[Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016Desigualdades en la tendencia de sífilis congénita en la ciudad de Niterói, Brasil, 2007-2016]

Syphilis in pregnant women and congenital syphilis from 2012 to 2021 in Switzerland: a multicentre, retrospective study

BACKGROUND AND AIMS OF THE STUDY

Congenital syphilis is a rare complication of syphilis in pregnant women. Vertical transmission may occur at any time during pregnancy. The incidence of congenital syphilis has been increasing worldwide. Congenital syphilis has been a notifiable disease for many years in Switzerland but reporting does not include maternal features associated with syphilis in pregnancy or infant's subsequent development. We described syphilis cases among pregnant women screened over a 10-year period in Switzerland and subsequent cases of congenital syphilis, in order to identify maternal risk profiles and to optimise prevention. Second, we compared the characteristics of pregnant women screened early (1st trimester) vs late in pregnancy (2nd or 3rd trimester). Finally, we assessed the risk factors for premature birth among these women with syphilis.

METHODS

A multicentre retrospective study conducted in Swiss hospitals from 2012 to 2021, including pregnant women who screened positive for syphilis (Treponema pallidum haemagglutination assay [TPHA] / T. pallidum particle agglutination assay [TPPA ] ≥1:80) and newborns exposed to T. pallidum in utero and/or congenitally infected and with a positive syphilis serology at birth. Data were collected from medical records.

RESULTS

A total of 147 syphilis-positive pregnant women and 102 infants were included. A history of treated syphilis was known for 44% (65/147) of the mothers corresponding to a serological scar and the remaining 56% (82/147) were newly identified syphilis cases. Syphilis screening was done during the first trimester in 54%, second trimester in 29% and third trimester in 13% of cases. Two babies were diagnosed with congenital syphilis (1.96%). Several potential factors that could contribute to women's risk of syphilis during pregnancy were identified such as a foreign origin (93% of mothers), lack of healthcare insurance (25%), no employment status (37%), drug use (5%), co-infection with other sexually transmitted infections (24%) and a late first antenatal consultation (42%). The number of pregnant women without insurance was higher in women diagnosed in the second or third trimester than in those diagnosed in the first trimester (odds ratio 0.41; 95% CI 0.19-0.89; p = 0.024). Syphilis diagnosed in the second or third trimester was associated with a late first antenatal consultation (odds ratio 77.82; 95% CI 9.81-617.21; p <0.001). A high rate of intrauterine growth retardation and of preterm birth was observed in newborns (18% versus 6% in Switzerland in 2022).

CONCLUSION

Congenital syphilis remains rare in Switzerland. However, we found potential maternal factors associated with a positive syphilis serology during pregnancy, which can help to improve future prevention measures. The study protocol was registered on ClinicalTrials.gov (ID NCT05975502).

Congenital Syphilis Prevention Challenges, Pacific Coast of Colombia, 2018-2022

High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018-2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having >1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.

Spatial distribution of congenital syphilis in the state of Bahia, Brazil from 2009 to 2018

Objective

To describe the temporal trend and spatial distribution of congenital syphilis (CS) cases in the state of Bahia, Brazil between 2009 and 2018.

Method

Mixed ecological study conducted through the analysis of data obtained from the Notifiable Diseases Information System and the Live Birth Information System. Global Moran Index I was performed in order to analyze spatial autocorrelation of CS cases in the municipalities of Bahia and the Local Spatial Association Indicator (LISA) was used to identify the formation of spatial regimes in the GeoDA software.

Results

8,786 cases of CS were registered in the period. An increasing growth in CS incidence, with a 511% increase between 2009 and 2018. Spatial autocorrelation was observed between the municipalities (I Moran = 0.452; p < 0.001) and four clusters were identified. More frequently, mothers were aged 20-29 years (50.7%); had incomplete primary education (54.9%); were Black and multiracial (93.2%); received prenatal care (82.2%); 49.0% were diagnosed with syphilis during prenatal care; 68.8% were not adequately treated, and 81.1% of their partners were not treated.

Conclusion

The results showed that CS consolidates as a serious public health problem in Bahia, with an incidence 8.4 times higher in the period than the WHO target of 0.5/1,000 live births, predominantly related to inadequate prenatal care and social vulnerability indicators: young mothers with low education levels, as well as individuals identified as Black and multiracial. Thus, programs aimed at women of childbearing age and pregnant women need to be intensified.

Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: An ecological study

Objective

The study aimed to analyze the temporal trend of congenital syphilis in Brazil in the period from 2008 to 2018 and its spatial distribution in the Immediate Regions of Urban Articulation, and to identify spatial correlations with socioeconomic factors and prenatal care.

Methods

Spatial correlations between the incidence of congenital syphilis and socioeconomic conditions and access to prenatal care were assessed. This ecological study conducted a time series analysis in Brazil and spatial analysis in 482 Immediate Regions of Urban Articulation. Cases of congenital syphilis reported in the Notifiable Diseases Information System and the Live Birth Information System from January 1, 2008, to December 31, 2018 were included. Socioeconomic conditions (percentage of individuals with inadequate water supply and sanitation) were extracted from the 2010 census, whereas the Live Birth Information System provided data on access to prenatal care (percentage of live births with 1-3 prenatal care appointments). The Joinpoint Regression software performed the temporal trend analysis, while the GeoDa software assessed territorial clusters using the Moran's I and Local Spatial Association Indicator.

Results

The incidence of congenital syphilis showed an upward trend (annual percent change 1 = 26.96; 95% CI: 18.2-36.3; annual percent change 2 = 10.25; 95% CI: 2.7-28.4) and was unevenly distributed across Immediate Regions of Urban Articulation in Brazil (Moran's I = 0.264, p ≤ 0.05). It also presented a direct spatial correlation with the percentage of individuals with inadequate water supply and sanitation (Moran's I = 0.02, p ≤ 0.05) and the percentage of live births with 1-3 prenatal care appointments (Moran's I = 0.03, p ≤ 0.05).

Conclusion

Agrowth trend of congenital syphilis in Brazil was observed between 2008 and 2018. Moreover, inequalities in socioeconomic conditions and access to prenatal care influenced the spatial distribution of this disease.

Temporal trend of congenital syphilis in the most populous municipality of metropolitan region II of Rio de Janeiro state

OBJECTIVE

This study aimed to explore the temporal trend in congenital syphilis, according to sociodemographic and prenatal care in the city of São Gonçalo - Rio de Janeiro, from 2007 to 2018.

METHODS

Ecological time series study, with data from SINAN (Information System for Notifiable Diseases) and SINASC (Information System on Live Births databases). We calculated annual incidence (per 1,000 live births) according to sociodemographic and prenatal variables. For the same variables, we calculated trends by logarithmic regression (Joinpoint Regression), estimating the annual percentage change.

RESULTS

A total of 2,420 cases were reported from 2007 to 2018, with an increasing trend: 64.9% per year (2010-2013) and 24.9% (2013-2018). In 2018, the highest rates were in adolescents (90.6/1,000 live births), black women (87.6/1,000 live births), low-educated women (122.8/1,000 live births), and those without prenatal care (677.4/1,000 live births). The annual percentage change of these categories was, respectively, 37.3% (2010-2018), 33.5% (2012-2018), 39.9% (2014-2018), and 85.0% (2011-2015), but all categories showed a crescent trend.

CONCLUSIONS

We identified high congenital syphilis incidences and crescent trends, especially in more vulnerable groups, pointing to social and healthcare inequalities. Prenatal care needs to be more comprehensive and qualified, primarily for young, low-educated, and black women.

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

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.

Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development.

Hospitalizations due to Congenital Syphilis in Neonates: Associated Factors from the Prenatal Care Process

Objective: To identify the factors associated with hospitalizations due to congenital syphilis in neonates, based on the characteristics of prenatal care. Materials and method: A quantitative case-control study, conducted by applying a questionnaire to 65 puerperal women with their babies hospitalized from July to November 2017. The data were analyzed using logistic regression, according to the plan proposed in the hierarchical approach. Results: 20% of the hospitalizations were due to syphilis (cases) and 80% to other causes (control). The vulnerability risk (p = 0.036), previous history of sexually transmitted infection (p = 0,006), use of oral contraceptives (p = 0.011) and parity (p = 0.043) variables were statistically significant. The absence of the partner during the consultation (p = 0.028), failure to perform a rapid test for syphilis (p = 0.035) and educational activity for the partner (p = 0.033) were also associated with the occurrence of the outcome, in addition to the variables of the newborn: low birth weight (p = 0.025), not being on exclusive breastfeeding (p = 0.036) and not having had skin-to-skin contact (p = 0.043). Conclusions: Congenital syphilis has several risk factors for its occurrence. It was possible to observe that the assistance inequalities existing in care during the prenatal consultations directly reflect on the occurrence of this condition.