal care	72	12.8	48	24	3.42	1.81–6.44
Record at the FHU							0.156
Yes	398	70.9	162	236	1.00
No	163	29.1	77	86	1.30	0.90–1.88
HIV serology at the maternity hospital							0.017
Negative	541	96.4	225	316	1.00
Positive	20	3.6	14	6	3.27	1.24–8.65

Variable	Unadjusted			Adjusted

	OR	95%CI	p	OR	95%CI	p
Level 1^a – Demographic characteristics
Education level			< 0.001			0.024
High school and university (C/I)	1.00			1.00
Basic education (C)	1.71	1.09–2.67		1.27	0.73–2.19
Basic education (I)/Illiterate	3.10	1.99–4.82		2.02	1.17–3.47
Access to telephone			0.001			0.006
Yes	1.00			1.00
No	2.95	1.58–5.52		2.45	1.28–4.70
Level 2^b – Behavioral characteristics
Religion			0.044			0.012
No religion	1.00			1.00
Catholic	1.16	0.77–1.74		1.70	1.07–2.68
Evangelical	0.68	0.45–1.03		0.86	0.53–1.39
Number of pregnancies including current one			0.002			0.008
1	1.00			1.00
2–3	1.64	1.11–2.43		1.77	1.12–2.79
≥ 4	2.23	1.39–3.58		2.27	1.30–3.95
Number of sex partners in the last 12 months			< 0.001			0.004
1	1.00			1.00
2	1.93	1.18–3.17		1.66	0.93–2.97
≥ 3	4.60	2.42–8.75		3.15	1.51–6.53
Age at which started using drugs (years)			< 0.001			0.003
Does not use	1.00			1.00
≥ 18	1.83	0.73–4.60		0.50	0.16–1.53
≤ 17	5.66	3.03–10.56		3.04	1.45– 6.40
Current partner uses drugs			<0.001			0.026
No	1.00			1.00
Yes	2.26	1.47–3.47		1.78	1.07–2.98
Level 3^c – Clinical, obstetric, and health care history in prenatal care and maternity hospital
Number of appointments in the prenatal care			< 0.001			< 0.001
≥ 7	1.00			1.00
6–4	1.31	0.86–2.00		1.48	0.88–2.49
3–1	3.60	2.17–5.98		3.53	1.86–6.69
No prenatal care	4.47	2.53–7.90		3.20	1.36–7.54
History of previous STI			< 0.001			< 0.001
No	1.00			1.00
Yes	10.68	6.46–17.66		9.70	5.46–17.24

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[1] Correspondence: Vilma Costa de Macêdo. Departamento de Enfermagem, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego, 1235 Anexo ao Hospital das Clínicas – Cidade Universitária, 50670-901 Recife, PE, Brazil. E-mail: vilmacmacedo@hotmail.com