ABSTRACT
Syphilis is a public health problem, especially in pregnant women, due to the risk of transmission to the fetus and the involvement of the central nervous system, causing neurosyphilis. A case-control study was carried out to analyze the variables associated with neurosyphilis in Brazilian newborns of pregnant women with syphilis admitted for childbirth. Newborns were submitted to treponemal and non-treponemal tests, cerebrospinal fluid analysis, and long bone radiography. Newborns diagnosed with neurosyphilis and congenital syphilis were defined as cases and controls, respectively. The length of hospitalization and mean cost of neurosyphilis treatment were also evaluated. Twenty-one cases of newborns with neurosyphilis and 42 controls with congenital syphilis were included in the study. Out of 63 pregnant women with syphilis, 95.2% (60/63) received prenatal care, 74.6% (47/63) were diagnosed with syphilis during this period, 31.9% (15/47) underwent treponemic tests, 80.8% (38/47) were treated with penicillin and only 46.8% (22/47) of the partners received the treatment. Clinical complications such as low birth weight were observed in 12.7% (8/63) of the newborns. About 50.8% (32/63) of the newborns were hospitalized due to syphilis complications and each case of neurosyphilis spent at least US$ 881.48 on treatment and hospitalization. The results showed that the prenatal coverage is not sufficient to prevent neurosyphilis. The late diagnosis of syphilis in pregnant women and inadequate follow-up of sexual partners may favor the vertical transmission of T. pallidum in pregnant Brazilian women. Thus, improving the quality of health services is important for a more effective control of neurosyphilis.
Subject(s)
Neurosyphilis/drug therapy , Penicillins/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Syphilis, Congenital/diagnosis , Syphilis/drug therapy , Adult , Brazil/epidemiology , Case-Control Studies , Female , Humans , Infant, Newborn , Neurosyphilis/diagnosis , Neurosyphilis/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnant Women , Syphilis/diagnosis , Syphilis/epidemiology , Syphilis Serodiagnosis , Syphilis, Congenital/epidemiologyABSTRACT
In Brazil, the reported number of syphilis cases among pregnant women has markedly increased. We conducted a cross-sectional study to determine the prevalence of Treponema pallidum infection and associated factors in pregnant women in Dourados, Mato Grosso do Sul, Brazil. Participants voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies against T. pallidum, the causative agent of syphilis. Data of newborns were obtained from medical records. We performed univariate and multivariate regression analyses to assess associations with syphilis. The seroprevalence of syphilis in pregnant women was 4.4% (n = 29/661). Twenty-five newborns were seropositive for T. pallidum, and complications due to syphilis were observed in 28% (n = 7/25). Although 96.5% (n = 28/29) of women with syphilis received antenatal care, Venereal Disease Research Laboratory tests were performed in the first trimester for 47.6% (n = 10/21) of women. Women who received treatment in the third trimester (28.6%; n = 6/21) were considered successfully treated at the time of delivery. The use of illicit drugs during pregnancy (odds ratio [OR]: 13.3, 95% CI: 1.9-91.2) and a history of abortion (OR: 3.7, 95% CI: 1.7-8) were associated with syphilis. Our findings highlight that the poor quality of antenatal care services contributes to the high prevalence of syphilis. In addition, there are social and behavioral risk factors associated with syphilis in pregnant women. Future studies are needed to determine limitations of clinical management and control services available to pregnant women with syphilis.
