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TESTING AND RESPONSE TO SYPHILIS IN MOBILITY CONTEXTS:

EXPERIENCE REPORT ON THE BR-101 HIGHWAY IN EUNÁPOLIS,

BRAZIL

Elines Santos Rocha Novaes1

Flaelma Almeida da Silva2

Olívia Ferraz Pereira Marinho3

Igor Dala Bernardina4

Abstract: Syphilis is a sexually transmitted infection (STI) with a high prevalence in Brazil, showing

a signicant increase in recent years, especially among socially vulnerable groups. Itinerant workers,

such as truck drivers and mobile professionals along the BR-101 highway, are at increased risk of

exposure due to constant mobility, limited access to regular healthcare services, and unprotected

sexual practices. In this context, the present study aims to report the extension-based experience of

testing and educational health actions aimed at confronting syphilis in mobile settings, conducted

in the municipality of Eunápolis, Bahia. The intervention took place from August to December

2024, in partnership with the Federal Highway Police (PRF) and the Specialized Care Service and

Testing and Counseling Center (SAE/CTA), involving 32 participants, mostly men, of mixed race

and in productive age. Rapid tests were performed exclusively by qualied SAE/CTA professionals

as part of their institutional duties. The students involved in the extension project did not conduct

any clinical procedures; their role was limited to supervised observation and analysis of anonymized

data previously authorized by the partner technical team. This experience report complies fully

with the ethical principles established by Resolution CNS No. 510/2016, as it did not involve direct

1 Master in Nursing, CETSC Professor at the Pitágoras Faculty of Medicine in Eunápolis.

2 Master in Education, CETSC Professor at the Pitágoras Faculty of Medicine in Eunápolis.

3 Master in Public Health, CETSC Professor at the Pitágoras Faculty of Medicine in Eunápolis.

4 Student of the Medicine Course at the Pitágoras Faculty of Medicine in Eunápolis.

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intervention or identiable data collection, and is therefore exempt from mandatory submission to

a Research Ethics Committee. No participants tested positive for syphilis, although one reported

having recently undergone treatment for the disease. Despite the absence of conrmed cases, the

study revealed signicant exposure to risk factors related to STI transmission, such as multiple sexual

partners and lack of condom use. The ndings also highlight the high acceptance of rapid testing,

the low perception of risk among users, and the effectiveness of extension activities as strategies for

promoting sexual health in contexts marked by mobility and social vulnerabilities.

Keywords: Syphilis. Rapid testing. Workers’ health. Itinerant population. University extension.

Introduction

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema

pallidum, of systemic evolution and potentially severe when left untreated. Despite the existence of

effective treatment with penicillin since the 1940s, the disease persists as a global and national public

health problem, with signicant impacts on the morbidity and mortality of vulnerable populations

(Avelleira and Bottino, 2006).

In Brazil, the epidemiological scenario is worrying. Between January and June 2022, more

than 122 thousand cases of the disease were reported, most of which were acquired syphilis, but with

signicant numbers also among pregnant women and newborns, revealing failures in primary care

and health surveillance (Brasil, 2023). These data demonstrate the persistence of vertical transmission

and the challenge of interrupting the chain of contagion in territories marked by social inequality.

The worsening of the syphilis epidemic in the country exposes structural inequalities in

access to prevention, diagnosis, and treatment. Ramos (2022) warns that the most affected populations

are, historically, the most vulnerable: young women, black women, homeless people, and populations

with low education and income. Silva et al. (2022), in turn, identied, in a longitudinal study in

southern Brazil, that key populations have a high prevalence of syphilis and co-infections with other

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STIs, especially among young men and informal workers.

In this context, workers in mobility situations, such as truck drivers, stand out, who carry out

their activity in constant displacements over long distances, often in precarious working conditions.

Studies such as the one by Masson and Monteiro (2010) indicate that these professionals face multiple

risk factors for STI infection, including difculty in accessing health services, lack of ties with primary

care teams, consumption of psychoactive substances and involvement in unprotected sexual relations.

In addition, actions aimed at testing and combating syphilis in itinerant populations are

still punctual and often limited to short-term campaigns. Dutra et al. (2014) draw attention to the

importance of integrating the approach to mental health and sexual behavior in STI screening and

prevention programs, especially in groups with reduced risk perception and low active search for

health services.

The use of cross-sectoral and territorial strategies to reach populations in transit has

shown promising results. Fonte et al. (2025) report the effectiveness of educational and rapid testing

actions in homeless people, reinforcing that mobile interventions and articulated with local public

policies expand access to care and favor the reduction of vulnerability. In this sense, the university’s

performance, through extension, is congured as a powerful instrument for health promotion, by

articulating education, service and community in concrete actions.

In view of this panorama, the general objective of this study is to report an extension

experience aimed at preventing and coping with syphilis in itinerant workers who circulate on BR-

101, in the municipality of Eunápolis, Bahia. The proposal is part of the eld of health education and

participatory surveillance, aiming to contribute to the debate on care strategies aimed at hard-to-reach

populations, in addition to reinforcing the formative role of university extension as a promoter of

equity in health.

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Methodology

The methodology of this study was designed as a descriptive research, of a basic nature

and quantitative-qualitative approach, developed in the form of an extension experience report.

The proposal aimed to share the strategies to cope with syphilis adopted in the context of human

mobility, particularly among truck drivers and passengers who travel on BR-101, in the municipality

of Eunápolis, Bahia, highlighting the role of the university in the promotion of sexual health and

prevention of sexually transmitted infections (STIs).

The study was carried out from August to December 2024, based on actions promoted by an

extension project linked to the Medicine course, developed in partnership with the Federal Highway

Police (PRF) and the Specialized Assistance Service and Testing and Counseling Center (SAE/CTA)

of the municipality of Eunápolis. The site of the intervention was the PRF post located at Km 720 of

BR-101, a strategic point of intense ow of cargo transport and interstate travel.

The extension activity was aimed at individuals in mobility situations, including truck drivers,

long-distance drivers and passengers. Convenience sampling was adopted, considering the voluntary

adherence of the participants. All subjects were previously informed about the objectives of the study

and signed the Informed Consent Form (ICF). The research guaranteed anonymity, condentiality of

information and non-exposure of sensitive data, in line with the precepts of Resolution No. 510/2016

of the National Health Council.

Data collection took place in a single day, with a structure adapted to ensure privacy,

condentiality and security, including space reserved for counseling and rapid tests. The intervention

took place in three complementary axes: (1) application of a structured questionnaire, (2) rapid

testing for syphilis, HIV and hepatitis B and C, and (3) educational actions in sexual health and

STI prevention. The questionnaire investigated sociodemographic variables, history of STIs, risk

behaviors, and access to health services.

The rapid tests were performed exclusively by SAE/CTA professionals, trained and authorized

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for this function. The students of the project did not participate in the collection of biological material,

limiting themselves to technical observation, recording and analysis of sociodemographic data and

questionnaire responses. The ow of care followed the pre- and post-test counseling protocol adopted

by the Ministry of Health, ensuring qualied listening, clarication on serology and referrals, when

necessary.

Finally, the data obtained from the questionnaires were organized in electronic spreadsheets,

with descriptive statistical treatment, using absolute and relative frequencies to characterize the target

population. The analysis aimed to understand the vulnerability prole of the participants and to

support future educational and care interventions aimed at this group.

Analysis and Discussion of Results

The national scientic literature has contributed signicantly to the understanding of syphilis

as a persistent public health issue, especially in contexts of social vulnerability and mobility. Avelleira

and Bottino (2006) highlight the challenges related to the diagnosis and treatment of the disease, even

in the face of the existence of effective therapies for decades. Ramos (2022) deepens this analysis by

associating the permanence of syphilis with the structural fragility of the Unied Health System (SUS),

social inequality, and negligence in public policies. Masson and Monteiro (2010), in turn, warn of the

increased risk among truck drivers, emphasizing factors such as the use of psychoactive substances

and involvement in unprotected sexual relations. Silva et al. (2022) identify a high prevalence of STIs

among key populations in southern Brazil, indicating that effective coping depends on strategies that

integrate prevention, testing, and health education. The studies by Fonte et al. (2025) and Pires et al.

(2023) reinforce the role of extension actions in hard-to-reach territories as a central tool to expand

diagnostic coverage and care. Thus, the present study is based on a robust theoretical basis that allows

a critical interpretation of the data collected on BR-101, in Eunápolis.

During the action, 32 participants (100%) were assisted (Table 1.), most of whom were men

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(96.8%), brown (46.9%) and aged between 25 and 34 years (37.5%), all of whom were mobile at the time

of the approach. These data corroborate the ndings of Masson and Monteiro (2010), who identied

the predominance of men of working age among truck drivers approached in STI prevention actions.

The prevalence of men in road mobility contexts reects the gender prole historically associated

with the cargo transport sector in Brazil and justies priority attention to this population in screening

and health education actions.

Table 1. Distribution of care in the action project for testing and intervention in syphilis control

according to sociodemographic variables

Sex n (%)

Male 31 (96,8%)

Female 01 (3,2%)

Age group

18-24 years old 01 (3,1%)

25-34 years 12 (37,5%)

35-44 years old 11 (34,3%)

45-54 years 01 (3,1%)

55-64 years old 06 (18,7%)

65 or more 01 (3,1%)

Race/Color

White 09 (28,1%)

Black 08 (25%)

Brown 15 (46,9%)

Schooling

Incomplete elementary school 08 (25%)

Complete elementary school 06 (18,7%)

Incomplete high school 02 (6,2%)

Complete high school 14 (43,7%)

Incomplete higher education 01 (3,1%)

Complete higher education 01(3,1%)

Marital status

Married 19 (59,3%)

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The sexual behavior of the participants indicated signicant exposure to risk factors for

STIs. Only 34.3% reported using condoms in all sexual relations, while 65.7% reported irregular use

or complete absence of the protection method. These data conrm the ndings of Alessi and Alves

(2015), according to which Brazilian truck drivers have risky sexual behaviors associated with social

vulnerability, distance from family, loneliness on the roads and limited supply of information on

sexual health in their daily work.

Single 13 (40,6%)

Monthly Income

< 1 minimum wage 10 (31,2%)

1 to 2 minimum wages 09 (28,1%)

2 to 5 minimum wages 09(28,1%)

5 to 10 minimum wages 02 (6,2%)

More than 10 minimum wages 02 (6,2%)

Profession

Truck driver/truck driver 19 (59,3)

Electrical Technician 02 (6,2%)

Machine operator 02 (6,2%)

Vendor 01 (3,1%)

Entrepreneur 01 (3,1%)

Electrician 02 (6,2%)

Production Assistant 01 (3,1%)

Autonomous 01 (3,1%)

Locksmith 01 (3,1%)

Logistics Assistant 02 (6,2%)

Tot al 32 (100%)

Source: Survey data, 2024.

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Table 2. Distribution of care in the action project for testing and intervention in syphilis control

according to risk variables for STI acquisition (behavior in the last 12 months)

Source: Survey data (2024)

Sexual partner n (%)

1-3 sexual partners 26 (71,8%)

4-6 sexual partners 03 (9,3%)

He had no partner 03 (9,3%)

Use of condoms during sexual intercourse

Always 11 (34,3%)

Most of the time 02 (6,4%)

Rarely 07 (21,8%)

Never 12 (37,5%)

Sexual practice (male)

Sex with women only 29 (90,6%)

Sex only with men 01 (3,2%)

Sex with men and women 0

Had no sexual relations 1 (3,2%)

Syphilis and other STIs test result

Reagent 32 (100%)

Non-reagent 0

Has already been treated for syphilis 01 (3,2%)

Tot al 32 (100%)

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Graph 1 - Used condoms during sexual intercourse in the last 12 months

Source: Field survey data, 2024

In addition, 21.9% of the participants stated that they had already used illicit drugs, which

further increases exposure to unprotected sexual practices, as Masson and Monteiro (2010) warn. The

association between the use of psychoactive substances and neglect of protective measures in sexual

relations is a factor widely recognized in the literature as a determinant of vulnerability to syphilis

and other STIs, especially among workers who are constantly on the move.

The sociodemographic analysis also showed that 14 (43.7%) of the participants had

completed high school, while only 2 (6.2%) declared having attended higher education (complete or

incomplete) (Graph 2). This data reinforces Ramos’ (2022) argument about the association between

lower educational levels and greater exposure to preventable diseases, such as sexually transmitted

infections. The limitation of access to qualied information, combined with the precariousness of

preventive health services along highways, contributes to the invisibility of syphilis in this population

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group, which reinforces the relevance of educational interventions as a coping strategy.

Graph 2 – Education Level of the research participants

Source: Field survey data, 2024.

Regarding sexual behavior, 59.4% of the participants reported having sexual relations with

people outside the marital relationship. This data deserves attention, considering that, as pointed out

by Masson and Monteiro (2010), the vulnerability of truck drivers to STIs is strongly related to the

experience of multiple sexual partners in contexts of low protection, in addition to the absence of

lasting bonds during commuting. The authors highlight that these behaviors are often aggravated

by loneliness, exhausting routine, and the absence of public policies aimed at the health of itinerant

workers.

One fact that draws attention in the study is that none of the participants tested positive for

syphilis, although one individual declared that he had already undergone previous treatment (Table 2).

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The absence of positive results may be related to several factors, such as low point prevalence, recent

testing, or sampling factors. However, the behavioral vulnerability expressed in the data indicates that

this group remains at high risk, which justies the continuity of testing and health education actions.

According to Silva et al. (2022), even in groups with a low positivity rate in certain time frames, the

persistence of risk practices supports the importance of periodic screening policies.

The educational actions carried out during the campaign included conversation circles,

distribution of condoms and guidance on symptoms, prevention and treatment of syphilis. This

strategy dialogues with the experience described by Fonte et al. (2025), who reported the effectiveness

of health education activities combined with rapid testing as an instrument to cope with syphilis in

populations of high social vulnerability. In the context of BR-101, the educational approach proved

to be well received by the participants, evidencing the potential of itinerant interventions in building

bonds with a population historically distant from health services.

Finally, the integration between the university, SAE/CTA and the Federal Highway Police

was one of the main factors for the success of the action. This model of inter-institutional articulation,

in addition to expanding the territorial reach, strengthens the notion of shared care and health as a

collective responsibility. As Ramos (2022) points out, the ght against syphilis requires not only

clinical actions, but also structured articulations between different sectors, with an emphasis on

promoting equity and expanded access to sexual and reproductive health.

In addition, it was observed that many participants reported being unaware of the symptoms

of syphilis and expressed doubts about the mode of transmission. Low sexual health literacy is a

relevant barrier to prevention and timely treatment. Dutra, Campos and Guimarães (2014) point out

that the lack of knowledge of the forms of transmission, symptoms and complications of STIs is directly

associated with greater vulnerability among individuals exposed to precarious social conditions or in

mobility contexts. In this study, this lack of knowledge was partially remedied by educational actions,

although it remains a challenge for future follow-up actions.

With regard to risk perception, a signicant part of the interviewees did not recognize

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themselves as vulnerable to STI infection. This behavior, widely documented in the literature, was

analyzed by Masson and Monteiro (2010), who observed a tendency among truck drivers to deny their

own exposure, even in the face of unprotected sexual practices and multiple partners. Such distorted

perception of risk compromises the effectiveness of prevention campaigns, making it essential that

educational strategies be culturally adapted, continuous and sensitive to the daily life of this population.

The execution of the campaign in a structure set up in the vicinity of the BR-101, with the

logistical support of the Federal Highway Police, represented a differential in the access of workers in

transit. The action provided a condential, welcoming and strategically located environment, favoring

spontaneous adherence to testing and counseling. The experience reinforces what was documented

by Fonte et al. (2025), when they reported that the success of actions aimed at vulnerable populations

depends on the creation of material and symbolic conditions that encourage health care as a right and

not as an obligation.

Rapid testing, in this context, proved to be not only a diagnostic tool, but also a health

education strategy. By participating in pre- and post-test counseling, truck drivers were encouraged to

reect on their habits, ways of life, and interpersonal relationships. This subjective dimension of care

is highlighted by Ramos (2022), when he states that coping with syphilis should not be restricted to

biomedical interventions, but should also consider social determinants and the links between health

professionals and the population.

The extension activity also made it possible to identify gaps in sexual and reproductive

health care in the territory, such as the lack of educational materials adapted to the language of truck

drivers, the scarcity of condoms distributed along the highway and the absence of regular itinerant

services aimed at men’s health. These data dialogue with what was pointed out by Dutra, Campos and

Guimarães (2014), who emphasize the need for intersectoral interventions, with greater articulation

between public security, health and education, to effectively address the spread of STIs among

historically invisible groups.

Another relevant data concerns the previous history of STIs. Although the rapid tests did not

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reveal active cases of syphilis, one participant reported having been diagnosed and treated previously.

This experience points to the importance of recurrent testing and longitudinal follow-up of users,

since reinfection is possible in cases of non-adoption of continuous preventive measures. According to

Avelleira and Bottino (2006), syphilis, even after effective treatment, requires continuous vigilance,

since clinical cure does not imply permanent immunity.

The lack of regularity in medical follow-up among the participants was also highlighted in

the data collected. Many reported seeking health services only in emergency situations, which hinders

early diagnosis and timely treatment of sexually transmitted infections. This conduct is associated

with the logic of itinerant work, which imposes exhausting working hours and the absence of ties

with health teams. Fonte et al. (2025) warn that this distancing from systematic care contributes to the

underreporting of cases and perpetuation of the chain of transmission, especially among people living

on the streets or in constant displacement.

Regarding the psychosocial context, some participants reported feelings of fear and insecurity

in relation to the diagnosis, demonstrating the existence of subjective barriers to care. This aspect is

addressed by Fonte et al. (2025), who identied, among people in vulnerable situations, the need for

qualied, judgment-free reception as a condition for adherence to diagnosis and treatment. In the

present study, the presence of well-oriented academics and experienced professionals contributed to

minimize this fear, promoting an environment of listening and trust.

Another important nding was spontaneous adherence to the nal lecture, which addressed

topics such as sexual health, condom use, reinfection, and STI treatment. The activity was well evaluated

by the participants and demonstrates the potential of health education strategies when articulated with

testing and counseling. The experience reinforces Ramos’ (2022) thesis that confronting syphilis

requires integrated and continuous actions, with a territorialized focus and sensitive to the specicities

of social groups.

The itinerant approach used in this extension action allowed us to reach a population that is

often invisible in traditional public health strategies. The performance at strategic points of the BR-

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101, in partnership with the PRF and the SAE/CTA, provided an accessible and non-institutionalized

care space. This experience conrms what Fonte et al. (2025) defend, when they highlight that

interventions in vulnerable territories should consider mobility and the discontinuity of links with

health services as structuring factors of social vulnerability.

In addition, the data collected suggest that, even in the face of a scenario of low syphilis

detection at the time of testing, the participants had multiple cumulative risk factors, such as low

education, extensive work routines, and lack of regular employment with health units. Masson and

Monteiro (2010) warn that such characteristics make truck drivers more susceptible not only to STI

infection, but also to institutional negligence, given the difculty of inserting this population in formal

care networks.

It is important to highlight that the project directly contributed to the training of medical

students in extension practice, by developing relational, communicative and epidemiological skills. As

Ramos (2022) points out, the strengthening of the SUS depends on the training of professionals who

are sensitive to inequalities and prepared to work in territories marked by exclusions and invisibilities.

The experience reported here demonstrated the importance of articulating teaching, research and

extension as a strategy to qualify medical training and health care.

Finally, the results of the intervention reinforce the need for public policies that recognize

the specicities of populations in the context of mobility. Avelleira and Bottino (2006) have already

warned that the success of syphilis control depends not only on the availability of treatment, but on

the ability to identify cases early and break the transmission cycles. Carrying out itinerant actions,

offering testing, health education, and intersectoral articulation, is a promising way to face this

challenge in territories such as southern Bahia.

Therefore, the analysis of the data obtained in the action carried out on BR-101 reinforces the

understanding that the ght against syphilis requires not only testing and treatment, but structured

actions of health promotion, permanent education, and qualied listening, especially with audiences

historically neglected by the health system. This nding reafrms the relevance of the SUS as a tool

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for inclusion and social justice, as defended by Ramos (2022), and it is essential to strengthen its

presence in mobility territories as a condition for comprehensive health care.

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