Prevalence of syphilis and associated factors among pregnant women in Brazil: systematic review and meta-analysis

Associate Editor Patrícia El Beitune (https://orcid.org/0000-0003-0431-0690) Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil

Author and year of publication	Region, location	Sample of pregnant women	Average age	Study design	Diagnostic method	Prevalence (%)	Study quality score by JBI Appraisal Checklist (1 to 9)(¹¹11 Joanna Briggs Institute. Checklist for prevalence studies critical appraisal tools for use in jbi systematic reviews. 2020 [cited 2023 Oct 10]. Available from: https://jbi.global/sites/default/files/2020-08/Checklist_for_Prevalence_Studies.pdf https://jbi.global/sites/default/files/2... )
Szwarcwald et al. (2007)(¹⁴14 Szwarcwald CL, Barbosa Junior A, Miranda AE, Paz LC. Resultados do estudo sentinela-parturiente, 2006: desafios para o controle da sífilis congênita no Brasil. DST J Bras Doenças Sex Transm. 2007;19(3-4):128-33.)	Brazil	13, 267	-	Cross-sectional	VDRL	1.10% (146)	6
Inagaki et al. (2009)(¹⁵15 Inagaki AD, Oliveira LA, Oliveira MF, Santos RC, Araújo RM, Alves JA, et al. Soroprevalência de anticorpos para toxoplasmose, rubéola, citomegalovírus, sífilis e HIV em gestantes Sergipanas. Rev Soc Bras Med Trop. 2009;42(5):532-6. doi: 10.1590/S0037-86822009000500010 https://doi.org/10.1590/S0037-8682200900... )	Aracaju, SE	9,550	24.5	Cross-sectional	VDRL and DBS	0.90% (n = 86)	8
Miranda et al. (2009)(¹⁶16 Miranda AE, Rosetti Filho E, Trindade CR, Gouvêa GM, Costa DM, Oliveira TG, et al. Prevalência de sífilis e HIV utilizando testes rápidos em parturientes atendidas nas maternidades públicas de Vitória, Estado do Espírito Santo. Rev Soc Bras Med Trop. 2009;42(4):386-91. doi: 10.1590/S0037-86822009000400006 https://doi.org/10.1590/S0037-8682200900... )	Vitória, ES	1,380	24.2	Cross-sectional	TR and VDRL	0.43% (n = 14)	8
Gonçalves et al. (2010)(¹⁷17 Gonçalves MA, Matos CC, Spegiorin LC, Oliani DC, Oliani AH, Mattos LC. Seropositivity rates for toxoplasmosis, rubella, syphilis, cytomegalovirus, hepatitis and HIV among pregnant women receiving care at a Public Health Service, São Paulo State, Brazil. Braz J Infect Dis. 2010;14(6):601-5. doi: 10.1590/S1413-86702010000600009 https://doi.org/10.1590/S1413-8670201000... )	São José do Rio Preto, SP	561	27.2	Cross-sectional	VDRL	0.89% (n = 10)	5
Machado Filho et al. (2010)(¹⁸18 Machado Filho AC, Sardinha JF, Ponte RL, Costa EP, Silva SS, Martinez-Espinosa FE. Prevalência de infecção por HIV, HTLV, VHB e de sífilis e clamídia em gestantes numa unidade de saúde terciária na Amazônia ocidental brasileira. Rev Bras Ginecol Obstet. 2010;32(4):176-83. doi: 10.1590/S0100-72032010000400005 https://doi.org/10.1590/S0100-7203201000... )	Amazônia ocidental, AM	674	23.9	Cross-sectional	VDRL and chemiluminescence assay	1.04 % (n = 8)	9
Araújo et al. (2013)(¹⁹19 Araújo MA, Freitas SC, Moura HJ, Gondim AP, Silva RM. Prevalence and factors associated with syphilis in parturient women in Northeast, Brazil. BMC Public Health. 2013;13:206. doi: 10.1186/1471-2458-13-206 https://doi.org/10.1186/1471-2458-13-206... )	Fortaleza, CE	222	-	Cross-sectional	VDRL	7.66% (n = 17)	8
Domingues et al. (2013)(²⁰20 Domingues RM, Saraceni V, Hartz ZM, Leal MC. Sífilis congênita: evento sentinela da qualidade da assistência pré-natal. Rev Saúde Pública. 2013;47(1):147-57. doi: 10.1590/S0034-89102013000100019 https://doi.org/10.1590/S0034-8910201300... )	Rio de Janeiro, RJ	2,422	-	Cross-sectional	VDRL	1.90% (n = 46)	9
Nóbrega et al. (2013)(²¹21 Nóbrega I, Dantas P, Rocha P, Rios I, Abraão M, Netto EM, et al. Syphilis and HIV-1 among parturient women in Salvador, Brazil: low prevalence of syphilis and high rate of loss to follow-up in HIV-infected women. Braz J Infect Dis. 2013;17(2):184-93. doi: 10.1016/j.bjid.2012.10.018 https://doi.org/10.1016/j.bjid.2012.10.0... )	Salvador, BA	3,300	25.8	Cross-sectional	VDRL and Trepanostika TP	0.52% (n = 28)	7
Pires et al. (2013)(²²22 Pires MC, Oliveira CN, Souza CL, Oliveira MV. Prevalence of syphilis, diagnostic methods and associated factors in patients treated in the laboratory of health Foundation of Vitória da Conquista (BA). DST J Bras Doenças Sex Transm. 2013;25(4):171-6.)	Vitória da Conquista, BA	2,232	-	Cross-sectional	VDRL and ELISA	2.24% (n = 50)	6
Boa-Sorte et al. (2014)(²³23 Boa-Sorte N, Purificação A, Amorim T, Assunção L, Reis A, Galvão-Castro B. Dried blood spot testing for the antenatal screening of HTLV, HIV, syphilis, toxoplasmosis and hepatitis B and C: prevalence, accuracy and operational aspects. Braz J Infect Dis. 2014;18(6):618-24. doi: 10.1016/j.bjid.2014.05.009 https://doi.org/10.1016/j.bjid.2014.05.0... )	Salvador, BA	692	27.1	Cross-sectional	DBS and ELISA	0.72% (n = 5)	9
Fernandes et al. (2014)(²⁴24 Fernandes HD, Araújo EC, Neves DC, Ribeiro KT. Prevalência de HIV e sífilis em parturientes atendidas em uma maternidade de referência na cidade de Marabá-Pará. Rev Para Med. 2014;28(3):55-62.)	Marabá, PA	477	-	Cross-sectional	VDRL	1.89% (n = 9)	8
Cunha and Merchan-Hamann (2015)(²⁵25 Cunha AR, Merchan-Hamann E. Sífilis em parturientes no Brasil: prevalência e fatores associados, 2010 a 2011. Rev Panam Salud Publica. 2015;38(6):479-86.)	Brazil	36,713	25.2	Cross-sectional	TR, VDRL, FTA-Abs and TPHA	0.89% (n = 327)	9
Moura et al. (2015)(²⁶26 Moura AA, Mello MJ, Correia JB. Prevalence of syphilis, human immunodeficiency virus, hepatitis B virus, and human T-lymphotropic virus infections and coinfections during prenatal screening in an urban Northeastern Brazilian population. Int J Infect Dis. 2015;39:10-5. doi: 10.1016/j.ijid.2015.07.022 https://doi.org/10.1016/j.ijid.2015.07.0... )	Maceió, AL	54,813	23.3	Cross-sectional	VDRL and DBS	2.80% (n = 1535)	8
Benzaken et al. (2017)(²⁷27 Benzaken AS, Sabidó M, Brito I, Bermúdez XP, Benzaken NS, Galbán E, et al. HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon. Int J Equity Health. 2017;16:92. doi: 10.1186/s12939-017-0589-8 https://doi.org/10.1186/s12939-017-0589-... )	Amazonas, AM and Roraima, RR	4,144	22.5	Cross-sectional	TR	1.52% (n = 63)	8
Bernardi et al. (2017)(²⁸28 Bernardi LE, Ramos MC, Silva MS, Rossetti ML. Pilot evaluation of a rapid immunochromatographic test for the diagnosis of gestational syphilis. DST J Bras Doenças Sex Transm. 2017;29(3):106-9. doi: 10.5533/DST-2177-8264-201729307 https://doi.org/10.5533/DST-2177-8264-20... )	Francisco Beltrão, PR	185	-	Cross-sectional	VDRL, RPR, FTA-Abs and TR	6.49% (n = 12)	6
Soares et al. (2017)(²⁹29 Soares LG, Zarpellon B, Soares LG, Baratieri T, Lentsck MH, Mazza VA. Gestational and congenital syphilis: maternal, neonatal characteristics and outcome of cases. Rev Bras Saúde Matern Infant. 2017;17(4):781-9. doi: 10.1590/1806-93042017000400010 https://doi.org/10.1590/1806-93042017000... )	Guarapuava, PR	2,868	-	Cross-sectional	VDRL	1.39% (40)	6
Padovani et al. (2018)(³⁰30 Padovani C, Oliveira RR, Pelloso SM. Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil. Rev Lat Am Enfermagem. 2018;26:e3019. doi: 10.1590/1518-8345.2305.3019 https://doi.org/10.1590/1518-8345.2305.3... )	Paraná, PR	53,684	-	Cross-sectional	VDRL and FTA-Abs	0.57% (n = 306)	7
Silva et al. (2020)(³¹31 Silva GM, Pesce GB, Martins DC, Prado CM, Fernandes CA. Sífilis na gestante e congênita: perfil epidemiológico e prevalência. Enferm Global. 2020;19(57):107-50. doi: 10.6018/eglobal.19.1.358351 https://doi.org/10.6018/eglobal.19.1.358... )	Paraná, PR	25,463	-	Cross-sectional	VDRL	0.97% (n = 247)	7
Almeida et al. (2021)(³³33 Almeida YH, Fernandes HF, Rosas CM, Menezes ED, Fernandes RC, Souza TL. Prevalence of syphilis, HIV and toxoplasmosis in prenatal screening in the population of the northern region of the state of Rio de Janeiro, Brazil. DST J Bras Doenças Sex Transm. 2021;33:e213309.)	Campos dos Goytacazes, RJ	970	(27.9 ± 6.65)	Cross-sectional	VDRL	2.68% (n = 26)	7
Roehrs et al. (2021)(³²32 Roehrs MP, Silveira SK, Gonçalves HH, Sguario RM. Sífilis materna no Sul do Brasil: epidemiologia e estratégias para melhorar. Femina. 2021;49(2):102-8.)	Florianópolis, SC	4443	-	Cross-sectional	Treponemic and non-treponemical test	4.77% (n = 212)	6
Yeganeh et al. (2021)(³⁴34 Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner J. High prevalence of sexually transmitted infections in pregnant women living in Southern Brazil. Sex Transm Dis. 2021;48(2):128-33. doi: 10.1097/OLQ.0000000000001276 https://doi.org/10.1097/OLQ.000000000000... )	Porto Alegre, RS	400	-	Cross-sectional	VDRL and rapid test	10.50% (n = 42)	8
Reis et al. (2022)(³⁵35 Reis AR, Duarte G, Menegueti MG, Reis RK, Silva AC, Gir E. Reactive treponemal and non-treponemal tests in pregnant women and associated factors. Rev Esc Enferm USP. 2022;56:e20220146. doi: 10.1590/1980-220X-REEUSP-2022-0146en https://doi.org/10.1590/1980-220X-REEUSP... )	Ribeirão Preto, SP	2675	-	Cross-sectional	Treponemic and non-treponemic test	2.69% (n = 72)	9
Scherer et al. (2022)(³⁶36 Scherer A, Silveira MF, Nunes BP. HIV, Hepatitis B, Hepatitis C, and Syphilis: prevalence and serodiscordance between women and their partners. DST J Bras Doenças Sex Transm. 2022;34:e22341194. doi: 10.5327/DST-2177-8264-2022341194 https://doi.org/10.5327/DST-2177-8264-20... )	Pelotas, RS	350	27.8± 6.5	Cross-sectional	Rapid test	2.00% (n = 7)	7
Guedes et al. (2023)(³⁷37 Guedes AL, Guimarães DC, Sarkis DJ, Gabriel TT, Delgado CS, Campos AA, et al. Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit. einstein (São Paulo). 2023;21:eAO0046. doi: 10.31744/einstein_journal/2023AO0046 https://doi.org/10.31744/einstein_journa... )	Juiz de Fora, MG	399	25±5.8	Cross-sectional	Treponemic and non-treponemic test	9.02% (n = 36)	8

Risk factors	Proportion of studies (%)
Black and brown skin color(²⁰20 Domingues RM, Saraceni V, Hartz ZM, Leal MC. Sífilis congênita: evento sentinela da qualidade da assistência pré-natal. Rev Saúde Pública. 2013;47(1):147-57. doi: 10.1590/S0034-89102013000100019 https://doi.org/10.1590/S0034-8910201300... ,²⁴24 Fernandes HD, Araújo EC, Neves DC, Ribeiro KT. Prevalência de HIV e sífilis em parturientes atendidas em uma maternidade de referência na cidade de Marabá-Pará. Rev Para Med. 2014;28(3):55-62.–²⁶26 Moura AA, Mello MJ, Correia JB. Prevalence of syphilis, human immunodeficiency virus, hepatitis B virus, and human T-lymphotropic virus infections and coinfections during prenatal screening in an urban Northeastern Brazilian population. Int J Infect Dis. 2015;39:10-5. doi: 10.1016/j.ijid.2015.07.022 https://doi.org/10.1016/j.ijid.2015.07.0... ,³⁰30 Padovani C, Oliveira RR, Pelloso SM. Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil. Rev Lat Am Enfermagem. 2018;26:e3019. doi: 10.1590/1518-8345.2305.3019 https://doi.org/10.1590/1518-8345.2305.3... ,³⁴34 Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner J. High prevalence of sexually transmitted infections in pregnant women living in Southern Brazil. Sex Transm Dis. 2021;48(2):128-33. doi: 10.1097/OLQ.0000000000001276 https://doi.org/10.1097/OLQ.000000000000... )	n = 6(42.8)
Low education(¹⁹19 Araújo MA, Freitas SC, Moura HJ, Gondim AP, Silva RM. Prevalence and factors associated with syphilis in parturient women in Northeast, Brazil. BMC Public Health. 2013;13:206. doi: 10.1186/1471-2458-13-206 https://doi.org/10.1186/1471-2458-13-206... ,²⁰20 Domingues RM, Saraceni V, Hartz ZM, Leal MC. Sífilis congênita: evento sentinela da qualidade da assistência pré-natal. Rev Saúde Pública. 2013;47(1):147-57. doi: 10.1590/S0034-89102013000100019 https://doi.org/10.1590/S0034-8910201300... ,²⁴24 Fernandes HD, Araújo EC, Neves DC, Ribeiro KT. Prevalência de HIV e sífilis em parturientes atendidas em uma maternidade de referência na cidade de Marabá-Pará. Rev Para Med. 2014;28(3):55-62.–²⁶26 Moura AA, Mello MJ, Correia JB. Prevalence of syphilis, human immunodeficiency virus, hepatitis B virus, and human T-lymphotropic virus infections and coinfections during prenatal screening in an urban Northeastern Brazilian population. Int J Infect Dis. 2015;39:10-5. doi: 10.1016/j.ijid.2015.07.022 https://doi.org/10.1016/j.ijid.2015.07.0... ,³⁰30 Padovani C, Oliveira RR, Pelloso SM. Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil. Rev Lat Am Enfermagem. 2018;26:e3019. doi: 10.1590/1518-8345.2305.3019 https://doi.org/10.1590/1518-8345.2305.3... )	n = 6(42.8)
Factors related to the partner (e.g. conflictual relationship, drug use and previous history of STIs by the partner)(¹⁹19 Araújo MA, Freitas SC, Moura HJ, Gondim AP, Silva RM. Prevalence and factors associated with syphilis in parturient women in Northeast, Brazil. BMC Public Health. 2013;13:206. doi: 10.1186/1471-2458-13-206 https://doi.org/10.1186/1471-2458-13-206... ,²¹21 Nóbrega I, Dantas P, Rocha P, Rios I, Abraão M, Netto EM, et al. Syphilis and HIV-1 among parturient women in Salvador, Brazil: low prevalence of syphilis and high rate of loss to follow-up in HIV-infected women. Braz J Infect Dis. 2013;17(2):184-93. doi: 10.1016/j.bjid.2012.10.018 https://doi.org/10.1016/j.bjid.2012.10.0... ,³⁴34 Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner J. High prevalence of sexually transmitted infections in pregnant women living in Southern Brazil. Sex Transm Dis. 2021;48(2):128-33. doi: 10.1097/OLQ.0000000000001276 https://doi.org/10.1097/OLQ.000000000000... ,³⁵35 Reis AR, Duarte G, Menegueti MG, Reis RK, Silva AC, Gir E. Reactive treponemal and non-treponemal tests in pregnant women and associated factors. Rev Esc Enferm USP. 2022;56:e20220146. doi: 10.1590/1980-220X-REEUSP-2022-0146en https://doi.org/10.1590/1980-220X-REEUSP... ,³⁷37 Guedes AL, Guimarães DC, Sarkis DJ, Gabriel TT, Delgado CS, Campos AA, et al. Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit. einstein (São Paulo). 2023;21:eAO0046. doi: 10.31744/einstein_journal/2023AO0046 https://doi.org/10.31744/einstein_journa... )	n = 5(35.7)
Factors related to pregnancy and prenatal care (e.g. late start of prenatal care, low number of consultations)(²⁰20 Domingues RM, Saraceni V, Hartz ZM, Leal MC. Sífilis congênita: evento sentinela da qualidade da assistência pré-natal. Rev Saúde Pública. 2013;47(1):147-57. doi: 10.1590/S0034-89102013000100019 https://doi.org/10.1590/S0034-8910201300... ,²⁴24 Fernandes HD, Araújo EC, Neves DC, Ribeiro KT. Prevalência de HIV e sífilis em parturientes atendidas em uma maternidade de referência na cidade de Marabá-Pará. Rev Para Med. 2014;28(3):55-62.,²⁶26 Moura AA, Mello MJ, Correia JB. Prevalence of syphilis, human immunodeficiency virus, hepatitis B virus, and human T-lymphotropic virus infections and coinfections during prenatal screening in an urban Northeastern Brazilian population. Int J Infect Dis. 2015;39:10-5. doi: 10.1016/j.ijid.2015.07.022 https://doi.org/10.1016/j.ijid.2015.07.0... ,³⁰30 Padovani C, Oliveira RR, Pelloso SM. Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil. Rev Lat Am Enfermagem. 2018;26:e3019. doi: 10.1590/1518-8345.2305.3019 https://doi.org/10.1590/1518-8345.2305.3... )	n = 4(2.5)
Low income(²¹21 Nóbrega I, Dantas P, Rocha P, Rios I, Abraão M, Netto EM, et al. Syphilis and HIV-1 among parturient women in Salvador, Brazil: low prevalence of syphilis and high rate of loss to follow-up in HIV-infected women. Braz J Infect Dis. 2013;17(2):184-93. doi: 10.1016/j.bjid.2012.10.018 https://doi.org/10.1016/j.bjid.2012.10.0... ,²²22 Pires MC, Oliveira CN, Souza CL, Oliveira MV. Prevalence of syphilis, diagnostic methods and associated factors in patients treated in the laboratory of health Foundation of Vitória da Conquista (BA). DST J Bras Doenças Sex Transm. 2013;25(4):171-6.,²⁵25 Cunha AR, Merchan-Hamann E. Sífilis em parturientes no Brasil: prevalência e fatores associados, 2010 a 2011. Rev Panam Salud Publica. 2015;38(6):479-86.,³⁰30 Padovani C, Oliveira RR, Pelloso SM. Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil. Rev Lat Am Enfermagem. 2018;26:e3019. doi: 10.1590/1518-8345.2305.3019 https://doi.org/10.1590/1518-8345.2305.3... )	n = 4(28.5)
Use of alcohol and illicit drugs(¹⁶16 Miranda AE, Rosetti Filho E, Trindade CR, Gouvêa GM, Costa DM, Oliveira TG, et al. Prevalência de sífilis e HIV utilizando testes rápidos em parturientes atendidas nas maternidades públicas de Vitória, Estado do Espírito Santo. Rev Soc Bras Med Trop. 2009;42(4):386-91. doi: 10.1590/S0037-86822009000400006 https://doi.org/10.1590/S0037-8682200900... ,¹⁹19 Araújo MA, Freitas SC, Moura HJ, Gondim AP, Silva RM. Prevalence and factors associated with syphilis in parturient women in Northeast, Brazil. BMC Public Health. 2013;13:206. doi: 10.1186/1471-2458-13-206 https://doi.org/10.1186/1471-2458-13-206... )	n = 2(14.3)

[1] Corresponding author Iana Mundim de Oliveira E-mail: ianamundim.ufg@gmail.com

Brasil

Brasil

Prevalence of syphilis and associated factors among pregnant women in Brazil: systematic review and meta-analysis

Abstract

Objective:

Methods:

Results:

Conclusion: