Epidemiology and predictors of positive serology for syphilis among men attending routine urological consultations

Leonardo O. Reis^1,2,3,4,*, Matheus B. Santos^1,2, Caio V. Suartz^4,5, Ana Claudia G. de Paula⁶, Gabriela R. Barbosa^2,3,4, Adriano Cintra², Fabiano A. Simões², Fábio Guimarães², João C. C. Alonso², Ronald F. Rejowski², Walker W. Laranja²
1 Paulínia Municipal Hospital, Paulínia, São Paulo, Brazil
2 School of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
3 Immuno-Oncology Institute, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brazil
4 INCT UroGen National Institute of Science, Technology and Innovation in Genitourinary Cancer (INCT), Campinas, São Paulo, Brazil
5 Northern Ontario School of Medicine, Thunder Bay, ON, Canada
6 Faculty of Medicine, University of July 9th, Mauá, São Paulo, Brazil
* Corresponding Author: Leonardo O. Reis. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.078361

Received 30 December 2025; Accepted 24 March 2026; Published online 21 May 2026

Abstract

Objectives: Sexually transmitted infections (STIs) remain a major global public health challenge. Urology consultations often serve as an entry point for men presenting with genitourinary symptoms that may be associated with underlying STIs. This work aims to describe epidemiological characteristics and identify behavioral and clinical predictors associated with self-reported lifetime STIs and laboratory-confirmed syphilis among men attending routine urology consultations in primary healthcare settings. Methods: This cross-sectional study comprised two analytically independent components of routine urological patients in São Paulo, Brazil. The first included 2582 men aged 34–55 years who completed a standardized sociodemographic and behavioral questionnaire to assess self-reported lifetime STI history. The second included a separate cohort of 1092 men who provided blood samples for serological testing for syphilis. Univariate and multivariate logistic regression models were used to evaluate predictors of STI positivity in each dataset. Results: In the questionnaire-based analysis, 587 participants (22.7%%) reported a prior STI. Independent predictors of lifetime STI history included older age (OR: 1.045; 95% CI: 1.017–1.074), earlier sexual debut (OR: 0.843; 95% CI: 0.805–0.882), lower erectile function (OR: 0.978; 95% CI: 0.958–0.998), absence of prior STI counseling (OR: 1.419; 95% CI: 1.102–1.828), and recreational drug use (OR: 2.163; 95% CI: 1.334–3.509). In the serology-based analysis, 79 of 1092 participants (7.2%) tested positive for syphilis. Age at sexual initiation was the strongest independent predictor of seropositivity (OR: 0.609; 95% CI: 0.470–0.790), with later sexual debut being protective. No other behavioral or clinical variables showed significant associations with syphilis. Syphilis seropositivity was 3 times higher in those with a previous history of STI. Conclusions: Earlier sexual debut, recreational drug use, lack of STI counseling, and increasing age were key determinants of STI risk. Age at sexual initiation consistently predicted both self-reported and laboratory-confirmed outcomes, emphasizing its role as a robust behavioral marker of vulnerability. Integrating structured sexual-health education, counseling, and preventive strategies into routine urological services may enhance early detection and reduce syphilis transmission.