Seroprevalence of Syphilis and Associated Factors among Women in Baghlan Province, Afghanistan: A Multicenter Cross-sectional Study
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Abstract
Background: Syphilis has re-emerged as a significant global public health concern, yet data on its burden among women in Afghanistan remain limited.
Methods: A multicenter cross-sectional study was conducted from January to December 2025 among 1,000 women of reproductive age attending gynecological and obstetric services at five private health facilities in Pul-e-Khumri, Baghlan Province, Afghanistan. Participants were consecutively enrolled, and data were collected using a structured questionnaire covering sociodemographic characteristics, reproductive history, sexual network factors, behavioral and hygiene-related practices, and self-reported genitourinary symptoms. Syphilis screening was performed using a treponemal rapid diagnostic test, and HIV was tested using a rapid antibody test. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with syphilis seropositivity in the study population.
Results: Among 1,000 participants, 7.1% tested positive for syphilis antibodies, with a small proportion also testing positive for HIV. In multivariable analysis, middle economic status and having a co-wife were independently associated with higher odds of seropositivity, while educational attainment and condom use were associated with lower odds. In the symptom-based model, genital sore showed the strongest independent association, followed by abdominal and groin pain.
Conclusion: This study provides evidence on syphilis among women of reproductive age in Afghanistan by documenting a high seroprevalence and identifying associated factors in a previously underreported population. These findings support strengthening screening and prevention efforts within reproductive health services.
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References
1. Begaj T, Sobrin L. Ophthalmic Consequences of Syphilis. Int Ophthalmol Clin. 2022;62(2):251-68.
2. (WHO) WHO. Data on syphilis: World Health Organization (WHO); 2024 [Available from: https://www.who.int/data/gho/data/themes/topics/data-on-syphilis.
3. (WHO) WHO. Syphilis Geneva: World Health Organization; 2025 [Available from: https://www.who.int/news-room/fact-sheets/detail/syphilis.
4. Rosset F, Celoria V, Delmonte S, Mastorino L, Sciamarrelli N, Boskovic S, et al. The epidemiology of syphilis worldwide in the last decade. J Clin Med. 2025;14(15):5308.
5. Esmaeilzadeh F, Mohammadi M, Amjadipour A, Jafari A, Ghelichi-Ghojogh M, Khezri R, et al. Prevalence of syphilis infections among the Iranian population: a systematic review and meta-analysis. Iran J Public Health. 2022;51(7):1513.
6. Shah SA, Zubair M, Soomro A, Sheikh R, Zhamalbekova A, Abidi SH. Analysis of seroprevalence and risk factors for syphilis and HIV among female sex workers and transgender individuals in different cities of Sindh, Pakistan. Plos One. 2025;20(1):e0312683.
7. Muhammad I, Khalifa EH, Salih MM, Ullah W, Elseid MS, Qasim M, et al. Analysis of molecular subtypes and antibiotic resistance in Treponema pallidum isolates from blood donors in Khyber Pakhtunkhwa, Pakistan. Plos one. 2024;19(6):e0305720.
8. Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bulletin of the World Health Organization. 2013;91:217-26.
9. Mathias BA, Muñoz TIC, Guaicha EPG, Quinde APG, Herrera MFB. Side effects of Sexually Transmitted Infections (STIs) on female fertility: diagnostic and treatment strategies–a literature review. Ibero-Am J Health Sci Res. 2024;4(1):84-92.
10. García-Cisneros S, Herrera-Ortiz A, Olamendi-Portugal M, Sánchez-Alemán MA. Re-emergence of syphilis in women of reproductive age and its association with the increase in congenital syphilis in Mexico during 2010–2019: an ecological study. BMC Infect Dis. 2021;21(1):992.
11. Hengel B, McManus H, Monaghan R, Mak DB, Bright A, Tolosa X, et al. Notification rates for syphilis in women of reproductive age and congenital syphilis in Australia, 2011–2021: a retrospective cohort analysis of national notifications data. Med J Australia. 2024;221(4):201-8.
12. Cutler JC. Survey of venereal diseases in Afghanistan. Bulletin of the World Health Organization. 1950;2(4):689.
13. Hashemi E, Waheed U, Saba N, Wazeer A. First report from Afghanistan on the prevalence of blood-borne infections: A retrospective cross-sectional multicentre study for an epidemiological assessment. J Blood Med. 2022:45-50.
14. Todd C, Ahmadzai M, Atiqzai F, Smith J, Miller S, Azfar P, et al. Prevalence and correlates of HIV, syphilis, and hepatitis knowledge among intrapartum patients and health care providers in Kabul, Afghanistan. AIDS Care. 2009;21(1):109-17.
15. (NSIA) NSaIA. Estimated Population of Afghanistan 2025-26. 2025.
16. Ginindza TG, Stefan CD, Tsoka-Gwegweni JM, Dlamini X, Jolly PE, Weiderpass E, et al. Prevalence and risk factors associated with sexually transmitted infections (STIs) among women of reproductive age in Swaziland. Infect Agents Cancer. 2017;12(1):29.
17. Liao K-J, Zhang S-K, Liu M, Wang Q-M, Liu J, Shen H-P, et al. Seroepidemiology of syphilis infection among 2 million reproductive-age women in rural China: a population-based, cross-sectional study. Chinese Med J. 2017;130(18):2198-204.
18. Dhillon S, Amoak D, Chidimbah Munthali GN, Sano Y, Antabe R, Luginaah I. Polygamy and safe sex negotiation among married women: evidence from Cameroon. BMC Infect Dis. 2023;23(1):817.
19. Huda MN, Ahmed MU, Uddin MB, Hasan MK, Uddin J, Dune TM. Prevalence and demographic, socioeconomic, and behavioral risk factors of self-reported symptoms of sexually transmitted infections (STIs) among ever-married women: evidence from nationally representative surveys in Bangladesh. Int J Environ Res Public Health. 2022;19(3):1906.
20. Guedes ALdL, Guimarães DCdS, Sarkis DJ, Gabriel TT, Delgado CS, Campos AAL, et al. Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit. Einstein (São Paulo). 2023;21:eAO0046.
21. Macêdo VCd, Lira PICd, Frias PGd, Romaguera LMD, Caires SdFF, Ximenes RAdA. Risk factors for syphilis in women: case-control study. Revista de Saúde Pública. 2017;51:78.
22. Organization WH. Condoms 2025 [Available from: https://www.who.int/news-room/fact-sheets/detail/condoms.
23. Avelleira JCR, Bottino G. Syphilis: diagnosis, treatment and control. Anais Brasileiros de Dermatologia. 2006;81:111-26.
24. Wu MY, Gong HZ, Hu KR, Zheng H-y, Wan X, Li J. Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis. Sexually transmitted infections. 2021;97(7):525-33.
25. Karp G, Schlaeffer F, Jotkowitz A, Riesenberg K. Syphilis and HIV co-infection. Eur J Int Med.. 2009;20(1):9-13.
26. Puspawati NMD, Yasa IWPS, Manuaba IBP, Wande IN, Somia IKA. Bidirectional Association within HIV and Syphilis Coinfection: A Pathophysiological and Clinical Review. Russian Open Med J. 2025;14(3):313.