High Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study

High Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study Omar David Tumalán-Gil, Verónica Ruiz-González, Santa García-Cisneros, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-559014/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background. Syphilis has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011-2015. Methods. Databases from the laboratory were analyzed and four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH) and patients from primary care clinics (others). Syphilis diagnosis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data was analyzed, and with follow-up information, a retrospective dynamic cohort was formed. Factors associated with seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. Results. A total of 81,863 baseline individuals were analyzed. Syphilis seroprevalence was 9.9% in VCT, 8.2% in PPr, 37.0% in PLWH, and 8.7% in others; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed-up; the incidence (cases per 100 years people) was 3.5 among VCT and 16.0 among PLWH; moreover, the frequency of re-infections was 11.1-24.4%. Men, transgender, persons between 20-39 years old, and individuals with a history of HIV or hepatitis B had a higher risk of syphilis. Conclusions. Several vulnerable groups have exhibited a reemergence of syphilis, with high prevalence of active syphilis, high incidence, and re-infections. Persons living with HIV had the highest risk. Infectious Diseases syphilis syphilis serodiagnosis cohort studies incidence Figures Figure 1 Figure 2 Figure 3 Background The World Health Organization (WHO) estimated the number of new cases of syphilis in 2012 at 5.6 million; it increased to 6 million in 2016. In the latter year, the incidence was 1.7 cases per thousand women and 1.6 cases per thousand men. Globally, the syphilis prevalence was 3.2% among female sex worker (FSW) and 6.0% among men who have sex with men (MSM). The WHO set the goal to reduce the incidence of Treponema pallidum by 90%, with a focus on priority groups: MSM, FSW, and intravenous drug users (IDUs). 1 , 2 Syphilis has increased in different parts of the world. Between 2013 and 2017, the number of cases per 100,000 inhabitants in the U.S. increased from 5.5 to 9.5. 3 The European Economic Community reported an increase from 4.7 cases to 6.1 cases per 100,000 inhabitants between 2012 and 2016. 4 In Mexico, an increase in syphilis was documented among young men, focused in Mexico City. 5 Syphilis is important because of the number of cases as well as the higher risk to acquire and transmit HIV. Moreover, syphilis and HIV coinfection negatively modifies both diseases. 6 The Clinica Especializada Condesa (CEC) in Mexico City is the institution that serves the largest number of people seeking HIV testing, as well as people living with HIV. The CEC also performs test for other sexually transmitted infections (STI), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis. The objective of the current study was to determine the prevalence, incidence, and risk factors of infection by T. pallidum among populations attending the CEC from 2011–2015. Methods A database was elaborated with the variables year, internal number, population type, sex, age, HIV by chemiluminescent microparticle immunoassay (CMIA), HIV rapid test 1, HIV rapid test 2, HIV Western blot, T. pallidum by CMIA, T. Pallidum rapid test, venereal disease research laboratory (VDRL) titer, HVB antigen detection, and HCV antibodies detection. Syphilis was detected using the reverse algorithm. This method starts with a treponemal test to later perform the VDRL. Some authors have mentioned that in the absence of clinical data, the antibody titer can be used to determine the stages of syphilis, as active syphilis (titer ≥ 1: 8), latent syphilis (titer 1:1–1:4) and cured syphilis (VDRL negative, positive treponemal test). 7 , 8 The attending population was classified into four groups: (1) people seeking HIV-1 voluntary counseling and testing (VCT), (2) people living with HIV (PLWH), (3) people in prison (PPr), and (4) others, people from others clinics, principally primary care clinics. The CEC sends patients with syphilis to their primary care clinics for treatment, only PLWH without social security attended CEC. The present study was approved by the ethics committee of the National Institute of Public Health from Mexico. The research was carried out according to national guidelines and the Declaration of Helsinki. All the people who attend the CEC are asked to sign a letter of informed consent. The database had identification keys, we did not have access to the names of the participants. From the baseline information, frequency analysis stratified by population group was performed, and chi-square (χ 2 ) tests were used to evaluate the differences. Subsequently, a bivariate analysis was performed to determine associated variables, both to the seroprevalence of syphilis and the presence of active syphilis. The trend test was used for the year and age variables, considering the four population groups. A retrospective dynamic cohort was elaborated with individuals that had two syphilis tests with at least four months between measurements and incidence densities was calculated using person years (py). During follow-up, syphilis was considered cured if the antibody titer decreased until negative or if the antibody concentration decreased four times or more. Syphilis re-infection was defined when it was cured at baseline and the titer was ≥ 1:1 during follow-up or if antibody titer increased four times or more. Persistent infection was considered if the antibody titer remained similar (± 2 times). 9 Incidence rate ratios (IRR) were calculated with 95% confidence intervals (CI), and a cumulative incidence curve was constructed using the Kaplan-Meier method. A p-value < 0.01 was considered statistically significant. Statistical analysis was performed using the SPSS program. Results Basal. A total of 129,613 blood/serum samples were processed in the CEC laboratory between 2011 to 2015. In 2011, there were 17,589 samples, and in 2015, there were 37,342. Results for syphilis detection were from 95,732 samples, of which 81,863 people attended at least once; 78.1% were VCT, 9.9% PPr, 2.2% PLWH, and 9.8% others. Table 1 shows the demographic characteristics and laboratory results of the four analyzed populations. In all groups, there was an increase in the number of samples analyzed over the years, with the exception of PPr that presented the greatest number of samples during 2012-2013. Men were the majority in all groups, from 63.3% among others to 85.5% among PLWH. The highest percentage of transgender was in the PLWH group. PLWH had the highest average age at 34.6 years, and VCT were the youngest on average (29.0 years). One-in-five VCT individuals were HIV positive; 3.8% of PPr individuals were HIV positive. Among PLWH, 4.9% had HBV antigens and 2.9% had antibodies against HCV. Table 1. Demographic and clinical characteristics in populations attending a specialized HIV clinic in Mexico. VCT N=63,916 PDL N=8,083 PLWH N=1,808 Others N=8,056 p % % % % Year 2011 8.9 16.1 18.8 13.3 <0.001 2012 19.3 25.3 24.5 17.5 2013 21.9 22.3 19.1 24.5 2014 23.4 17.3 14.8 23.3 2015 26.5 19.0 22.8 21.5 Sex Female 34.3 31.8 11.9 36.6 <0.001 Male 64.3 67.2 85.5 63.3 Transsexual 1.3 1.0 2.6 0.1 Age (years) ≤ 9 1.1 0.1 - 7.9 <0.001 10-19 11.7 2.4 2.0 19.2 20-29 49.9 33.7 32.2 28.7 30-39 22.0 37.9 36.8 19.8 40-49 9.9 18.8 21.7 12.4 50-59 3.9 5.9 6.1 6.8 ≥ 60 1.5 1.3 1.1 5.1 HIV test Negative 81.4 91.0 - 86.0 <0.001 Positive 18.6 3.8 100 7.2 Not done - 5.2 - 6.7 HBV test Negative 89.1 74.2 77.3 83.9 <0.001 Positive 0.9 0.9 4.9 0.6 Not done 10.0 24.9 17.8 15.5 HCV test Negative 95.4 81.5 81.7 86.0 <0.001 Positive 0.9 3.1 2.9 1.4 Not done 3.6 15.4 15.4 12.6 VCT: People seeking HIV-1 voluntary counseling and testing; PPr: people in prison; PLWH: people living with HIV; Others: patients from primary care clinics. Bold: p<0.01 statistically significant. The seroprevalence of syphilis was 8.2% (95% CI 7.6-8.8) among PPr, 8.7% (95% CI 8.1-9.3) among others, 9.9% (95% CI 9.7-10.1) in the VCT population, and 37.0% (95% CI 34.8-39.2) among PLWH. Figure 1 shows the seroprevalence of syphilis and active syphilis. Almost 40% of people with antibodies showed a cured infection, except among PLWH, in which the percentage was 32.4%. The VCT and PLWH populations had the highest seroprevalence of active syphilis, with 3.6 and 13.1%, respectively. The seroprevalence of syphilis decreased over time in the CVT and PPr groups (p<0.001). The transgender population had the highest seroprevalence; it was higher among the PPr followed by PLWH, with more than 40% in both cases (p<0.001). At an older age, the seroprevalence of syphilis increased in the four analyzed population groups (p<0.001). Individuals with other STIs (HIV, HBV, or HCV) had a higher association with the seroprevalence of syphilis (p<0.05; Table 2, left). When analyzing the frequency of active syphilis, there was a decrease during the study period in the VCT group. In contrast, active syphilis increased among PLWH during the analyzed period. Women presented the lowest proportion of active syphilis in the four groups; the highest frequency of active syphilis was in transgender and men living with HIV: 17.0% and 14.2%, respectively (p<0.001). People aged 20-29 and 30-39 years had the highest frequency of active syphilis in the VCT group. A history of STIs was associated with a higher frequency of active syphilis in the entire population (Table 2, right). Table 2 Seroprevalence of T. pallidum and active syphilis in populations attending a specialized HIV clinic in Mexico. Seroprevalence T. pallidum Active syphilis VCT PPr PLWH Others VCT PPr PLWH Others Year 2011 13.2 9.9 37.5 2.0 4.7 1.8 4.7 2.0 2012 9.7 7.7 38.8 2.5 3.6 1.4 13.5 2.5 2013 9.5 9.2 33.0 2.0 3.4 1.8 15.7 2.0 2014 9.2 8.9 38.4 1.9 3.1 1.6 14.6 1.9 2015 9.9 5.9 37.0 2.4 3.8 1.9 16.2 2.4 Trend p <0.001 0.005 0.812 0.700 <0.001 0.775 <0.001 0.700 Sex Female 1.7 7.2 14.9 2.3 0.4 0.8 3.7 2.3 Male 14.1 8.2 39.9 2.1 5.3 1.9 14.2 2.1 transsexual 18.9 43.9 42.6 0.0 5.0 13.4 17.0 0.0 p <0.001 <0.001 <0.001 0.720 <0.001 <0.001 <0.001 0.720 Age (years) ≤ 9 0.7 33.3 -- 0.9 0.0 0.0 -- 0.9 10-19 3.0 5.7 13.9 1.6 1.8 2.6 13.9 1.6 20-29 9.0 7.5 29.0 2.8 4.0 2.1 14.8 2.8 30-39 13.5 8.1 39.9 1.6 4.6 1.5 13.5 1.6 40-49 12.9 8.4 42.0 2.6 3.1 1.1 11.5 2.6 50-59 13.1 10.2 48.6 2.5 2.1 1.5 9.0 2.5 ≥ 60 18.2 22.3 52.6 2.7 1.4 2.9 0.0 2.7 p trend <0.001 <0.001 <0.001 0.021 <0.001 0.217 0.223 0.021 HIV test Negative 5.1 6.5 ---- 0.8 1.8 1.2 --- 0.8 Positive 30.8 29.4 37.0 7.9 11.4 10.7 13.1 7.9 p <0.001 <0.001 ---- <0.001 <0.001 <0.001 ---- <0.001 HBV test Negative 9.9 7.9 34.0 1.3 3.6 1.8 11.3 1.3 Positive 41.9 34.3 49.4 13.3 17.2 10.0 21.3 13.3 p <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 HCV test Negative 9.9 7.8 32.8 1.4 3.6 1.9 11.5 1.4 Positive 26.6 12.6 53.8 3.6 9.5 1.6 19.2 3.6 p <0.001 0.003 <0.001 <0.001 <0.001 0.030 <0.001 <0.001 Seroprevalence of antibodies against T. pall idum . VCT: People seeking HIV-1 voluntary counseling and testing; PPr: people in prision; PLWH: people living with HIV; Others: patients from others clinics. Active syphilis, titters ≥ 1:8 in non-treponemic tests. Bold: p<0.01 statistically significant Dynamic Retrospective Cohort . There were samples from 11,124 individuals with a baseline syphilis outcome and at least one additional visit to the CEC, the median time between visits was 10.6 months (interval interquartil 6.0-18.0). Figure 2 shows that from baseline, 10,844 people were negative for the treponemal test and 283 were positive. During follow-up of negative samples, 413 positive samples were detected in the second measurement. Considering the non-treponemal test at baseline and second measurement, 59.6% had a cured infection, 13.6% had re-infection, and 26.8% had persistent infection among the VCT group; 29.6% had a cured infection, 11.1% re-infection, and 59.3% persistent infection among PPr; 56.1% had cured infection, 24.4% re-infection, and 19.5% persistent infection among PLWH; 50.0% had cured infection, 21.4% re-infection and 28.6% persistent infection in the others group. Considering all groups, 49.4% of persons with persistent syphilis infection had twelve months or more between the two measurements (treatment failure); among people without HIV this percentage was 41.9% (26/62) and among people living with HIV it was 73.7% (14/19), this difference was statistically significant (p=0.019). The highest incidence of syphilis was found in the PLWH group, with 16.0 cases per 100 py (95% CI 12.6-20.3), followed by the VCT population, with 3.5 cases (95% CI 3.1-3.8), PPr group with 0.95 cases (95% CI 0.5-1.7), and finally others with 0.86 cases (95% CI 0.3-2.6). Among the PLWH, at 39.67 months (95% CI 30.91-48.41), 50% of the population acquired syphilis, a value that was lower compared to VCT individuals (52.5 months; 95% CI 48.51-56.5). This difference was statistically significant (p < 0.001; Log Rank; Figure 3). For the other groups, it was impossible to calculate the infection time due to the sample size and the low proportion of positive cases. Table 3 shows the incidence rate ratio for syphilis. Notably, the incidence increased in relation to the calendar year, but this change was not statistically significant. Men and transgender had an incidence of 4.6 cases per 100 py and had a 9-times greater risk to have syphilis compared to women. The 20-29 and 30-39 year age groups had the highest incidence of T. pallidum infection, with 3.9 and 3.4 cases per 100 py, respectively. These groups also had twice the risk of infection compared to individuals over 50 years old. People with a history of HIV infection had an incidence of 12.2 cases per 100 py, those with a history of HBV infection had an incidence of 11.4 cases, and individuals with HCV infection showed 1.7 cases per 100 py. Table 3 Incidence and risk factors for T. pallidum infection in populations attending a specialized HIV clinic in Mexico. Cases/years follow-up Incidence per 100 py* IRR** Year 2015 10/309 3.23 1.03 (0.47-2.02) 2014 70/1,867 3.75 1.20 (0.84-1.70 2013 126/3,288 3.83 1.22 (0.90-1.67) 2012 140/4,238 3.30 1.05 (0.78-1.43) 2011 67/2,137 3.14 1.0 Sex Male 386/8,411 4.59 8.68 (5.35-15.06) Transgender 10/213 4.69 8.88 (3.64-20.54) Female 17/3,217 0.53 1.0 Age (years) ≤ 9 0/51 -- 10-19 31/956 3.24 1.82 (0.79-4.91) 20-29 244/6,267 3.89 2.19 (1.05-5.51) 30-39 99/2,951 3.35 1.89 (0.88-4.82) 40-49 31/1,120 2.77 1.56 (0.67-4.19) ≥50 7/394 1.78 1 HIV basal test Positive 113/923 12.24 4.42 (3.53-5.51) Negative 298/10,767 2.77 1.0 HBV basal test Positive 9/78 11.54 3.21 (1.46-6.17) Negative 343/9,554 3.59 1.0 HCV basal test Positive 2/114 1.75 0.5 (0.1-1.82) Negative 386/11,009 3.51 1.0 *py: persons years of follow-up; bold: statistically significant. **IRR : Incidence rate ratio Discussion The prevalence of syphilis in the groups that attended the CEC is high (8.2% among PPr to 37.0% among PLWH) compared to other vulnerable populations such female sex workers (14.2%), 10 people in prison (2.0%), 11 and MSM (9.5%, 14.8%, and 30% in 2014, 2016, and 2017, respectively). 12 Likewise, the prevalence detected at the CEC is higher than groups such as pregnant women (0.26%), blood donors (1.4%), and the general population (3.1%). 13–15 The highest seroprevalence of syphilis and active syphilis was among men and transgender people. It is possible that a high proportion of men attending the CEC are MSM, a group in which the HIV epidemic in Mexico is concentrated. 15 In the case of men, the high frequency and incidence of active syphilis could be related to sexual practices, unprotected anal sex, a large number of sexual partners, and/or casual relationships. The transgender population had different vulnerabilities, namely being sex workers, unfavorable economic conditions, and/or stigma and discrimination. 16 The highest frequency of active syphilis, as well as the highest incidence of syphilis, was found in 20-39-year-old individuals. These data are consistent with the worldwide trend, which shows that the largest number of new STI cases occur in the young population. 3 Thus, it is necessary to focus syphilis prevention and diagnosis programs in these groups. The presence of other STIs is a risk factor for acquisition and transmission of T. pallidum , as shown with HIV and HBV but not HCV (whose main route of transmission is parenteral rather than sexual). People living with HIV have a suppressed immune system, and this suppression increases their susceptibility to other STIs such as syphilis. 17 People with HIV-syphilis coinfection have a higher risk of neurological complications, which may be more frequent, progress faster, and present atypical signs. These individuals may also have treatment failure or present serofast (individuals without syphilis but higher antibodies titers). 18 On the other hand, syphilitic lesions increase the risk of acquiring and transmitting HIV; persons with syphilis have a 4-fold greater risk of acquiring HIV. 19 This value is similar to current study among people attending the CEC. The higher prevalence and incidence of syphilis among PLWH may be by the individual risk perception and their social networks. 20 From the onset of antiretroviral treatment, the number of deaths decreased and life expectancy improved. Consequently, some PLWH continued with risky sexual behaviors, such as sex without a condom, anal sex, occasional sexual partners, concurrent sexual partners, and/or alcohol and illegal drug use. 21 A high percentage of people had persistent infection, that is, they maintained similar levels of antibodies during the study period. Failures in syphilis treatment have been documented from 3% among people without HIV to 17% among PLWH. 22 Furthermore, among PLWH, the antibody titers take longer to decrease (serofast patients) up to 25% of population. 23 The CEC prescribes the treatment for syphilis; however, it is unknown if people receive the treatment, as most of the participants are sent to their family medical clinic for follow-up. Only the PLWH without social security are followed in the CEC. There are few studies on the incidence of syphilis in Mexico. Among FSW, it was 4.31 cases, and among their stable sexual partners, it was 3.64 cases per 100 py. 24 In current study, the VCT group had a similar incidence, 3.4 cases. However, the highest incidence was among the PLWH, with 16 cases per 100 py. The syphilis incidence was higher than detected in other countries, including Italy (1.94), Singapore (6.21), and Australia (5.47 per 100 py), all among PLWH. 23 , 25 , 26 It was similar to the very high incidence of syphilis reported in Argentina (14.9 cases per 100 py). 27 In addition to the high incidence, there was a high percentage of syphilis re-infection. In other countries, this re-infection has been reported and appears to be a risk factor for re-infection, being asymptomatic, living with HIV, being a MSM, and failure in case follow-up. 28 In relation to limitations of current study, did not include sociodemographic, sexual behavior, and clinical information about participants; it was to difficult to know if all patients received the adequate treatment and follow up because there is no epidemiological surveillance information about others clinics; the prevalence of active infection without clinical information may be overestimating the prevalence especially among PLWH that presents serofast; and there was a potential selection bias in the dynamic cohort, due to the small number of cases with follow up. Conclusion Different vulnerable groups showed high prevalence of active syphilis, high incidence, and re-infections. The results confirm that it is necessary to allocate more resources for the detection, treatment and monitoring of syphilis cases, as established by WHO, which prioritizes three STIs: human papillomavirus, Neisseria gonorrhoeae , and T. pallidum , the latter with objectives of eliminating congenital syphilis and controlling syphilis in specific populations. 29 The strategy should be focused specifically among vulnerable groups, such as FSW, IDUs, MSM, and transgender women. 30 List Of Abbreviations People seeking HIV-1 voluntary counseling and testing: VCT People in prison: PPr People living with HIV: PLWH World Health Organization: WHO Female sex worker: FSW Men who have sex with men: MSM Intravenous drug users: IDUs Clinica Especializada Condesa: CEC Sexually transmitted infections: STI Hepatitis B Virus: HBV Hepatitis C Virus: HCV Chemiluminescent microparticle immunoassay: CMIA Venereal disease research laboratory: VDRL chi-square: χ 2 person years: py Incidence rate ratios: IRR Confidence intervals: CI Declarations Ethics approval and consent to participate. The participants signed an informed consent letter. The study was approved by the ethics committee of the National Institute of Public Health Consent for publication. Not applicable Availability of data and materials. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests. The authors declare that they have no competing interests Funding. Not funding Authors' contributions. ODTG. Construct the dataset and statistical analyses. VRG. Laboratory analyses about syphilis, VHB, VHC and HIV. GCS Revised the dataset about laboratory results. AGR coordinate the laboratory analyses and the basic information about the assistant to “Clinica Especializada Condesa”. AHO. Write the manuscript and analyzed the information. MOP Revised the paper. MASA Write the manuscript, statistical analyses and analyzed the information. Acknowledgements. Not applicable Authors' information. 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Kenyon C, Lynen L, Florence E, Caluwaerts S, Vandenbruaene M, Apers L, et al. Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012. Euro Surveill. 2014;19:20958. World Health Organization. Global health sector strategy against sexually transmitted infections 2016–2021. Towards the end of STIs. WHO/RHR/16.09. World Health Organization. Report on global sexually transmitted infection surveillance, 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-559014","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":36788270,"identity":"7865b813-a513-4ec2-988b-7528833e7884","order_by":0,"name":"Omar David Tumalán-Gil","email":"","orcid":"","institution":"Instituto Nacional de Salud Pública","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Omar","middleName":"David","lastName":"Tumalán-Gil","suffix":""},{"id":36788271,"identity":"38acdef5-d7c4-4daa-adfd-15f1d47df04c","order_by":1,"name":"Verónica Ruiz-González","email":"","orcid":"","institution":"Clinica Especializada Condesa","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Verónica","middleName":"","lastName":"Ruiz-González","suffix":""},{"id":36788272,"identity":"bed33642-cd35-4dd7-b095-28e64e9718f0","order_by":2,"name":"Santa García-Cisneros","email":"","orcid":"","institution":"Instituto Nacional de Salud Pública","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Santa","middleName":"","lastName":"García-Cisneros","suffix":""},{"id":36788273,"identity":"cb051496-2984-46a2-9711-0449eda027dd","order_by":3,"name":"Andrea González-Rodríguez","email":"","orcid":"","institution":"Coordinación programa VIH/SIDA, Ciudad de México","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"González-Rodríguez","suffix":""},{"id":36788274,"identity":"2315a8a6-af85-4998-810c-999507dbcb8a","order_by":4,"name":"Antonia Herrera-Ortiz","email":"","orcid":"","institution":"Instituto Nacional de Salud Pública","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Antonia","middleName":"","lastName":"Herrera-Ortiz","suffix":""},{"id":36788275,"identity":"626d8ba2-19f4-42a1-b1e1-719f67a68f7d","order_by":5,"name":"Maria Olamendi-Portugal","email":"","orcid":"","institution":"Instituto Nacional de Salud Pública","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Olamendi-Portugal","suffix":""},{"id":36788276,"identity":"57223c07-3514-4ffc-8385-da13a781d051","order_by":6,"name":"Miguel Sanchez-Aleman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYLACxgYGBn5mkrVINpOsxeAAsap1+w8/e/Bzh4298XHew58LGLYlNhDSYnYjzdyw90was9lhvjTpGQy3jQnaYnaDwUyase0wm9lhHjNmHobbcoS1nD/+DajlP49xM4/xZ6AWHsJaDuSAbDkgYcDMYyBNnC03csoke9uSDSSADpOeYUCMX84f3ybxs83Onr//jPHngorbhEMMBTAzGJCkHqxlFIyCUTAKRgEWAADxEjW95YiQIgAAAABJRU5ErkJggg==","orcid":"","institution":"Instituto Nacional de Salud Pública","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Miguel","middleName":"","lastName":"Sanchez-Aleman","suffix":""}],"badges":[],"createdAt":"2021-05-25 19:24:49","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-559014/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-559014/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":11019566,"identity":"65b74ffb-4626-4472-8379-d4b4e3bda151","added_by":"auto","created_at":"2021-07-01 19:29:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12694,"visible":true,"origin":"","legend":"Seroprevalence of T. pallidum and active syphilis in populations attending a specialized HIV clinic in Mexico. α-Tp: antibodies against T. pallidum. Antibodies titers was not performed in 0.2% of people seeking HIV-1 voluntary counseling and testing (VCT), in 0.04% of people in prison (PPr), in 4.5% of people living with HIV (PLWH) and in 0.1% others.","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-559014/v2/e53eb52f814304ad42f6048c.png"},{"id":11019194,"identity":"dfe5ff3d-50d8-4da3-944c-043379dd1476","added_by":"auto","created_at":"2021-07-01 19:26:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22165,"visible":true,"origin":"","legend":"Retrospective dynamic cohort in populations attending a specialized HIV clinic in Mexico. ","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-559014/v2/180b465c48f4a88d0055a202.png"},{"id":11019018,"identity":"ee0233b4-f1ba-472a-8db4-53b67f28db42","added_by":"auto","created_at":"2021-07-01 19:23:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9613,"visible":true,"origin":"","legend":"Cumulative incidence of T. pallidum in populations attending a specialized HIV clinic in Mexico. VCT: People seeking HIV-1 voluntary counseling and testing; PPr: people in prison; PLWH: people living with HIV; Others: patients from others clinics.","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-559014/v2/dbbe1a3b3a0b095c4a400914.png"},{"id":16561707,"identity":"b956942e-c0fb-450d-8ad3-6771f27fb14a","added_by":"auto","created_at":"2021-12-17 18:16:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":448802,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-559014/v2/473002f2-d27b-4811-9ec7-592ad6514eaa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHigh Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eThe World Health Organization (WHO) estimated the number of new cases of syphilis in 2012 at 5.6\u0026nbsp;million; it increased to 6\u0026nbsp;million in 2016. In the latter year, the incidence was 1.7 cases per thousand women and 1.6 cases per thousand men. Globally, the syphilis prevalence was 3.2% among female sex worker (FSW) and 6.0% among men who have sex with men (MSM). The WHO set the goal to reduce the incidence of \u003cem\u003eTreponema pallidum\u003c/em\u003e by 90%, with a focus on priority groups: MSM, FSW, and intravenous drug users (IDUs).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSyphilis has increased in different parts of the world. Between 2013 and 2017, the number of cases per 100,000 inhabitants in the U.S. increased from 5.5 to 9.5.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The European Economic Community reported an increase from 4.7 cases to 6.1 cases per 100,000 inhabitants between 2012 and 2016.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e In Mexico, an increase in syphilis was documented among young men, focused in Mexico City.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Syphilis is important because of the number of cases as well as the higher risk to acquire and transmit HIV. Moreover, syphilis and HIV coinfection negatively modifies both diseases.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Clinica Especializada Condesa (CEC) in Mexico City is the institution that serves the largest number of people seeking HIV testing, as well as people living with HIV. The CEC also performs test for other sexually transmitted infections (STI), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis. The objective of the current study was to determine the prevalence, incidence, and risk factors of infection by \u003cem\u003eT. pallidum\u003c/em\u003e among populations attending the CEC from 2011\u0026ndash;2015.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eA database was elaborated with the variables year, internal number, population type, sex, age, HIV by chemiluminescent microparticle immunoassay (CMIA), HIV rapid test 1, HIV rapid test 2, HIV Western blot, \u003cem\u003eT. pallidum\u003c/em\u003e by CMIA, \u003cem\u003eT. Pallidum\u003c/em\u003e rapid test, venereal disease research laboratory (VDRL) titer, HVB antigen detection, and HCV antibodies detection. Syphilis was detected using the reverse algorithm. This method starts with a treponemal test to later perform the VDRL. Some authors have mentioned that in the absence of clinical data, the antibody titer can be used to determine the stages of syphilis, as active syphilis (titer\u0026thinsp;\u0026ge;\u0026thinsp;1: 8), latent syphilis (titer 1:1\u0026ndash;1:4) and cured syphilis (VDRL negative, positive treponemal test).\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e The attending population was classified into four groups: (1) people seeking HIV-1 voluntary counseling and testing (VCT), (2) people living with HIV (PLWH), (3) people in prison (PPr), and (4) others, people from others clinics, principally primary care clinics. The CEC sends patients with syphilis to their primary care clinics for treatment, only PLWH without social security attended CEC. The present study was approved by the ethics committee of the National Institute of Public Health from Mexico. The research was carried out according to national guidelines and the Declaration of Helsinki. All the people who attend the CEC are asked to sign a letter of informed consent. The database had identification keys, we did not have access to the names of the participants.\u003c/p\u003e \u003cp\u003eFrom the baseline information, frequency analysis stratified by population group was performed, and chi-square (χ\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e) tests were used to evaluate the differences. Subsequently, a bivariate analysis was performed to determine associated variables, both to the seroprevalence of syphilis and the presence of active syphilis. The trend test was used for the year and age variables, considering the four population groups.\u003c/p\u003e \u003cp\u003eA retrospective dynamic cohort was elaborated with individuals that had two syphilis tests with at least four months between measurements and incidence densities was calculated using person years (py). During follow-up, syphilis was considered cured if the antibody titer decreased until negative or if the antibody concentration decreased four times or more. Syphilis re-infection was defined when it was cured at baseline and the titer was \u0026ge;\u0026thinsp;1:1 during follow-up or if antibody titer increased four times or more. Persistent infection was considered if the antibody titer remained similar (\u0026plusmn;\u0026thinsp;2 times).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Incidence rate ratios (IRR) were calculated with 95% confidence intervals (CI), and a cumulative incidence curve was constructed using the Kaplan-Meier method. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01 was considered statistically significant. Statistical analysis was performed using the SPSS program.\u003c/p\u003e "},{"header":"Results","content":"\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eBasal.\u003c/span\u003e\u003c/strong\u003e \u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eA total of\u0026nbsp;129,613 blood/serum samples were processed in the CEC laboratory between 2011 to 2015. In 2011, there were 17,589 samples, and in 2015, there were 37,342.\u003c/span\u003e \u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eResults for syphilis detection were from 95,732 samples, of which 81,863 people attended at least once; 78.1% were VCT, 9.9% PPr, 2.2% PLWH, and 9.8% others. Table 1 shows the demographic characteristics and laboratory results of the four analyzed populations. In all groups, there was an increase in the number of samples analyzed over the years, with the exception of PPr that presented the greatest number of samples during 2012-2013. Men were the majority in all groups, from 63.3% among others to 85.5% among PLWH. The highest percentage of transgender was in the PLWH group. PLWH had the highest average age at 34.6 years, and VCT were the youngest on average (29.0 years). One-in-five VCT individuals were HIV positive; 3.8% of PPr individuals were HIV positive. Among PLWH, 4.9% had HBV antigens and 2.9% had antibodies against HCV.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003eTable 1. Demographic and clinical characteristics in populations attending a specialized HIV clinic in Mexico.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;line-height:107%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"width:417.9pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eVCT\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eN=63,916\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePDL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eN=8,083\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePLWH\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eN=1,808\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp 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medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eYear\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2011\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e8.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e16.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e18.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e13.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2012\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e19.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e25.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e24.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e17.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2013\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e21.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e22.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e19.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e24.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2014\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e23.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e17.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e14.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e23.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2015\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e26.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e19.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e22.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e21.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eSex\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e34.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e31.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e11.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e36.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e64.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e67.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e85.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e63.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eTranssexual\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e1.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e0.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.5pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eAge (years)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026le; 9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e1.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e0.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e7.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e10-19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e11.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e19.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan 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14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePositive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e18.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e3.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e100\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e7.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eNot done\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e5.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e6.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eHBV test\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e89.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e74.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e77.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e83.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePositive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e0.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e0.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e4.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e0.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eNot done\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e10.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e24.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e17.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e15.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eHCV test\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e95.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e81.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e81.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e86.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePositive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e0.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e1.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border: medium none;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.9pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eNot done\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.6pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e3.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e15.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e15.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.65pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e12.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 14.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;line-height:107%;\"\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003eVCT: People seeking HIV-1 voluntary counseling and testing; PPr: people in prison; PLWH: \u0026nbsp;people living with HIV; Others: patients from primary care clinics. Bold: p\u0026lt;0.01 statistically significant.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eThe seroprevalence of syphilis was 8.2% (95% CI 7.6-8.8) among PPr, 8.7% (95% CI 8.1-9.3) among others, 9.9% (95% CI 9.7-10.1) in the VCT population, and 37.0% (95% CI 34.8-39.2) among PLWH. Figure 1 shows the seroprevalence of syphilis and active syphilis. Almost 40% of people with antibodies showed a cured infection, except among PLWH, in which the percentage was 32.4%. The VCT and PLWH populations had the highest seroprevalence of active syphilis, with 3.6 and 13.1%, respectively.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:200%;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eThe seroprevalence of syphilis decreased over time in the CVT and PPr groups (p\u0026lt;0.001). The transgender population had the highest seroprevalence; it was higher among the PPr followed by PLWH, with more than 40% in both cases (p\u0026lt;0.001). At an older age, the seroprevalence of syphilis increased in the four analyzed population groups (p\u0026lt;0.001). Individuals with other STIs (HIV, HBV, or HCV) had a higher association with the seroprevalence of syphilis (p\u0026lt;0.05; Table 2, left).\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:200%;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eWhen analyzing the frequency of active syphilis, there was a decrease during the study period in the VCT group. In contrast, active syphilis increased among PLWH during the analyzed period. Women presented the lowest proportion of active syphilis in the four groups; the highest frequency of active syphilis was in transgender and men living with HIV: 17.0% and 14.2%, respectively (p\u0026lt;0.001). People aged 20-29 and 30-39 years had the highest frequency of active syphilis in the VCT group. A history of STIs was associated with a higher frequency of active syphilis in the entire population (Table 2, right).\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:200%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;text-align:center;'\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003eTable 2 Seroprevalence of \u003cem\u003eT. pallidum\u003c/em\u003e and active syphilis in\u003c/span\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003epopulations attending a specialized HIV clinic in Mexico.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"width: 5.2e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 198.75pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eSeroprevalence T. \u003cem\u003epallidum\u003c/em\u003e\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.95pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 205.55pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eActive syphilis\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.85pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eVCT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePPr\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003ePLWH\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eOthers\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.95pt;border: medium none;padding: 0in 5.4pt;height: 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2011\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e3.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2014\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e9.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e8.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan 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medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e1.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e14.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e1.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e2015\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e9.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e5.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e0.720\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.95pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:115%;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e0.720\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eAge (years)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan 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5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.65pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 3.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 3.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-size:15px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e0.030\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 3.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 3.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:115%;font-family: \"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;text-align:center;'\u003e\u003cspan style='font-size: 13px; line-height: 107%; font-family: \"Arial\", sans-serif; color: rgb(0, 0, 0);'\u003eSeroprevalence of antibodies against\u0026nbsp;\u003c/span\u003e\u003cem\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eT. pall\u003c/span\u003eidum\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003e. VCT: People seeking HIV-1 voluntary counseling and testing; PPr: people in prision; PLWH: people living with HIV; Others: patients from others clinics. Active syphilis, titters \u0026ge; 1:8 in non-treponemic tests. Bold: p\u0026lt;0.01 statistically significant\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:200%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:200%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eDynamic Retrospective Cohort\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e. There were samples from 11,124 individuals with a baseline syphilis outcome and at least one additional visit to the CEC, the median time between visits was 10.6 months (interval interquartil 6.0-18.0). Figure 2 shows that from baseline, 10,844 people were negative for the treponemal test and 283 were positive. During follow-up of negative samples, 413 positive samples were detected in the second measurement. Considering the non-treponemal test at baseline and second measurement, 59.6% had a cured infection, 13.6% had re-infection, and 26.8% had persistent infection among the VCT group; 29.6% had a cured infection, 11.1% re-infection, and 59.3% persistent infection among PPr; 56.1% had cured infection, 24.4% re-infection, and 19.5% persistent infection among PLWH; 50.0% had cured infection, 21.4% re-infection and 28.6% persistent infection in the others group. Considering all groups, 49.4% of persons with persistent syphilis infection had twelve months or more between the two measurements (treatment failure); among people without HIV this percentage was 41.9% (26/62) and among people living with HIV it was 73.7% (14/19), this difference was statistically significant (p=0.019).\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eThe highest incidence of syphilis was found in the PLWH group, with 16.0 cases per 100 py (95% CI 12.6-20.3), followed by the VCT population, with 3.5 cases (95% CI 3.1-3.8), PPr group with 0.95 cases (95% CI 0.5-1.7), and finally others with 0.86 cases (95% CI 0.3-2.6).\u003c/span\u003e \u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eAmong the PLWH, at 39.67 months (95% CI 30.91-48.41), 50% of the population acquired syphilis, a value that was lower compared to VCT individuals (52.5 months; 95% CI 48.51-56.5). This difference was statistically significant (p \u0026lt; 0.001; Log Rank; Figure 3). For the other groups, it was impossible to calculate the infection time due to the sample size and the low proportion of positive cases.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:200%;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eTable 3 shows the incidence rate ratio for syphilis. Notably, the incidence increased in relation to the calendar year, but this change was not statistically significant. Men and transgender had an incidence of 4.6 cases per 100 py and had a 9-times greater risk to have syphilis compared to women. The 20-29 and 30-39 year age groups had the highest incidence of \u003cem\u003eT. pallidum\u003c/em\u003e infection, with 3.9 and 3.4 cases per 100 py, respectively. These groups also had twice the risk of infection compared to individuals over 50 years old. People with a history of HIV infection had an incidence of 12.2 cases per 100 py, those with a history of HBV infection had an incidence of 11.4 cases, and individuals with HCV infection showed 1.7 cases per 100 py.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;text-align:center;'\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;text-align:center;'\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;text-align:center;'\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003eTable 3 Incidence and risk factors for \u003cem\u003eT. pallidum\u003c/em\u003e\u003c/span\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;infection\u003c/span\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;in populations attending a specialized HIV clinic in Mexico.\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"width: 3.3e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1pt medium;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1pt medium;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eCases/years follow-up\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1pt medium;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eIncidence per 100 py*\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1pt medium;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eIRR**\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eYear\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2015\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e10/309\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e3.23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e1.03 (0.47-2.02)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2014\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e70/1,867\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e3.75\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e1.20 (0.84-1.70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2013\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e126/3,288\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e3.83\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e1.22 (0.90-1.67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2012\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e140/4,238\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2011\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e67/2,137\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e3.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 0.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eSex\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 0.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 0.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 0.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e386/8,411\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e4.59\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e8.68 (5.35-15.06)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eTransgender\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e10/213\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e4.69\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e8.88 (3.64-20.54)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e17/3,217\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e0.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eAge (years)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026le; 9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e0/51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e--\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e10-19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e31/956\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e20-29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e244/6,267\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e3.35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.89 (0.88-4.82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e40-49\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e31/1,120\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e2.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.56 (0.67-4.19)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026ge;50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e7/394\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eHIV basal test\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003ePositive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e113/923\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e12.24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e4.42 (3.53-5.51)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e298/10,767\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e2.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 163.05pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eHBV basal test\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003ePositive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e9/78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e11.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e3.21 (1.46-6.17)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e343/9,554\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e3.59\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 163.05pt;border: medium none;padding: 0in 5.4pt;height: 4.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eHCV basal test\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 4.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 4.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003ePositive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e2/114\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.75\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium none;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e0.5 (0.1-1.82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85.35pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.7pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;text-align:right;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e386/11,009\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e3.51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;margin:0in;text-align:right;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;text-align:center;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003e*py: persons years of follow-up; bold: statistically significant. **IRR\u003cstrong\u003e:\u003c/strong\u003e Incidence rate ratio\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eThe prevalence of syphilis in the groups that attended the CEC is high (8.2% among PPr to 37.0% among PLWH) compared to other vulnerable populations such female sex workers (14.2%),\u003csup\u003e10\u003c/sup\u003e people in prison (2.0%),\u003csup\u003e11\u003c/sup\u003e and MSM (9.5%, 14.8%, and 30% in 2014, 2016, and 2017, respectively).\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Likewise, the prevalence detected at the CEC is higher than groups such as pregnant women (0.26%), blood donors (1.4%), and the general population (3.1%).\u003csup\u003e13\u0026ndash;15\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe highest seroprevalence of syphilis and active syphilis was among men and transgender people. It is possible that a high proportion of men attending the CEC are MSM, a group in which the HIV epidemic in Mexico is concentrated.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In the case of men, the high frequency and incidence of active syphilis could be related to sexual practices, unprotected anal sex, a large number of sexual partners, and/or casual relationships. The transgender population had different vulnerabilities, namely being sex workers, unfavorable economic conditions, and/or stigma and discrimination.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe highest frequency of active syphilis, as well as the highest incidence of syphilis, was found in 20-39-year-old individuals. These data are consistent with the worldwide trend, which shows that the largest number of new STI cases occur in the young population.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Thus, it is necessary to focus syphilis prevention and diagnosis programs in these groups. The presence of other STIs is a risk factor for acquisition and transmission of \u003cem\u003eT. pallidum\u003c/em\u003e, as shown with HIV and HBV but not HCV (whose main route of transmission is parenteral rather than sexual). People living with HIV have a suppressed immune system, and this suppression increases their susceptibility to other STIs such as syphilis.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e People with HIV-syphilis coinfection have a higher risk of neurological complications, which may be more frequent, progress faster, and present atypical signs. These individuals may also have treatment failure or present serofast (individuals without syphilis but higher antibodies titers).\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e On the other hand, syphilitic lesions increase the risk of acquiring and transmitting HIV; persons with syphilis have a 4-fold greater risk of acquiring HIV.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e This value is similar to current study among people attending the CEC.\u003c/p\u003e \u003cp\u003eThe higher prevalence and incidence of syphilis among PLWH may be by the individual risk perception and their social networks.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e From the onset of antiretroviral treatment, the number of deaths decreased and life expectancy improved. Consequently, some PLWH continued with risky sexual behaviors, such as sex without a condom, anal sex, occasional sexual partners, concurrent sexual partners, and/or alcohol and illegal drug use.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA high percentage of people had persistent infection, that is, they maintained similar levels of antibodies during the study period. Failures in syphilis treatment have been documented from 3% among people without HIV to 17% among PLWH.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Furthermore, among PLWH, the antibody titers take longer to decrease (serofast patients) up to 25% of population.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e The CEC prescribes the treatment for syphilis; however, it is unknown if people receive the treatment, as most of the participants are sent to their family medical clinic for follow-up. Only the PLWH without social security are followed in the CEC.\u003c/p\u003e \u003cp\u003eThere are few studies on the incidence of syphilis in Mexico. Among FSW, it was 4.31 cases, and among their stable sexual partners, it was 3.64 cases per 100 py.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e In current study, the VCT group had a similar incidence, 3.4 cases. However, the highest incidence was among the PLWH, with 16 cases per 100 py. The syphilis incidence was higher than detected in other countries, including Italy (1.94), Singapore (6.21), and Australia (5.47 per 100 py), all among PLWH.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e It was similar to the very high incidence of syphilis reported in Argentina (14.9 cases per 100 py).\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e In addition to the high incidence, there was a high percentage of syphilis re-infection. In other countries, this re-infection has been reported and appears to be a risk factor for re-infection, being asymptomatic, living with HIV, being a MSM, and failure in case follow-up.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn relation to limitations of current study, did not include sociodemographic, sexual behavior, and clinical information about participants; it was to difficult to know if all patients received the adequate treatment and follow up because there is no epidemiological surveillance information about others clinics; the prevalence of active infection without clinical information may be overestimating the prevalence especially among PLWH that presents serofast; and there was a potential selection bias in the dynamic cohort, due to the small number of cases with follow up.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eDifferent vulnerable groups showed high prevalence of active syphilis, high incidence, and re-infections. The results confirm that it is necessary to allocate more resources for the detection, treatment and monitoring of syphilis cases, as established by WHO, which prioritizes three STIs: human papillomavirus, \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e, and \u003cem\u003eT. pallidum\u003c/em\u003e, the latter with objectives of eliminating congenital syphilis and controlling syphilis in specific populations.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e The strategy should be focused specifically among vulnerable groups, such as FSW, IDUs, MSM, and transgender women.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e "},{"header":"List Of Abbreviations","content":"\u003cp\u003ePeople seeking HIV-1 voluntary counseling and testing: VCT\u003c/p\u003e\n\u003cp\u003ePeople in prison: PPr\u003c/p\u003e\n\u003cp\u003ePeople living with HIV: PLWH\u003c/p\u003e\n\u003cp\u003eWorld Health Organization: WHO\u003c/p\u003e\n\u003cp\u003eFemale sex worker: FSW\u003c/p\u003e\n\u003cp\u003eMen who have sex with men: MSM\u003c/p\u003e\n\u003cp\u003eIntravenous drug users: IDUs\u003c/p\u003e\n\u003cp\u003eClinica Especializada Condesa: CEC\u003c/p\u003e\n\u003cp\u003eSexually transmitted infections: STI\u003c/p\u003e\n\u003cp\u003eHepatitis B Virus: HBV\u003c/p\u003e\n\u003cp\u003eHepatitis C Virus: HCV\u003c/p\u003e\n\u003cp\u003eChemiluminescent microparticle immunoassay: CMIA\u003c/p\u003e\n\u003cp\u003eVenereal disease research laboratory: VDRL\u003c/p\u003e\n\u003cp\u003echi-square: \u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eperson years: py\u003c/p\u003e\n\u003cp\u003eIncidence rate ratios: IRR\u003c/p\u003e\n\u003cp\u003eConfidence intervals: CI\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate.\u0026nbsp;\u003c/strong\u003eThe participants signed an informed consent letter. The study was approved by the ethics committee of the National Institute of Public Health\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication.\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials.\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests.\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e\u0026nbsp; Not funding\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026apos; contributions.\u0026nbsp;\u003c/strong\u003eODTG. Construct the dataset and statistical analyses. VRG. Laboratory analyses about syphilis, VHB, VHC and HIV. GCS Revised the dataset about laboratory results. AGR coordinate the laboratory analyses and the basic information about the assistant to \u0026ldquo;Clinica Especializada Condesa\u0026rdquo;. AHO. Write the manuscript and analyzed the information. MOP Revised the paper. MASA Write the manuscript, statistical analyses and analyzed the information.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements.\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026apos; information.\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNewman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One 2015;10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Licence: CC BY-NC-SA 3.0 IGO.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"syphilis, syphilis serodiagnosis, cohort studies, incidence","lastPublishedDoi":"10.21203/rs.3.rs-559014/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-559014/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground. Syphilis has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011-2015. \u003c/p\u003e\u003cp\u003eMethods. Databases from the laboratory were analyzed and four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH) and patients from primary care clinics (others). Syphilis diagnosis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data was analyzed, and with follow-up information, a retrospective dynamic cohort was formed. Factors associated with seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. \u003c/p\u003e\u003cp\u003eResults. A total of 81,863 baseline individuals were analyzed. Syphilis seroprevalence was 9.9% in VCT, 8.2% in PPr, 37.0% in PLWH, and 8.7% in others; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed-up; the incidence (cases per 100 years people) was 3.5 among VCT and 16.0 among PLWH; moreover, the frequency of re-infections was 11.1-24.4%. Men, transgender, persons between 20-39 years old, and individuals with a history of HIV or hepatitis B had a higher risk of syphilis. \u003c/p\u003e\u003cp\u003eConclusions. Several vulnerable groups have exhibited a reemergence of syphilis, with high prevalence of active syphilis, high incidence, and re-infections. Persons living with HIV had the highest risk.\u003c/p\u003e","manuscriptTitle":"High Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2021-07-01 19:23:51","doi":"10.21203/rs.3.rs-559014/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2021-06-03 18:04:24","doi":"10.21203/rs.3.rs-559014/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba7e14ef-f472-4d29-83c6-c3d827e81856","owner":[],"postedDate":"July 1st, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":5422833,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2021-12-17T18:14:47+00:00","versionOfRecord":[],"versionCreatedAt":"2021-07-01 19:23:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-559014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-559014","identity":"rs-559014","version":["v2"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}