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March 17, 2026Open Access

Prevalence and Associated Factors of Syphilis-Hiv Co-Infection in the Population of São Paulo: A Systematic Review With Meta-Analysis

Key Points

This research aims to analyze the prevalence and associated factors of syphilis-HIV co-infection in São Paulo.
Conducted a systematic review following PRISMA guidelines.
Searched databases including PubMed and Embase for relevant studies.
Included observational studies that reported prevalence data from 2019 to 2024.
Performed meta-analysis using random-effects model to estimate pooled prevalence and odds ratios.
Assessed heterogeneity with I² test and performed subgroup analyses.
The combined prevalence of syphilis-HIV co-infection was 16.3%.
Prevalence rates varied: MSM at 18.7%, HIV+ pregnant women at 12.4%, and young adults at 17.5%.
Identified behavioral factors included inconsistent condom use and engaging with multiple partners.
Healthcare gaps such as inadequate prenatal care contributed to higher risks.
Reported a 10% treatment failure rate for benzathine penicillin.

Abstract

Syphilis-HIV co-infection represents a significant public health challenge, particularly in the state of São Paulo (SP), where high prevalence rates have been documented. The interaction between behavioral and sociodemographic factors and gaps in health care contributes to the persistence of this dual infection. Key populations such as men who have sex with men (MSM), young adults (18–30 years) and HIV+ pregnant women are more vulnerable to syphilis, associated with the use of dating apps, inconsistent condom use and failures in prenatal care. We sought to synthesize evidence on the prevalence and associated factors of syphilis-HIV co-infection in São Paulo, providing support for targeted public policies. The prevalence of syphilis-HIV co-infection in the SP population was estimated, and we identified main associated factors: behavioral and sociodemographic variables and access to health services. A systematic review was conducted following PRISMA guidelines. The databases PubMed, SciELO, LILACS and Embase were searched using the descriptors “syphilis”, “HIV”, “coinfection” and “São Paulo”. Observational studies (cross-sectional, cohort and case-control) published between 2019 and 2024 that reported prevalence data and factors associated with syphilis-HIV co-infection in SP were included. Meta-analysis was performed using a random-effects model, calculating pooled prevalence and odds ratios (OR) for risk factors. Heterogeneity was assessed using the I² test and subgroup analyses by specific populations. The analysis included 15 studies, totaling 8,542 participants. The combined prevalence of syphilis-HIV co-infection was 16.3%, with significant variation between subgroups: MSM: 18.7%, HIV+ pregnant women: 12.4% and young adults: 17.5%. Associated factors for coinfection included: behavioral aspects such as inconsistent condom use, multiple sexual partners, and the use of dating apps; healthcare-related factors such as gaps in prenatal care and late diagnosis of syphilis; and therapeutic factors, with a 10% failure rate of benzathine penicillin treatment. The results reinforce the need for integrated interventions, including expanded rapid testing, improved prenatal care coverage, serological monitoring, and adjustments to therapeutic regimens in cases of reinfection.

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