Mapping the Silent Burden: Sero-Epidemiological Prevalence and Co- occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea in 1578 Ghanaian Outpatient Cohort using a Retrospective Study

Background : Sexually transmitted infections (STIs) remain a major public health burden in low- and middle-income countries, particularly in sub-Saharan Africa where diagnostic limitations and asymptomatic infections contribute to under-reporting. However, in Ghana, data on the co-occurrence of HIV with other STIs in outpatient settings are limited. This study assessed the prevalence and co-infection patterns of HIV, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and gonorrhea among outpatients in the Greater Accra Region of Ghana. Methods: A retrospective cross-sectional study involving 1,578 outpatients was conducted at a primary healthcare facility between January and December 2024. Sociodemographic and laboratory data were extracted from the hospital information management system. Descriptive statistics summarized prevalence of HIV and other STIs. Chi-square tests and binary logistic regression were used to determine associations and predictors of HIV infection. A p-value < 0.05 was considered statistically significant. Results: Of the 1,578 participants, 54.9% were female, and most (50.5%) were aged 25–45 years. Overall HIV prevalence was 6.4%, while HBV, HCV, syphilis, and gonorrhea were 13.0%, 5.5%, 6.0%, and 15.6%, respectively. HIV–STI co-infection represented 2.0% of all HIV-positive cases. Age was significantly associated with HIV status (p = 0.002), with the highest positivity recorded among individuals >45 years. Logistic regression showed that participants aged 1–25 years (aOR = 0.30; 95% CI: 0.14–0.63; p < 0.001) and 26–45 years (aOR = 0.50; 95% CI: 0.31–0.83; p = 0.003) had significantly lower odds of HIV infection compared to those >45 years. Gender and the presence of other STIs were not significantly associated with HIV positivity (p > 0.05). Conclusion: A considerable burden of HIV and other STIs was observed, with low but notable co-infection rates. Individuals older than 45 years were at highest risk of HIV infection. Strengthening integrated HIV/STI screening, promoting early diagnosis, and targeting age-specific health education particularly for older adults are critical to improving prevention and control strategies in Ghanaian outpatient settings.