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A mathematical model for the impact of PrEP on syphilis and HIV-syphilis coinfection

Erick Manuel Delgado Moya1, Ranses Alfonso Rodriguez2, Alain Pietrus3, Julián Bravo-Castillero4, Aymee Marrero Severo5
1Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
2Applied Mathematics Department, Florida Polytechnic University, Florida, USA
3Laboratoire de Mathématiques Informatique et Applications (LAMIA), Université des Antilles, Pointe-á-Pitre 97157, Guadeloupe
4Universidad Nacional Autónoma de México, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Unidad Académica Yucatán, Tablaje Catastral No 6998, Mérida, 97357, Yucatán, Mexico
5Department of Applied Mathematics, Faculty of Mathematics and Computer Science, University of Havana, Havana, Cuba
Copyright © Erick Manuel Delgado Moya, Ranses Alfonso Rodriguez, Alain Pietrus, Julián Bravo-Castillero, Aymee Marrero Severo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pre-exposure prophylaxis (PrEP) is an effective strategy for HIV prevention, offering individual protection and broader public health benefits. Enrollment in PrEP programs not only provides access to HIV prevention but also serves as a strategic entry point for the diagnosis of other sexually transmitted infections (STIs). Because participation requires regular HIV testing and routine STI screening (e.g., for syphilis), PrEP implementation facilitates early detection and treatment of coexisting infections, strengthening integrated sexual health surveillance and control efforts. We developed a mathematical model capturing syphilis dynamics, incorporating PrEP as a mechanism for diagnosis and treatment engagement. The model considers coinfection via high-risk sexual contact, partial protection of PrEP (HIV but not syphilis), and diagnostic pathways linked to PrEP program entry. Independent analysis of syphilis (without PrEP) established population persistence, basic reproduction numbers, and stability of disease-free and endemic equilibria. Integrating PrEP, we derived conditions under which PrEP-related parameters—particularly diagnostic access—positively influence syphilis transmission dynamics. Sensitivity analysis showed that higher PrEP adherence reduces reproduction numbers for syphilis and coinfection. Computational simulations using literature-based parameters confirmed these findings: increased PrEP use and lower discontinuation rates decreased new infections and improved treatment outcomes. These results highlight the role of PrEP in improving the detection and treatment of syphilis and HIV–syphilis coinfection.

Keywords: HIV, syphilis, coinfection, PrEP, model