Syphilis is a re-emerging sexually transmitted infection (STI) and a growing public health concern in Brazil. This scenario disproportionately affects sexual and gender minorities, highlighting inequalities in access to prevention, diagnosis, and treatment. Among people with HIV (PWH), syphilis coinfection is associated with higher viral loads and increased risk of HIV transmission.

To assess the prevalence of active syphilis and associated factors in PWH hospitalized at a reference center in a state in the Southeast region, in the context of a universal screening strategy to address the HIV and STI epidemics.

This was a cross-sectional study analyzing data from PWH hospitalized at a reference center between October 2021 and April 2024. Universal syphilis screening was performed at hospital admission, and active syphilis was defined as VDRL ≥ 1:8. Sociodemographic and clinical information was collected: age, gender identity, race/skin color, education, HIV viral load (HIV VL), CD4 T-cell count (CD4), and coinfections. Characteristics were compared according to active syphilis diagnosis (yes vs. no) using chi-square/Fisher’s exact test for categorical variables and Wilcoxon test for continuous variables.

Among 1,881 hospitalized PWH, median age was 41 years, with a predominance of cisgender men (62%), followed by cisgender women (35%) and travestis/trans women. The most frequently self-declared race was mixed (44%), followed by white (28%) and black (26%). Regarding education, 59% had completed secondary school, 33% elementary school, and 8% higher education. The prevalence of active syphilis was 13.8%. Among cases with syphilis at admission, there was a lower median age (36 vs. 42 years), a higher proportion of cisgender men (70% vs. 61%), and higher frequency in the 25–34 and 35–44 age groups. Elevated HIV VL and hepatitis C coinfection (5% vs. 2%) were also more common.

Universal syphilis screening in hospitalized PWH expands access to timely diagnosis and treatment from a combined prevention perspective and is a strategy that may be evaluated in other settings, such as general hospitals and sexually active individuals regardless of serostatus.