Table 3 Multilevel multivariable regression model for factors associated with self-reported diagnosis of syphilis (overall and symptomatic) in 68 countries

Region

Central-West Europe (AT, CH, DE, LI, LU)

ref.

West Europe (BE, FR, IE, NL, MC, UK)

1.75

1.05–2.93

0.033

0.84

0.48–1.49

0.560

1.22

0.71–2.08

0.467

0.99

0.64–1.52

0.955

Southwest Europe (AD, ES, IT, MT, PT, SM)

1.46

0.84–2.54

0.177

1.29

0.88–1.91

0.191

1.86

1.06–3.29

0.032

1.67

1.07–2.62

0.024

Northwest Europe (DK, FI, IS, NO, SE)

0.51

0.29–0.88

0.016

0.51

0.35–0.76

0.001

0.57

0.31–1.05

0.073

0.64

0.38–1.06

0.085

Northeast Europe (EE, LT, LV)

0.54

0.25–1.16

0.113

0.75

0.40–1.43

0.381

0.32

0.07–1.42

0.133

0.38

0.09–1.64

0.194

Central-East Europe (CZ, HU, PL, SK, SL)

0.78

0.46–1.34

0.371

1.01

0.70–1.46

0.970

1.14

0.65–2.02

0.647

1.26

0.79–2.02

0.328

Southeast Europe (AL, BA, BU, CY, HR, GR, HR, ME, MK, RO, RS, TR, XK)

0.69

0.42–1.12

0.132

0.88

0.62–1.24

0.460

0.96

0.56–1.64

0.879

1.06

0.68–1.66

0.785

East Europe (BY, MD, RU, UA)

0.97

0.55–1.71

0.908

0.87

0.57–1.33

0.526

1.26

0.67–2.35

0.470

1.26

0.75–2.10

0.387

Middle East (IL, LB)

0.76

0.36–1.62

0.476

0.66

0.37–1.17

0.155

0.62

0.22–1.71

0.356

0.57

0.23–1.41

0.222

Philippines

0.46

0.20–1.10

0.080

0.57

0.31–1.05

0.072

0.47

0.18–1.25

0.130

0.57

0.25–1.29

0.178

Canada

1.05

0.46–2.42

0.902

0.56

0.26–1.20

0.137

0.72

0.31–1.71

0.460

0.68

0.34–1.35

0.268

Mexico

1.48

0.65–3.38

0.346

1.47

0.87–2.51

0.153

1.89

0.85–4.21

0.117

1.63

0.89–2.98

0.117

Central America (CR, GT, HN, NI, PA, SV)

1.64

0.98–2.74

0.057

1.86

1.29–2.67

0.001

1.97

1.12–3.44

0.018

2.30

1.45–3.66

< 0.001

Andean region (BO, EC, CO, PE, VE, SR)

1.84

1.11–3.05

0.019

1.86

1.29–2.68

0.001

2.48

1.46–4.22

0.001

2.42

1.57–3.72

< 0.001

Southern Cone (AR, CL, UY, PY)

2.04

1.18–3.53

0.011

1.74

1.17–2.58

0.006

3.03

1.72–5.33

< 0.001

2.75

1.75–4.32

< 0.001

Brazil

3.53

1.56–8.02

0.003

2.00

0.94–4.27

0.072

4.46

2.02–9.83

< 0.001

3.71

2.04–6.73

< 0.001

Survey artefacts

French translation

no

ref.

yes

1.92

1.66–2.23

< 0.001

2.05

1.75–2.39

< 0.001

1.09

0.76–1.55

0.645

1.21

0.86–1.71

0.281

Major data discrepancies

no

ref.

yes

1.35

1.28–1.43

< 0.001

1.30

1.22–1.38

< 0.001

1.23

1.11–1.37

< 0.001

1.17

1.04–1.31

0.008

Sample composition

Age group

< 25 years

ref.

25–29 years

1.69

1.58–1.80

< 0.001

1.33

1.24–1.43

< 0.001

1.67

1.47–1.89

< 0.001

1.36

1.20–1.55

< 0.001

30–39 years

1.95

1.84–2.08

< 0.001

1.30

1.21–1.39

< 0.001

1.92

1.71–2.16

< 0.001

1.38

1.22–1.56

< 0.001

40–49 years

1.99

1.86–2.13

< 0.001

1.15

1.06–1.24

0.001

1.85

1.62–2.12

< 0.001

1.21

1.05–1.40

0.008

50 + years

1.64

1.52–1.77

< 0.001

0.97

0.89–1.06

0.521

1.48

1.26–1.73

< 0.001

0.99

0.84–1.18

0.953

Settlement size (inhabitants)

village/countryside (< 10,000)

ref.

small town (10,000–99,999)

1.04

0.94–1.14

0.435

1.03

0.93–1.15

0.512

0.96

0.79–1.16

0.653

0.91

0.75–1.11

0.349

medium town (100,000–499,999)

1.17

1.07–1.28

0.001

1.07

0.97–1.18

0.166

1.09

0.91–1.31

0.354

0.97

0.80–1.16

0.711

big city (500,000–999,999)

1.40

1.27–1.53

< 0.001

1.17

1.06–1.30

0.002

1.24

1.03–1.49

0.023

1.03

0.85–1.25

0.753

very big city (≥ 1 million)

1.59

1.46–1.74

< 0.001

1.16

1.05–1.27

0.002

1.31

1.11–1.56

0.002

0.96

0.81–1.15

0.687

Diagnosed HIV

no

ref.

yes

5.27

5.05–5.50

< 0.001

3.84

3.65–4.04

< 0.001

4.11

3.78–4.46

< 0.001

2.96

2.70–3.25

< 0.001

Financial coping

comfortable

ref.

neither struggling nor comfortable

1.03

0.98–1.07

0.252

1.07

1.02–1.12

0.010

1.17

1.07–1.27

0.001

1.18

1.08–1.30

< 0.001

struggling

1.15

1.09–1.21

< 0.001

1.10

1.04–1.17

0.001

1.31

1.18–1.45

< 0.001

1.21

1.09–1.36

0.001

Testing behavior

Last STI screen

no screening

ref.

> 6–12 months ago

0.74

0.68–0.80

< 0.001

0.61

0.56–0.67

< 0.001

1–6 months ago

1.54

1.46–1.62

< 0.001

0.95

0.90–1.01

0.101

within the previous 4 weeks

2.61

2.46–2.77

< 0.001

1.43

1.34–1.53

< 0.001

Sexual behavior

Number of sex partners, previous 12 months

none or one

ref.

2–4

1.25

1.15–1.34

< 0.001

1.06

0.94–1.18

0.358

1.30

1.11–1.52

0.001

0.94

0.76–1.18

0.617

5–7

1.92

1.78–2.08

< 0.001

1.46

1.29–1.65

< 0.001

2.51

2.16–2.92

< 0.001

1.59

1.26–2.00

< 0.001

8–10

2.26

2.07–2.47

< 0.001

1.57

1.38–1.79

< 0.001

2.89

2.44–3.42

< 0.001

1.71

1.34–2.19

< 0.001

11–20

2.99

2.78–3.21

< 0.001

1.87

1.66 --2.12

< 0.001

3.58

3.10–4.14

< 0.001

1.91

1.52–2.41

< 0.001

> 20

5.96

5.56–6.38

< 0.001

2.74

2.43–3.09

< 0.001

5.88

5.12–6.77

< 0.001

2.51

1.99–3.16

< 0.001

Anal intercourse, condom use with last non-steady partner (NSP)

no anal intercourse with NSP

ref.

never condom with NSP

3.25

2.95–3.58

< 0.001

1.54

1.34–1.77

< 0.001

3.46

2.82–4.24

< 0.001

1.90

1.45–2.49

< 0.001

seldom condom with NSP

5.82

5.35–6.33

< 0.001

1.95

1.71–2.23

< 0.001

5.72

4.81–6.81

< 0.001

2.31

1.78–2.99

< 0.001

sometimes condom with NSP

4.72

4.36–5.10

< 0.001

1.79

1.58–2.04

< 0.001

5.48

4.68–6.42

< 0.001

2.30

1.80–2.95

< 0.001

mostly condom with NSP

2.93

2.73–3.14

< 0.001

1.41

1.25–1.59

< 0.001

3.80

3.29–4.39

< 0.001

1.87

1.47–2.37

< 0.001

always condom with NSP

1.34

1.24–1.44

< 0.001

0.83

0.73–0.94

0.003

1.62

1.39–1.89

< 0.001

1.00

0.78–1.27

0.977

no answer condom with NSP

1.18

1.06–1.31

0.002

0.96

0.84–1.10

0.572

1.31

1.05–1.63

0.015

1.05

0.81–1.37

0.705

PrEP use

never / don’t know

ref.

when needed

2.09

1.78–2.46

< 0.001

1.50

1.26–1.78

< 0.001

2.12

1.50–2.98

< 0.001

1.74

1.23–2.46

0.002

former daily use

2.68

2.10–3.42

< 0.001

2.18

1.68–2.82

< 0.001

1.34

0.71–2.52

0.361

1.00

0.51–1.95

0.995

current daily use

3.35

3.02–3.72

< 0.001

1.85

1.65–2.07

< 0.001

1.92

1.47–2.49

< 0.001

1.14

0.86–1.50

0.364

Multi-partner sex during last NSP sex

no

ref.

yes

2.47

2.36–2.60

< 0.001

1.31

1.23–1.38

< 0.001

2.42

2.20–2.66

< 0.001

1.35

1.22–1.49

< 0.001

Country level rates

Country-level screening rates (Quartiles)

11.28%–

ref.

26.57%–

1.61

1.01–2.56

0.044

1.18

0.91–1.52

0.203

30.27%–

1.75

1.24–2.46

0.001

1.27

1.00–1.61

0.051

41.74–47.34%

2.56

1.57–4.19

< 0.001

1.70

0.95–3.02

0.073

cons.

0.01

0.01–0.01

< 0.001

0.00

0.00–0.00

< 0.001

Random part

68 countries¹

random intercept

0.04

0.02–0.09

0.06

0.03–0.13