Health literacy and syphilis knowledge: findings from a national survey of U.S. women of reproductive age.

BACKGROUND: After decades of relative stability, syphilis rates among reproductive-age women in the United States have sharply increased, with maternal cases tripling between 2016 and 2022. This surge has also contributed to a concerning rise in congenital syphilis. Gaps in healthcare access and stigma surrounding sexually transmitted infections have compounded the problem. Focused public health initiatives are needed to strengthen prevention, screening, and treatment efforts. METHODS: We conducted a national survey to assess health literacy and syphilis knowledge among 643 women aged 18 to 49. Participants completed validated measures, including the Brief Health Literacy Screener and a syphilis knowledge assessment. Recruitment was conducted online to achieve geographic diversity across 48 states, with intentional oversampling of Michigan participants to support future region-specific analyses. Overall, 120 (18.7%) screened positive for inadequate health literacy and 523 (81.3%) did not. Among those who screened positive, 72.5% (87/120) were syphilis-knowledgeable versus 89.1% (466/523) among those who did not screen positive. In logistic regression, syphilis knowledge was associated with nearly three times the odds of not screening positive for inadequate health literacy (AOR = 2.99, 95% CI: 1.71-5.22; p < .001). Education was not associated with health literacy (p = .802). Age and race were significant predictors of health literacy, but neither age nor race predicted syphilis knowledge in adjusted models. CONCLUSION: This study highlights the connection between health literacy and syphilis knowledge. It emphasizes the need for integrated health education that targets knowledge and literacy, especially among younger and marginalized groups. Incorporating health literacy and syphilis education into sexual health strategies could improve prevention and reduce disparities in syphilis rates among women of reproductive age and racially marginalized populations.