Persistent and co-occurring sexual risk behaviors after syphilis diagnosis in primary health care users in Brazil: A cross-sectional descriptive study

Aim This study aimed to describe patterns of persistence and co-occurrence of post-diagnosis sexual risk behaviors among Primary Health Care users with syphilis and to examine their distribution across sociodemographic markers. Methods This cross-sectional study was conducted in a Primary Health Care unit in Brazil. Adults with documented positive rapid syphilis tests at least 6 months prior to interview were actively traced from the registry (August 2017–February 2022). Post-diagnosis sexual risk persistence was assessed using the Sexual Risk Persistence Score (SRPS; 0–3), composed of inconsistent condom-use, alcohol-use before sex, and drug-use before sex. Descriptive, bivariate, and correlation analyses were performed. Results The final sample included 42 participants. Most were women (62%), older than 24 years (76%), had only primary education (52%), self-identified as Brown/mixed race (76%), were single (69%), and unemployed (57%). Persistence of at least one post-diagnosis risk behavior (SRPS ≥ 1) was observed in 93%. Multiple concurrent behaviors were frequent (SRPS 2–3: 52%). Sociodemographic markers, including sex, gender identity, race/skin color, occupation, and education, were associated with behavioral patterns. Educational level was negatively correlated with alcohol use before sex (ρ = −0.429; p = 0.005), and alcohol and drug use before sex were positively correlated (ρ = 0.331; p = 0.032). Conclusions In this Primary Health Care setting, inconsistent condom-use and substance-use frequently persisted and co-occurred after syphilis diagnosis. These findings suggest that post-diagnosis vulnerability extends beyond individual behavior and highlight the importance of longitudinal and equity-oriented Primary Health Care strategies beyond diagnosis and treatment alone.