Syphilis is a sexually transmitted bacterial infection that may also be transmitted by transfusion. Active cases of syphilis are increasing globally. The prevalence of syphilis cases rose 22% between 2020 and 2022 in first-time blood donors in the US. Although well studied in the past, risk factors for transfusion transmitted STDs need to be re-evaluated due to increasing uses of HIV pre- and post- exposure drugs as well as dynamic views on sexual identity. In the US, the Transfusion-Transmissible Infections Monitoring System (TTIMS), comprised of four blood centers, actively monitors cases of HIV, HBV, HCV, and active syphilis infections (ASI) in blood donors. From 2021 to 2023 (before the U.S. FDA guidelines on individual donor assessments), TTIMS interviewed 369 potential donors with ASI to determine risk factors and compared them to 868 control donors with false positive HIV or HBV infections. Based on multivariable modeling, factors associated with ASI include age between 40 and 54 years (compared to >55 years), Black race (compared to White), lower income, being single/separated/divorced/widowed (compared to married or living together), being gay or homosexual (compared to heterosexual), first-time donors (compared to repeat donors), having >2 sexual partners in previous 12 months, and a history of any sexually transmitted infection. While further monitoring is needed, risk factors of ASI may help to identify subgroups for educational and prevention programs and help to refine individual donor questionnaires.
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