Epidemiological profile of patients with congenital and gestational syphilis in a city in the State of São Paulo, Brazil

Maschio-Lima, Taiza; Machado, Iara Lúcia de Lima; Siqueira, João Paulo Zen; Almeida, Margarete Teresa Gottardo

doi:10.1590/1806-93042019000400007

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (4) • Oct-Dec 2019 • https://doi.org/10.1590/1806-93042019000400007 copy

Epidemiological profile of patients with congenital and gestational syphilis in a city in the State of São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to assess the epidemiological profile of congenital and syphilis during pregnancy in residents of São José do Rio Preto in São Paulo State.

Methods:

ecological study of the epidemiological profile of patients with congenital and gestational syphilis, based on the Sistema de Informação de Agravos de Notificação (Information System for Notifiable Diseases) from 2007 to 2016.

Results:

there were 396 cases of syphilis reported in pregnant women and 290 of congenital syphilis. In 2016, the rate of detecting syphilis in pregnant women was 13.2 cases/1,000 live births, while congenital syphilis the incidence rate was 6.5 cases/1,000 live births. For gestational syphilis, 54% of the diagnosis was performed in 2nd or 3rd trimester and 85% were reported at the primary care. Adequate treatment for pregnant women occurred in 96% of the notifications with 52% of partners treated. In congenital syphilis, 82% of the mothers underwent prenatal care. However, 94% of the pregnant women were treated inadequately while 82% of the partners did not receive any treatment.

Conclusions:

there has been an increase in the number of cases of gestational syphilis in pregnant women and a decrease in the cases of congenital syphilis from 2014. These results showed that the goal of 0.5 case/1,000 live births proposed by World Health Organization is still far from being achieved in this city.

Key words
Vertical transmission of infectious diseases; Pregnant women; Epidemiological surveillance; Notifiable diseases

	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Gestational syphilis
N^† † Total number of cases of syphilis in pregnant woman corresponds to 396;	10	13	15	34	40	46	58	46	63	71
%	2.53	3.28	3.79	8.59	10.10	11.62	14.65	11.62	15.91	17.93
DR GS^‡ ‡ Detection rate of gestational syphilis;	2.1	2.6	2.9	6.5	7.7	8.6	10.8	8.1	11.1	13.2
Congenital syphilis
N^* * Total number of cases of congenital syphilis corresponds to 290;	6	3	4	19	30	41	55	63	34	35
%	2.07	1.03	1.38	6.55	10.34	14.14	18.97	21.72	11.72	12.07
IR CS^ Incidence rate of congenital syphilis.	1.2	0.6	0.8	3.6	5.7	7.7	10.3	11.1	6.0	6.5

Characteristics	N=396	%
Sociodemographic
Age group (years)
≤ 19	92	23.23
20 -29	217	54.80
≥ 30	87	21.97
Race
Caucasian	227	57.32
Mixed	115	29.04
Black	40	10.10
Unknown/blank	14	3.54
Schooling
Unknown/blank	66	16.67
Illiterate	2	0.51
Incomplete elementary degree	108	27.27
Elementary degree	35	8.84
Incomplete high school degree	81	20.45
High school degree	91	22.98
Incomplete higher education degree	5	1.26
Higher education degree	8	2.02
Occupation
Housewife	182	45.96
Student	13	3.28
Receptionist	12	3.03
Housekeeper	12	3.03
Cook	3	0.76
Manicure	6	1.52
Sex worker	7	1.77
Saleswoman	4	1.01
Unemployed	3	0.76
Administrative assistant	3	0.76
Others	27	6.82
Unknown/blank	124	31.31
Clinical and epidemiological
Notifying health unit
Primary care	338	85.35
Tertiary care	34	8.59
Specialized care	22	5.56
City Secretary of Health	2	0.51
Gestational trimester
1^st trimester	163	41.16
2^nd trimester	134	33.84
3^rd trimester	80	20.20
Unknown gestational age	10	2.53
Unknown/blank	9	2.27
Clinical stage of the disease
Unknown/blank	89	22.47
Primary	149	37.63
Secondary	36	9.09
Tertiary	40	10.10
Latent	82	20.71
Treatment for pregnant women
Yes	383	96.72
No	12	3.03
Unknown/blank	1	0.25
Treatment for the partner
Yes	207	52.27
No	152	38.38
Unknown/blank	37	9.34
Reason the partner did not treat
Unknown/blank	244	61.62
No relation with the pregnant woman	40	10.10
Partner did not attend	25	6.31
Partner with non-reactive serology	20	5.05
Partner was not notified by the health service	4	1.01
Partner refused treatment	2	0.51
Other reasons	61	15.40

Characteristics	N=396	%
Background of pregnant woman and partner
Prenatal care
Yes	237	81.72
No	53	18.28
Diagnosis of the pregnant woman
During prenatal care	183	63.10
During birth/curettage	98	33.79
After birth	8	2.76
Not performed	1	0.34
Partner treated
No	239	82.41
Yes	31	10.69
Unknown/blank	20	6.90
Treatment for pregnant women
Inadequate/Not treated	274	94.48
Adequate	12	4.14
Unknown/blank	4	1.38
Child's clinic and laboratorial
Clinical diagnosis
Asymptomatic	207	71.38
Symptomatic	23	7.93
Not applicable	33	11.38
Unknown/blank	27	9.31
Non-Treponemal test (blood)
Reagent	178	61.38
Not reagent	59	20.34
Not performed	32	11.03
Unknown/blank	21	7.24
Non-Treponemal test (cerebrospinal fluid)
Reagent	7	2.41
Not reagent	175	60.34
Not performed	81	27.93
Unknown/blank	27	9.31
Cerebrospinal fluid alterations
No	157	54.14
Yes	26	8.97
Not performed	70	24.14
Unknown/blank	37	12.76
Long bones alterations
No	184	63.45
Yes	42	14.48
Not performed	39	13.45
Unknown/blank	25	8.62
Child's treatment scheme and outcome
Newborn Treatment
Crystalline Penicillin G 100.000-150.000UI/kg/day, for 10 days	127	43.79
Penicillin G Procaine 50.000 UI/kg/day, for 10 days	91	31.38
Penicillin G Benzatin 50.000 UI/kg/day, single dose	9	3.10
Other scheme	7	2.41
Not performed	36	12.41
Unknown/blank	20	6.90
Outcome
Alive	241	83.10
Death from syphilis	4	1.38
Death of other cause	2	0.69
Abortion	26	8.97
Stillbirth	14	4.83
Unknown/blank	3	1.03

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[1] Authors’ contribution

Conception and planning of the study: TML, ILLM, MTGA. Data collection, analyses and interpretation: TML, ILLM, JPZS, MTGA. Preparation and revi-sion of the manuscript: TML, JPZS, MTGA. All authors have approved the final version of the ma-nuscript and are publicly responsible for the content of the article.