Volume 97, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The number of new syphilis cases in Brazil has risen alarmingly in recent years. However, there is limited data regarding syphilis prevalence in the Brazilian prison population. To facilitate the development of effective interventions, a cross-sectional study was undertaken to determine the prevalence of infection, active syphilis, and associated risk factors among Brazilian prisoners. We administered a questionnaire to a population-based sample of prisoners from 12 prisons in Central-West Brazil and collected sera for syphilis testing, from January to December 2013. Univariable and multivariable regression analyses were performed to assess associations with active syphilis. We recruited 3,363 prisoners (men: 84.6%; women: 15.4%). The overall lifetime and active syphilis prevalences were 10.5% (9.4% among men; 17% among women, < 0.001) and 3.8% (2% among men; 9% among women, < 0.001), respectively. The variables associated with active syphilis in men prisoners were homosexual preference, history of sexually transmitted infections, and human immunodeficiency virus status. Among women, the factors were sex with intravenous drug users, genital ulcer disease, and previous incarceration. Despite the high prevalence of active syphilis, 88.5% reported unawareness of their serological status and 67% reported unprotected sexual practices. Women had the highest rates of infection, including them in a high-risk group for the development of syphilis during pregnancy. Thus, implementing screening programs to enable continuous measures of control and prevention of infection in the prison environment, mainly in women institutions, is important to prevent severe forms of this disease and congenital infections.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Ho EL, Lukehart SA, , 2011. Syphilis: using modern approaches to understand an old disease. J Clin Invest 121: 45844592.[Crossref] [Google Scholar]
  2. World Health Organization, 2012. Global Incidence and Prevalence of Selected Curable Sexually Transmitted Infections—2008. Geneva, Switzerland: Department of Reproductive Health and Research, WHO.
  3. World Health Organization, 2014. Elimination of Mother-to-Child Transmission (EMTCT) of HIV and Syphilis. Global Guidance on Criteria and Processes for Validation. Geneva, Switzerland: WHO.
  4. Ministério da Saúde, , 2008. Prevalências e Frequências Relativas de Doenças Sexualmente Transmissíveis (DST) em Populações Selecionadas de Seis Capitais Brasileiras, 2005. Available at: http://www.dst.uff.br/publicacoes/Prevalencias%20DST%20Brasil%20capitais_para_web.pdf.
  5. Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, , Broutet N, 2014. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine 32: 15271535.[Crossref] [Google Scholar]
  6. Fernandes FR, ., 2014. Syphilis infection, sexual practices and bisexual behaviour among men who have sex with men and transgender women: a cross-sectional study. Sex Transm Infect 18. [Google Scholar]
  7. Parvez F, Katyal M, Alper H, Leibowitz R, Venters H, , 2013. Female sex workers incarcerated in New York city jails: prevalence of sexually transmitted infections and associated risk behaviors. Sex Transm Infect 89: 280284.[Crossref] [Google Scholar]
  8. Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Boamah I, , Adu-Gyamfi C, Asare I, Hesse IF, Mensah G, 2008. Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: a national multicenter study. BMC Infect Dis 8: 33.[Crossref] [Google Scholar]
  9. Kazi AM, Shah SA, Jenkins CA, Shepherd BE, Vermund SH, , 2010. Risk factors and prevalence of tuberculosis, human immunodeficiency virus, syphilis, hepatitis B virus, and hepatitis C virus among prisoners in Pakistan. Int J Infect Dis 14: 6066.[Crossref] [Google Scholar]
  10. Fazel S, Baillargeon J, , 2011. The health of prisoners. Lancet 377: 956965.[Crossref] [Google Scholar]
  11. Burattini M, Massad E, Rozman M, Azevedo R, Carvalho H, , 2000. Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison. Rev Saude Publica 34: 431436.[Crossref] [Google Scholar]
  12. Brasil, 2014. Levantamento Nacional de Informações Penitenciárias - Dezembro de 2014. Infopen. Departamento Penitenciário Nacional. Brasília: Ministério da Justiça.
  13. World Health Organization, 2014. Prisons and Health. Geneva, Switzerland: WHO Regional Office for Europe, WHO.
  14. Karp G, Schlaeffer F, Jotkowitz A, Riesenberg K, , 2009. Syphilis and HIV co-infection. Eur J Intern Med 20: 913.[Crossref] [Google Scholar]
  15. Brasil, 2014. Novo Diagnóstico de Pessoas Presas no Brasil. Departamento de monitoramento e Fiscalização do Sistema Carcerário e do Sistema de Execução de Medidas Socioeducativas (DMF/CNJ). Brasília: Conselho Nacional de Justiça.
  16. Sgarbi RVE, ., 2015. A cross-sectional survey of HIV testing and prevalence in twelve Brazilian correctional facilities. PLoS One 10: 112.[Crossref] [Google Scholar]
  17. Young H, Moyes A, Seagar L, McMillan A, , 1998. Novel recombinant-antigen enzyme immunoassay for serological diagnosis of syphilis. J Clin Microbiol 36: 913917. [Google Scholar]
  18. Callegari FM, Pinto-Neto LF, Medeiros CJ, Scopel CB, Page K, Miranda AE, , 2014. Syphilis and HIV co-infection in patients who attend an AIDS outpatient clinic in Vitoria, Brazil. AIDS Behav 18 ( Suppl 1 ): S104S109.[Crossref] [Google Scholar]
  19. Azbel L, Wickersham JA, Grishaev Y, Riesenberg K, , 2013. Burden of infectious diseases, substance use disorders, and mental illness among Ukrainian prisoners transitioning to the community. PLoS One 8: e59643.[Crossref] [Google Scholar]
  20. Brasil, 2015. Sistema Nacional de Políticas Públicas sobre Drogas – (Sisnad), 3. ed. Available at: file:///C:/Users/cbrooks/Downloads/politicas_drogas_sisnad_3ed.pdf.
  21. Albuquerque AC, da Silva DM, Rabelo DC, de Lucena WA, de Lima PC, Coelho MR, , Tiago GG, 2014. Seroprevalence and factors associated with human immunodeficiency virus (HIV) and syphilis in inmates in the state of Pernambuco, Brazil. Cien Saude Colet 19: 2125.[Crossref] [Google Scholar]
  22. Verneuil L, Vidal JS, Ze Bekolo R, Vabret A, Petitjean J, , Leclercq R, Leroy D, 2009. Prevalence and risk factors of the whole spectrum of sexually transmitted diseases in male incoming prisoners in France. Eur J Clin Microbiol Infect Dis 28: 409413.[Crossref] [Google Scholar]
  23. Solomon L, Flynn C, Muck K, Vertefeuille J, , 2004. Prevalence of HIV, syphilis, hepatitis B, and hepatitis C among entrants to Maryland correctional facilities. J Urban Health 81: 2537.[Crossref] [Google Scholar]
  24. Sagnelli E, ., 2012. Blood born viral infections, sexually transmitted diseases and latent tuberculosis in Italian prisons: a preliminary report of a large multicenter study. Eur Rev Med Pharmacol Sci 16: 21422146. [Google Scholar]
  25. Marques NM, Margalho R, Melo MJ, Cunha JG, Meliço-Silvestre AA, , 2011. Seroepidemiological survey of transmissible infectious diseases in a Portuguese prison establishment. Braz J Infect Dis 15: 272275. [Google Scholar]
  26. Bautista-Arredondo S, ., 2015. A cross-sectional study of prisoners in Mexico city comparing prevalence of transmissible infections and chronic diseases with that in the general population. PLoS One 10: e0131718.[Crossref] [Google Scholar]
  27. Muga R, Roca J, Tor J, Pigem C, Rodriguez R, , Egea JM, Vlahov D, Muñoz A, 1997. Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs. Int J STD AIDS 8: 225228.[Crossref] [Google Scholar]
  28. Schuelter-Trevisol F, Custódio G, Silva AC, Oliveira MB, Wolfart A, Trevisol DJ, , 2013. HIV, hepatitis B and C, and syphilis prevalence and coinfection among sex workers in Southern Brazil. Rev Soc Bras Med Trop 46: 493497.[Crossref] [Google Scholar]
  29. Brasil, 2015. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Nota informativa: Abastecimento da penicilina benzatina 1.200.000 UI e espiramicina 1.500.000 UI no país. Brasília.
  30. Arora P, Nagelkerke NJ, Jha P, , 2012. A systematic review and meta-analysis of risk factors for sexual transmission of HIV in India. PLoS One 7: e44094.[Crossref] [Google Scholar]
  31. Feng TJ, Liu XL, Cai YM, Pan P, Hong FC, , Jiang WN, Zhou H, Chen XS, 2008. Prevalence of syphilis and human immunodeficiency virus infections among men who have sex with men in Shenzhen, China: 2005 to 2007. Sex Transm Dis 35: 10221024. [Google Scholar]

Data & Media loading...

  • Received : 09 Feb 2017
  • Accepted : 14 May 2017
  • Published online : 31 Jul 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error