Sexual Orientation and HIV Coinfection Among Serofast Syphilis Patients: A Retrospective Analysis in Surakarta, Indonesia

Abstract

Introduction: Syphilis and its serofast state — persistent low-level non-treponemal reactivity after adequate therapy — complicate the assessment of cure, particularly where HIV coinfection is common, and Indonesian data are scarce. This study profiled serofast syphilis patients and compared the determinants of HIV coinfection.

Methods: Retrospective analytic review of electronic medical records of all serofast syphilis patients attending Dr. Moewardi Regional General Hospital, Surakarta (January 2020–April 2026). Proportions are reported with 95% confidence intervals (CI); HIV-positive and HIV-negative groups were compared by Fisher exact and chi-square tests with odds ratios (OR) and Cramér's V, multivariable logistic regression and receiver-operating-characteristic (ROC) analysis.

Results: Of 46 patients, 91.3% were male, 45.7% aged 20–30 years, 39.1% had late latent syphilis, and 80.4% were HIV-coinfected (95% CI 66.8–89.3). Men who have sex with men accounted for 73.9% and strongly predicted HIV coinfection (OR 17.73, 95% CI 3.26–96.34; p<0.001; adjusted OR 41.56; AUC 0.838). Other characteristics were similar, and estimates were imprecise given the small comparison group.

Conclusion: Serofast syphilis in this setting reflects a young, male, MSM, HIV-coinfected population; sexual orientation best distinguishes coinfection, supporting integrated HIV monitoring rather than reflexive re-treatment.