Maternal and congenital syphilis in a university hospital in the capital of a state in northeastern Brazil: a challenge for the Brazilian health system.

Abstract

Introduction: Syphilis is a systemic infectious disease caused by a bacterium of the spirochaeta genus and spitochaetaceous family called Treponema pallidum, which, when untreated or inadequately treated, may present a chronic evolution, the infection may be asymptomatic and in this case its diagnosis only will be possible through specific serology. OBJECTIVE: To determine the profile of syphilis during pregnancy and the rate of congenital syphilis in pregnant women admitted to the HUPAA maternity ward. METHODS: Cross-sectional, retrospective, descriptive study, analyzing 93 medical records of pregnant women with syphilis and 304 of newborns with congenital syphilis admitted to the neonatology department of the University Hospital Universidade Federal de Alagoas from 2013 to 2016. RESULTS: A incidence of syphilis in pregnant women who were treated at HUPAA was: 13 cases in 2013, 23 cases in 2014, 32 cases in 2015 and 25 cases in 2016; totaling ninety-three cases over the four-year study period. Of the 93 pregnant women studied, all underwent prenatal consultations, however 40 cases were diagnosed with syphilis outside the prenatal consultation, that is, upon admission to hospital, while 53 were diagnosed during the prenatal consultation.  Considering education, 67.7% of mothers with syphilis had low education, that is, they had completed incomplete grades 5 to 8, of which 8.6% had no education. Analyzing congenital syphilis in the Neonatology Sector, 73 cases were observed in 2013, 109 in 2014, 72 in 2015 and 50 cases in 2016, totaling 304 new cases of syphilis acquired through vertical transmission. In relation to the treatment of the sexual partner of the total of 93 pregnant women with syphilis, the absence of treatment was the majority with 77 cases, while 16 cases received treatment. CONCLUSIONS: The number of newborns with congenital syphilis in the present study over a four-year period was approximately 3.2 times more than the number of pregnant women with syphilis in the same period of the present study, justified by the presence of newborns in the series who were born in other maternity hospitals from the public network and were referred for treatment in the Neonatology Sector. What draws attention is the alarming rate of children born with syphilis during the period of this study (31.7/1000 live births). The determinant failures for the aforementioned high rates of syphilis are well established: late diagnosis (during hospital admission), untreated partner and failure in the health system (not knowing the treatment status of the pregnant women's partner).