Syphilis in Pregnancy: The Reality in a Public Hospital

Abstract

Objective: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions. Methods: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution. Results: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births – this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight. Conclusion: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.

Analysis of the Space and Time Distribution of Syphilis in Brazil: Cases of Acquired Syphilis From 2010-2018 and Congenital and Syphilis in Pregnant Women From 2001-2017

“…However, it worth noting that many records contained missing race/ethnicity classi cation data in P1, which can be considered as a bias in the interpretation of our results. Indeed, the data presented herein corroborate other studies that identi ed a signi cant correlation between these sociodemographic characteristics and SiP [15,[21][22][23][24][25][26][27]29,30,[32][33][34][35][36][37][38]. We suggest that distinct strategies are required to reach more vulnerable populations and to minimize inequalities that enable greater access to health services.…”

“…Low adherence to treatment among patients and their partners is a main obstacle that must be overcome. Insu cient social awareness regarding prevention and treatment re ects the urgent need for educational policies aimed at preventing congenital infections [25,26] in Brazil, especially in the affected macroregions and microregions identi ed in this study.…”

“…It has been reported that CS diagnosis usually occurs within seven days after birth (typically between the 1 st and 2 nd day of life) [23,25]. In addition to prematurity, newborns usually present classic signs and symptoms of infection soon after birth, including low birth weight, anemia, jaundice, respiratory distress, visceromegaly, congenital malformations, serosanguinous discharge and rhinitis, skin lesions, heart disease and/or hearing loss [23,26,27]. Interestingly, it was found that despite the predominance of prenatal care in 70+% of the CS cases investigated herein, signi cantly high numbers of cases of CS were nonetheless reported throughout the country.…”

“…The observed variations in noti cation rates among the municipalities may be the result of a decline in the underreporting of cases or re ect problems in local health systems, such as a lack of access to specialized services. Importantly, incomplete reporting hinders the elaboration of preventive strategies by policymakers, resulting in ineffective epidemiological surveillance [26,39]. It is evident that the Brazilian healthcare system will continue to be challenged by this scenario, as despite government investment in awareness campaigns, the circumstances remain far from ideal.…”

Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand

“…This is comparable with the study from the US, in which the major contributing factor was late initiation of antenatal care and the proportion of mothers who did not receive prenatal care was 31%. As in another study, the majority of our syphilis diagnosis occurred during the second and third trimester of pregnancy, which indicated late access to care. Late timing of infection and late diagnosis of maternal syphilis usually lead to incomplete treatment or mothers are left untreated due to the lack of time to complete the course of treatment, which accounted for more than half of the cases of inadequate treatment in our study.…”