Temporal Trend of Gestational Syphilis between 2008 and 2018 in Brazil: Association with Socioeconomic and Health Care Factors

Abstract

The increased number of cases in recent years has turned syphilis into a global public health problem. In 2020, 115,371 cases of acquired syphilis were reported (detection rate of 54.5 cases/100,000 inhabitants) in Brazil. In that same period, the country notified 61,441 cases of gestational syphilis (detection rate of 21.6 per 1000 live births). The number of syphilis cases points to the need to reinforce surveillance, prevention, and infection control actions, which is a worrying scenario for government organizations. This study aims to describe the temporal trend of gestational syphilis from 2008 to 2018 in Brazilian regions and to associate its detection rate with socioeconomic and health care indicators. We conducted an ecological study of temporal trends using secondary data from the Department of Informatics of the Unified Health System. The temporal trend was analyzed using the Joinpoint Regression program. The annual percent change (APC) and 95% confidence intervals (95%CI) were estimated and tested; statistical significance was assessed using the Monte Carlo permutation test. Correlations were assessed using Pearson’s correlation coefficient, and statistical significance was calculated using Pearson’s product-moment correlation. The gestational syphilis detection rate increased between 2008 and 2018. The South region showed the greatest trend, whereas the Midwest region presented the lowest trend. The following variables were significantly correlated with the gestational syphilis detection rate: Municipal Human Development Index, illiteracy rate, percentage of primary health care coverage, and proportion of doctors, nurses, and basic health units per inhabitant. Health policies are needed to mitigate social vulnerabilities and strengthen primary health care.

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial

“…1 Health education is fundamental in preventing syphilis transmission among this vulnerable population. 15,16…”

“…The pre-test results revealed inadequate knowledge about syphilis among both the control group (CG) and intervention group (IG), indicating a lack of guidance from healthcare professionals regarding the disease. 15 Knowledge has an inverse relationship with T. pallidum infection, highlighting the importance of providing access to knowledge for women to prevent infection. 15…”

“…15 Knowledge has an inverse relationship with T. pallidum infection, highlighting the importance of providing access to knowledge for women to prevent infection. 15…”

Congenital syphilis in Brazil: a reflection of the fragility of screening and treatment of maternal syphilis

“…In vertical transmission, the infection spreads to the fetus via hematology, predominantly via the placenta, and may cause consequences such as miscarriages, stillbirths, premature birth, infant or neonatal death and early or late congenital manifestations. 4,5 Screening for syphilis in pregnancy recommended by the Ministry of Health must be carried out in the 1st prenatal consultation (preferably in the 1st trimester), at the beginning of the 3rd trimester and in the maternity ward at the time of delivery or abortion6. For the diagnosis of syphilis in pregnancy, a non-treponemal test in association with a treponemal test is required7.…”

“…PAHO recommends that 95% of pregnant women have access to at least one prenatal visit and be tested and treated for syphilis. 5 Penicillin G Benzathine is recommended as the first choice for treatment and it is considered to be adequate when the pregnant woman completes it within 30 days before delivery, the dosage being in accordance with the clinical phase of the disease. 2,7 According to the Ministry of Health's 2022 epidemiological bulletin on syphilis, in Brazil, from 2011 to 2021, 466,584 cases of syphilis were reported in pregnant women, 221,600 cases of congenital syphilis and 2,064 deaths from congenital syphilis, the detection rates for pregnant women with syphilis have maintained growth, but with less intensity from 2018 onwards.…”