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Pinheiro YT, Dantas JDC, Holanda JRR, Feitosa ADNA, Augusto Rosendo da Silva R. Epidemiology of Syphilis in Pregnancy and Congenital Syphilis in Brazil and the Risk or Associated Factors: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e50702. [PMID: 38175689 PMCID: PMC10797499 DOI: 10.2196/50702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Syphilis in pregnancy and congenital syphilis are growing public health issues worldwide. Several factors can influence their occurrence in the population. Therefore, understanding the epidemiology of this condition and the factors that influence its occurrence is fundamental for decision-making by clinicians and health managers. However, so far, no systematic review has summarized and analyzed data on the incidence, prevalence, and predictors of these diseases in Brazilian cities, considering different sociocultural, demographic, economic, sanitary, and spatial-temporal characteristics presented across locations. OBJECTIVE We propose a systematic review protocol to gather and analyze data on the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil, taking into account different local or regional contexts. METHODS Searches will be conducted in CINAHL, MEDLINE, LILACS, Embase, and Web of Science databases. We will include observational studies (ie, cross-sectional, longitudinal, or case-control studies), analyzing the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil from primary data. The diagnosed syphilis will be assessed based on direct pathogen detection tests or through immunological, treponemal or nontreponemal tests, following Brazilian protocols for diagnosing syphilis. The studies are currently undergoing screening in the databases, and after this step, 2 reviewers will perform all identified documents. The Newcastle-Ottawa Scale and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system will be used to assess methodological quality and quality of evidence of studies, respectively. The Kappa coefficient will assess the agreement between researchers in each study stage. Cochran Q test will assess the heterogeneity among studies. Then, a random-effects meta-analysis will be performed. RESULTS Results will be discussed based on subgroup analysis, which is as follows: (1) type of syphilis (in pregnancy or congenital), (2) type of study (case-control and cross-sectional studies for analysis of associated factors and longitudinal studies for risk factors), and (3) contextual factors (ie, region of country, socioeconomic and demographic characteristics, and year of study). This systematic review is expected to be completed by December 2023, and our results will be disseminated through publication in peer-reviewed journals and scientific events. CONCLUSIONS This systematic review aims to assist health care managers and professionals in their decision-making to control these diseases in Brazil, considering location heterogeneity. Furthermore, countries with health systems and demographic and socioeconomic contexts similar to those of Brazil may benefit from this information. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50702.
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Lima MG, Bahia JC, Oliveira FS, Vieira FV, Cavalcante AMR, Matos MA, Guimarães JV. Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial. Int J STD AIDS 2023; 34:969-977. [PMID: 37464586 DOI: 10.1177/09564624231188750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Gestational syphilis requires early detection and proper treatment to prevent negative maternal-fetal outcomes. This study aimed to evaluate the effectiveness of an educational intervention on treatment adherence and knowledge about syphilis in postpartum women with positive Treponema pallidum results. METHODS A randomized, parallel, and open clinical trial was conducted with 64 postpartum women who tested positive for T. pallidum, assigned to two groups (1:1 ratio). The Intervention Group (IG) received an educational intervention on syphilis, including an explanatory leaflet and hands-on demonstrations, along with standard guidelines. The Control Group (CG) received standard guidelines alone. Pre-test and post-test assessments were conducted to measure knowledge and treatment adherence. Statistical analyses included descriptive and inferential methods, assessing group homogeneity using the Chi-square or Fishers exact test. The interventions effectiveness was determined using relative risk, and pre- and post-test scores were compared using the independent t test. RESULTS The post-test revealed improvements in knowledge scores for general knowledge, treatment, and prevention domains (p < .05). The IG demonstrated an increase in post-test knowledge scores (p = .001), with association between post-test scores and treatment adherence (p = .001). CONCLUSION The educational intervention on syphilis improved knowledge and treatment adherence in postpartum women with syphilis.
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Affiliation(s)
- Maira Gr Lima
- Master in Nursing, Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
| | - Julyana C Bahia
- Master in Nursing, Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
| | - Flávia S Oliveira
- Master in Nursing, Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
| | - Flaviana Vm Vieira
- PhD in nursing, professor at Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
| | - Agueda Maria Rz Cavalcante
- PhD in nursing, professor at Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
| | - Marcos André Matos
- PhD in nursing, professor at Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
| | - Janaína V Guimarães
- PhD in nursing, professor at Faculdade de Enfermagem da Universidade Federal de Goiás (FEN - UFG), Goiânia/Goiás, Brazil
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Tong H, Heuer A, Walker N. The impact of antibiotic treatment for syphilis, chlamydia, and gonorrhoea during pregnancy on birth outcomes: A systematic review and meta-analysis. J Glob Health 2023; 13:04058. [PMID: 37325885 DOI: 10.7189/jogh.13.04058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background Sexually transmissible infections are important causes of loss of health and lives in women and infants worldwide. This paper presents the methods and results of a systematic review that focuses on the impact of antibiotic treatment for syphilis, chlamydia, and gonorrhoea during pregnancy on birth outcomes for the Lives Saved Tool (LiST). Methods We searched PubMed, Embase, Cochrane Libraries, Global Health and Global Index Medicus for articles available until May 23rd, 2022. The search criteria focused on the impact of treatment for the three sexually transmitted infection among pregnant women. Nearly all the articles found were non-randomized studies. Results Treatment for pregnant women with active syphilis reduced the risk of preterm birth by 52% (95% CI = 42%-61%; 11 043 participants, 15 studies; low quality); stillbirth by 79% (95% CI = 65%-88%; 14 667 participants, eight studies; low quality); and low birth weight by 50% (95% CI = 41%-58%; 9778 participants, seven studies; moderate quality). Treatment for pregnant women with chlamydia infection reduced the risk of preterm birth by 42% (95% CI = 7%-64%; 5468 participants, seven studies; low quality) and might reduce the risk of low birth weight by 40% (95% CI = 0%-64%; 4684 participants, four studies; low quality). No studies provided data on treatment of gonorrhoea therefore no meta-analysis was conducted. Conclusions Because few studies adjusted for potential confounding factors, the overall quality of evidence was considered low. However, given the consistent and large effects, we recommend updating the estimated effect of timely detection and treatment for syphilis on preterm birth and stillbirth in the LiST model. More research is required to ascertain the effect of antibiotic treatment for chlamydia and gonorrhoea infection in pregnancy.
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Liu H, Chen N, Tang W, Shen S, Yu J, Xiao H, Zou X, He J, Tucker JD, Qiu X. Factors influencing treatment status of syphilis among pregnant women: a retrospective cohort study in Guangzhou, China. Int J Equity Health 2023; 22:63. [PMID: 37024898 PMCID: PMC10080893 DOI: 10.1186/s12939-023-01866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Many syphilis infected pregnant women do not receive treatment, representing a major missed opportunity to reduce the risk of syphilis-related adverse pregnancy outcomes. This study explored correlates of treatment among pregnant women with syphilis in Guangzhou, China. METHODS Pregnant women with a diagnosis of syphilis in Guangzhou between January 2014 and December 2016 were included. Information of syphilis treatment and correlates were extracted from a comprehensive national case-reporting system. Multivariate logistic regression was used to identify the correlations between information on the demographic characteristics, previous history, clinical characteristics about current syphilis, information of diagnosing hospital, and receiving no treatment or inadequate treatment among syphilis-seropositive pregnant women. A causal mediation analysis was used to explore the potential mediating role of the timing of syphilis diagnosis in the correlates. RESULTS Among 1248 syphilis-seropositive pregnant women, 379 (30.4%) women received no treatment or inadequate treatment. Migrant pregnant women (adjusted OR = 1.83, 95% CI: 1.25-2.73), multiparous participants (adjusted OR = 3.68, 95% CI: 2.51-5.50), unmarried participants (adjusted OR = 3.21, 95% CI: 1.97-5.28) and unemployed participants (adjusted OR = 2.43, 95% CI: 1.41-4.39) were more likely to receive no treatment or inadequate treatment. Participants who with history of syphilis infection (adjusted OR = 0.59, 95% CI: 0.42-0.82) and with high school and higher education participants (adjusted OR = 0.69, 95% CI: 0.49-0.97) were less likely to receive untreated or inadequately treatment. And that the impact of all these factors (except for the migrants) on treatment status are fully mediated through the syphilis diagnosis time, with the direct effect of migrants that would have resulted in a higher rate of no or inadequate treatment (OR = 2.34, 95% CI: 1.08-5.32) was partially cancelled out by the syphilis diagnosis time. CONCLUSIONS Pregnant women who were migrant without local residence and women with syphilis diagnosed at a later gestational age were more likely to slip through the cracks of the existing antenatal care system. More programs should focus on eliminating these gaps of residence-related health inequalities. This research highlights actionable elements for health services interventions that could increase syphilis treatment rates among pregnant women.
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Affiliation(s)
- Huihui Liu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Niannian Chen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Weiming Tang
- Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Jia Yu
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Huiyun Xiao
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Xingwen Zou
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Jianrong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Joseph D Tucker
- Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, NC, 27599, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
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New trends in congenital syphilis: epidemiology, testing in pregnancy, and management. Curr Opin Infect Dis 2022; 35:452-460. [PMID: 36066379 DOI: 10.1097/qco.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW In light of alarming increases in the incidence of congenital syphilis in many middle and higher income countries across the globe, this review summarizes recent changes in the epidemiology of syphilis, highlights recommended changes to testing in pregnancy and provides an update for the management of syphilis infection in pregnancy (SIP) and of the infant born to a mother with SIP. RECENT FINDINGS The re-emergence of congenital syphilis is a result of increasing infectious syphilis in women of childbearing age, which is in turn a result of increasing syphilis in the general population particularly in Indigenous and marginalized populations. Potential reasons for the increase include changing sexual practices and increased travel and migration, as well as factors that limit healthcare access, particularly access to antenatal care and limited awareness and education amongst mothers and maternity services. A single antenatal test for syphilis is insufficient; more frequent testing in pregnancy is necessary even for women deemed to be low risk. The management of SIP and of the newborn is complex and guidelines should be readily available with clear recommendations. SUMMARY Congenital syphilis is preventable. The current crisis calls for a global and national multipronged, co-ordinated approach involving public health and hospital systems which includes education of individuals and healthcare workers, availability of updated guidelines for prevention and treatment, prioritization of antenatal testing, assurance of accessible and prompt treatment and appropriate assessment and follow-up of infants.
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Torres PMA, Reis ARDP, dos Santos AST, Negrinho NBDS, Menegueti MG, Gir E. Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review. Rev Bras Enferm 2022; 75:e20210965. [PMID: 36102473 PMCID: PMC9728816 DOI: 10.1590/0034-7167-2021-0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the evidence available in literature on factors associated with inadequate treatment of syphilis in pregnant women. METHODS an integrative review, carried out in the LILACS, CINAHL, Web of Science, Scopus, PubMed and EMBASE databases, with controlled descriptors therapeutic and prenatal syphilis. RESULTS nine publications composed the interpretative analysis, in which low education, income and maternal age, temporary lack of medication and HIV infection were associated with inadequate treatment of syphilis during pregnancy, in addition to delay or absence of prenatal care and receiving the 1st dose of penicillin, lack of tests or treatment less than 30 days before childbirth, and partners' low compliance with treatment. FINAL CONSIDERATIONS among the main factors associated with inadequate treatment, clinical and sociodemographic aspects stand out, as well as failures in drug dispensing, prescription and monitoring of treatment of pregnant women and their partners by the health system.
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Affiliation(s)
| | | | | | | | | | - Elucir Gir
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil
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Torres PMA, Reis ARDP, Santos ASTD, Negrinho NBDS, Menegueti MG, Gir E. Fatores associados ao tratamento inadequado da sífilis na gestação: revisão integrativa. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0965pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos: analisar as evidências disponíveis na literatura sobre os fatores associados ao tratamento inadequado da sífilis em gestantes. Métodos: revisão integrativa, realizada nas bases de dados LILACS, CINAHL, Web of Science, Scopus, PubMed e EMBASE, com os descritores controlados sífilis gestantes terapêutica e pré-natal. Resultados: nove publicações compuseram a análise interpretativa, nas quais baixa escolaridade, renda e idade materna, falta temporária do medicamento e infecção por HIV foram associadas ao tratamento inadequado da sífilis na gestação, além do atraso ou ausência do pré-natal e no recebimento da 1ª dose de penicilina, falta de exames ou tratamento com menos de 30 dias antes do parto, e a baixa adesão do parceiro ao tratamento. Considerações Finais: dentre os principais fatores associados ao tratamento inadequado, destacam-se os aspectos clínicos da gestante, sociodemográficos, além de falhas na dispensação do medicamento, prescrição e acompanhamento do tratamento da gestante e do parceiro pelo sistema de saúde.
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Roncalli AG, Rosendo TMSDS, Santos MMD, Lopes AKB, Lima KCD. Effect of the coverage of rapid tests for syphilis in primary care on the syphilis in pregnancy in Brazil. Rev Saude Publica 2021; 55:94. [PMID: 34910026 PMCID: PMC8621623 DOI: 10.11606/s1518-8787.2021055003264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE: To analyze the effect of rapid tests coverage in Primary Care on syphilis detection rate in pregnant women in Brazil, in municipalities with more than 100,000 inhabitants. METHODS: The dependent variable was the syphilis detection rate in pregnant women between 2012 and 2018. As the main independent variables, the methods for measuring the coverage of rapid tests for syphilis in Primary Care were used and, as adjustment variables, some indicators of health services and socioeconomic. We opted for a linear regression model for panel data (panel data analysis), considering the municipality as the unit of analysis and the year as the time variable. RESULTS: From the results of the final model, we can infer that, for a given municipality, as the rate of rapid tests increases by one point for every thousand live births, the detection rate of syphilis in pregnant women increases by an average of 0.02 cases per thousand live births (p < 0.001). This value is adjusted for Family Health coverage, proportion of health facilities per inhabitant, per capita expenditure on health and the Human Development Index. CONCLUSIONS: There was a substantial improvement in the amount of rapid tests available, as well as a significant increase in the number of tests performed in pregnant women, which predicts an increase in syphilis rates in pregnant women. However, a worrying hypothesis is that the number of tests performed on pregnant women during the analyzed period may have been insufficient to detect the progress of the epidemic in this population.
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Affiliation(s)
- Angelo Giuseppe Roncalli
- Universidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasils
| | | | | | - Ana Karla Bezerra Lopes
- Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Ciências da Saúde. Natal, RN, Brasil
| | - Kenio Costa de Lima
- Universidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasils
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Oliveira IMD, Oliveira RPB, Alves RRF. Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017. Rev Saude Publica 2021; 55:68. [PMID: 34730749 PMCID: PMC8522754 DOI: 10.11606/s1518-8787.2021055003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments’ percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms’ data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.
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de Souza CDF, Machado MF, Correia DS, do Carmo RF, Cuevas LE, Santos VS. Spatiotemporal clustering, social vulnerability and risk of congenital syphilis in northeast Brazil: an ecological study. Trans R Soc Trop Med Hyg 2020; 114:657-665. [PMID: 32537650 DOI: 10.1093/trstmh/traa034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/07/2020] [Accepted: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To investigate the spatial distribution of congenital syphilis (CS) and its association to social vulnerability indexes in northeast Brazil. METHODS This was an ecological study referring to all cases of CS and CS deaths recorded in the northeast region of Brazil from 2008 to 2015. Data were obtained from three Brazilian information systems. We examined statistical correlations between CS indicators by state and municipality and their socioeconomic and social vulnerability characteristics. We used Bayesian empirical local models to identify fluctuations of the indicators. Spatial statistical tests were used to identify spatial clusters and the municipalities at high risk of CS. RESULTS The incidence of CS ranged from 2.1 cases/1000 live births (LB) in 2008 to 6.9/1000 LB in 2015, with an annual increase of 19.9% (p < 0.001). The mortality coefficient of CS ranged from 2.9/1000 LB in 2008 to 6.5/1000 LB in 2015, resulting in an annual increase of 15.1% (p < 0.001). Nine spatial clusters were identified. Cases of congenital syphilis occurred in well-defined spatiotemporal clusters and in areas with high levels of social vulnerability. CONCLUSIONS CS incidence is associated with social vulnerability. CS control programmes should target spatial clusters and populations with high levels of social vulnerability.
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Affiliation(s)
| | - Michael F Machado
- Department of Medicine, Federal University of Alagoas, Arapiraca, Brazil
| | | | - Rodrigo F do Carmo
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victor S Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
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Standardized treatment and determinants on 9,059 syphilis-infected pregnant women during 2015-2018 in Hunan, China. Sci Rep 2020; 10:12026. [PMID: 32694571 PMCID: PMC7374608 DOI: 10.1038/s41598-020-69070-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022] Open
Abstract
This study was aimed to describe the standardized treatment rate of syphilis-infected pregnant women in Hunan province and to explore the determinants for standardized treatment. All syphilis-infected pregnant women registered in the Information System of Prevention of Mother-to-Child Transmission of Syphilis Management (IPMTCT) in Hunan between January 2015 and December 2018 were included in this study. Among 9,059 pregnant women with syphilis, 7,797 received syphilis treatment, with a treatment rate of 86.1%, and 4,963 underwent standardized syphilis treatment, with an average standardized treatment rate of 54.8%. The facilitators for the standardized treatment included abnormal reproductive histories (aOR = 1.15, 95%CI:1.03–1.28), time of first prenatal care within 1–12 weeks (aOR = 5.17, 95%CI:4.19–6.37) or within 13–27 weeks (aOR = 5.56, 95%CI:4.46–6.92), previous syphilis infection (aOR = 1.64, 95%CI: 1.48–1.81), and definite syphilis infection status of sexual partner (negative: aOR = 1.73, 95%CI:1.57–1.91; positive: aOR = 1.62, 95%CI:1.34–1.95). The barriers included marital status being unmarried/divorced/widowed (aOR = 0.81, 95%CI: 0.65–0.99), pluripara (aOR = 0.58, 95%CI: 0.46–0.74), number of children ≥ 2 (aOR = 0.45, 95%CI: 0.35–0.57), and syphilis clinical stage being primary/secondary/tertiary (aOR = 0.72, 95%CI: 0.58–0.88) or unclear (aOR = 0.78, 95%CI: 0.70–0.86). Though the treatment rate of syphilis-infected pregnant women was high, the standardized treatment rate was low. The facilitators and barriers on standardized treatment of gestational syphilis were identified at the patient level.
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Anugulruengkitt S, Yodkitudomying C, Sirisabya A, Chitsinchayakul T, Jantarabenjakul W, Chaithongwongwatthana S, Puthanakit T. Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand. Pediatr Int 2020; 62:330-336. [PMID: 31886919 DOI: 10.1111/ped.14132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention. METHODS A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria. RESULTS From 2013 to 2017, 69 syphilis-infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18-32) years and 12 (17%) women had human immunodeficiency virus co-infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non-reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non-reactive rapid plasma reagin at the age of 7 months. CONCLUSIONS Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care.
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Affiliation(s)
- Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
| | - Chatnapa Yodkitudomying
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
| | - Anongnart Sirisabya
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thaninee Chitsinchayakul
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand.,Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Surasith Chaithongwongwatthana
- Division of Infectious Diseases, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
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