Fatores demográficos e clínicos associados à sífilis congênita e gestacional no Noroeste Paulista

Abstract

Pregnant women constitute a group with high vulnerability to syphilis, leading to an increase in the incidence of congenital syphilis, and syphilis is considered a public health problem. Objectives: This study aimed to characterize the epidemiological profile of syphilis in pregnant and congenital cases reported in a city in the Northwest of São Paulo State between 2015 and 2017, to analyze the prevalence of congenital and gestational syphilis cases and to associate the demographic and clinical factors of an Epidemiological Group in the Northwest of São Paulo State between 2013 and 2017.Sample and Method: An exploratory and descriptive study was carried out in the databases of the Unified Health System: Information System for Notification Diseases (Sinan - syphilis in pregnant women and congenital syphilis) (Sinasc) of Santa Fé do Sul and an Epidemiological Group in Jales, consisting of demographic and clinical information completed by health professionals. The study sample in the city of Santa Fé do Sul consisted of 32 pregnant women diagnosed with syphilis, aged between 18 and 45 years and six newborns diagnosed with congenital syphilis in the period from 2015 to 2017. In total, 153 cases of pregnant women with syphilis and 55 cases of congenital syphilis were reported in the Jales Epidemiological Surveillance Group from 2013 to 2017. Minitab 17 software was used for the statistical analysis and the chi-square statistical test was used to observe the associations between the cases of gestational and congenital syphilis and demographic and clinical variables in the study period, as well as the possible associations between congenital syphilis and symptoms evaluated in newborns. Results: The sociodemographic profile of the pregnant women with syphilis was of young women with no or some degree of education and the incidence of congenital syphilis was 5.36/1,000 live births in the period studied. Despite the high incidence, there was no fatal case of the disease. The number of absolute cases of gestational syphilis in the Epidemiological Group in the Northwest of São Paulo State studied during the period from 2013 to 2017 increased from 2013 (13 cases) to 2017 (43 cases), reaching a maximum in 2016 with 44 cases (28.8%). In 2013, the occurrence of gestational syphilis was predominant in patients aged 15 to 24 years (11 cases, 84.6%), and this percentage dropped until 2016 (16 cases, 36.4%), increasing in 2017 (25 cases, 58.1%). In 2013, there were no cases of gestational syphilis, reaching a maximum of 19 cases (43.2%) in 2016. There was a significant increase in cases of primary syphilis from 2013 to 2015, with a considerable reduction until 2017; latent syphilis cases increased consistently until 2017, reaching 18 cases (41.8%). The majority of pregnant women underwent the treponemal (86.0%) and non-treponemal test (90.7%). According to the prenatal care characteristics analyzed, we verified that, of the 153 pregnant women diagnosed with syphilis, only 54 pregnant women (35.3%) performed the minimum number of prenatal visits. The number of partners treated (62.8%) was higher than that of untreated partners (27.9%) throughout the study period, and the number of untreated and ignored partners was higher among the treated partners. The cities with the highest number of syphilis diagnosed in pregnant women were Fernandópolis and Santa Fé do Sul. In relation to Congenital Syphilis, a significant number of cases were identified, reaching a total of 55 cases, being 28 males and 27 females. In 2016, (27.3%, 15 cases) occurred, observing that three newborns were symptomatic, while the others presented the asymptomatic form of the disease. In relation to the cerebrospinal fluid test, three had reactant results, two in the year 2016 and one in the year 2017. In relation to the x-ray evaluation of long bones, 31 newborns were submitted to this examination and four of them presented bone alterations. Regarding the treatment, four newborns received Procaine Penicillin, as there were clinical and/or immunological and/or x-ray and/or hematological alterations, and 28 of them were treated with Penicillin G Crystal. Of the 55 cases reported, 14 received another type of treatment, which were not described or identified in the notification system, two infants were not treated and two were ignored. The cities that had the highest percentage of cases of congenital syphilis were Fernandópolis and Jales. Conclusions: The sociodemographic profile of pregnant women with syphilis in Santa Fe do Sul was young women with low education and there was a considerable increase in syphilis cases during the period investigated both in the city and in the Epidemiological Group in the Northwest of São Paulo State. The mean incidence of gestational syphilis was 10.37/1,000 live births and the congenital heart rate was 3.73/1,000 live birthsbetween 2013 and 2017. The occurrence of gestational syphilis predominantly occurred in patients aged 15 to 24 years, with a significant increase in cases of primary and latent syphilis and significant associations between the years evaluated and the clinical classification and the range age of patients with gestational syphilis. There were no significant associations between the other demographic and clinical variables of gestational syphilis cases. All demographic and clinical variables were similar in congenital syphilis. The results of this study show that there is still a long way to go to reach the WHO goal of eliminating syphilis as a public health problem. Urgent strategic actions are needed to control gestational and congenital syphilis in the Northwest of São Paulo State.