Survival analysis of syphilis infection in pregnant women of Papuan and non-Papuan ethnicities in Jayapura City and Regency, Papua, Indonesia

<h2>Abstract</h2><h3>Problem considered</h3> In Papua, Indonesia, syphilis in pregnancy persists as a public health concern, yet the role of ethnicity and culture in infection risk is poorly understood. <h3>Methods</h3> We conducted a prospective cohort study with an embedded mixed-methods design among 977 pregnant women attending their first Antenatal Care (ANC) visits across 15 health centers in Jayapura City and Regency (July 2025–August 2025). <h3>Results</h3> the overall cumulative incidence of syphilis during pregnancy was 11.7%, differing significantly by ethnicity—13.8% among Papuan women and 8.7% among non-Papuan women (log-rank p=0.03). Papuan women exhibited a higher syphilis risk compared to non-Papuans (AHR = 1.43; 95% CI: 0.98–2.08), associated with cultural taboos against premarital pregnancy. Additional risk factors included unmarried status (AHR = 1.78; 95% CI: 1.34–2.36), hepatitis B coinfection (AHR = 2.33; 95% CI: 1.31–4.16), inconsistent condom use, and uncircumcised partners. Kaplan–Meier curves showed a steep decline in syphilis-free probability during the second and third trimesters. Qualitative insights underscored the influence of stigma, gendered sexual decision-making, and reliance on ANC for diagnosis and treatment. <h3>Conclusion</h3> Maternal syphilis in Jayapura is influenced by intertwined biological, behavioral, and socio-cultural factors. Targeted, culturally sensitive interventions, enhanced ANC utilization, integrated STI/Hepatitis services, and promotion of safe sexual practices are essential to reduce incidence and support elimination efforts.