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Intersecting Risk Factors Associated With High Syphilis Seroprevalence Among a Street-Involved Population in Canada.

Lucy Mackrell1, Jillian P Antoun1, Megan Carter1,2

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Summary
This summary is machine-generated.

Syphilis is rising in Ontario, particularly among women and people using illicit drugs. A study found higher infection rates at the intersection of sexual risk factors, drug use, and housing instability.

Keywords:
people who are unhousedpeople who use drugsseroprevalencestreet-involved populationsyndemicsyphiliswomen

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • Syphilis rates have surged by 340% in Ontario between 2013 and 2023.
  • Women represent the fastest-growing demographic affected by this increase.
  • This study focuses on intersecting risk factors within a street-involved population.

Purpose of the Study:

  • To examine the prevalence of syphilis seropositivity.
  • To identify intersecting risk factors associated with syphilis seropositivity.
  • To evaluate an outreach model of care for syphilis in Ontario.

Main Methods:

  • Data from the Syphilis Point of Care Rapid Test and Immediate Treatment Evaluation (SPRITE) study (2023-2024).
  • Analysis of syphilis seroprevalence using reactive treponemal antibodies.
  • Mixed-effects regression with log-binomial distribution to assess risk factors.

Main Results:

  • Overall syphilis seroprevalence was 7.6% among 630 participants (42% women).
  • Seropositivity was significantly higher in individuals with multiple risk factors (drug use, housing instability).
  • Women (aPR 1.62) and illicit drug users, especially crystal methamphetamine users (aPR 2.88), showed increased seropositivity.

Conclusions:

  • Syphilis risk is elevated at the intersection of sexual risk, illicit drug use, and housing instability.
  • Targeted outreach is crucial for reaching at-risk, equity-deserving populations.
  • The SPRITE study demonstrates the utility of outreach models in addressing syphilis resurgence.