Factors influencing the positivity of diagnostic tests for congenital syphilis.

OBJECTIVE: The objective of this study was to analyze the factors that influence the positivity of treponemal and non-treponemal tests in cases of congenital syphilis. METHODS: This cross-sectional and correlational study was carried out from the analysis of the database of Disease and Notification Information System (SINAN, in Portuguese) using the data obtained through the Epidemiological Surveillance Group 29, with 639 notifications of congenital syphilis between 2007 and 2018. The data were analyzed by a descriptive and inferential analysis from logistic regression with a significance level of 5% (p≤0.05). RESULTS: The positivity of the treponemal test was higher by 4.5 times in infants living in rural areas and 19.6 times among those whose mothers obtained the diagnosis of syphilis after birth. The treponemal test showed positivity 3.2 times higher for the variable "having been diagnosed between 2007 and 2015" and 5.5 times higher for the variable "having been diagnosed with maternal syphilis in the postpartum period." CONCLUSION: This study shows that testing during prenatal care is essential for early diagnosis and prevention of syphilis complications.

Congenital syphilis: the re-emergence of a forgotten disease.

A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality.

Gestational and congenital syphilis: gaps to be elucidated.

Congenital and gestational syphilis are increasingly prevalent multisystemic infections in Brazil. This study aimed to present a case series of three children diagnosed with congenital syphilis even though their mother had unreactive treponemal tests. The VDRL (Venereal Disease Research Laboratory) titers of a 22-year-old mother with three pregnancies decreased after treatment. The mother did not have a reactive treponemal test, but all the three children were diagnosed with early congenital syphilis. This case series highlights the difficulty in diagnosing gestational and congenital syphilis in Brazil.

A ruptured thoracic aortic aneurysm and the difficulties of confirming syphilis.

A 43-year-old woman died suddenly and was found at PM to have a ruptured thoracic aortic aneurysm. The endothelial surface of the aorta showed a 'tree-bark' appearance. Histology of the aneurysm wall showed a patchy, mainly perivascular, plasma cell infiltrate. Multiple spirochete-like organisms were identified on T. pallidum IHC. However, PM syphilis serology (screen including rapid plasma reagin (RPR) and T. pallidum particle agglutination (TPPA)) on femoral blood was negative. PCR testing on FFPE aortic wall tissue was negative. Further history revealed routine antenatal syphilis screening tests had been negative, no known history or risk of exposure to syphilis or other treponemes. This case raises the possibility of false negative syphilis testing. While acknowledged in RPR testing, with the modern testing regime using multiple methods, the rate of false negative results is now thought to be markedly reduced, and false positive results are a much greater problem in clinical medicine. The most common cause of false negative results is early in primary infection before an immune response has been mounted and in those patients that are immunocompromised. False negative results are also more often seen in tertiary syphilis, as in this case. Newer testing methods which include 16S rRNA sequencing have become available and early discussion with a microbiologist would be recommended. Strong macroscopic and microscopic suggestion of syphilis as the cause of the aneurysm makes it necessary to include the possibility of infection in the Post Mortem Report to Coroner as this will have implications for her sexual partners and children.

Congenital Syphilis and the Prozone Phenomenon: Case Report.

Congenital syphilis represents an important public health challenge in the United States, and its prevalence has been increasing for the past 10 years because of many factors. The diagnosis can be difficult given its various and nonspecific clinical manifestations in newborns, and the possibility of false negative results during prenatal care. The prozone phenomenon, caused by an excess of antibody, which interferes with the regular screening tests, is a cause of false negative tests. This could delay the diagnosis and increase morbidity and mortality in the newborn. We present a case of congenital syphilis in a 3-month-old infant whose mother had prenatal care and negative tests for syphilis, which contributed to the late diagnosis. In the face of clinical findings suggestive of congenital syphilis and negative maternal syphilis tests healthcare providers should consider the possibility of maternal false negative test caused by the prozone phenomenon.

Seroreduction of syphilis non-treponemal titers during pregnancy for women with and without HIV co-infection.

OBJECTIVE: To evaluate the effect of HIV co-infection on non-treponemal titers during pregnancy in women with syphilis. METHODS: This is a secondary analysis of pregnant women with syphilis in the prospective, observational Zambian Preterm Birth Prevention Study (ZAPPS). Treponemal (Treponema pallidum particle agglutination) and non-treponemal (rapid plasma reagin; RPR) testing were performed on serum biospecimens, resulting in 47 participants with serologically confirmed syphilis (27 HIV-positive, 20 HIV-negative). The primary outcome, achievement of RPR titer seroreduction during pregnancy, was analyzed by logistic regression. Secondary outcomes included overall titer reduction, seroreduction rate, serologic cure, and adverse pregnancy outcomes. RESULTS: Seroreduction of RPR titer occurred in 78% (21/27) of women with HIV versus 45% (9/20) of women without (adjusted odds ratio 4.66; 95% confidence interval [CI] 1.14 - 19.08). Overall RPR titer reduction, rate of seroreduction per week, and the proportion achieving serologic cure each trended higher among women with HIV compared with those without HIV. There was a trend toward decreased stillbirth incidence in participants achieving seroreduction (odds ratio 0.15, 95% CI 0.01-1.58). CONCLUSION: HIV co-infection in this cohort of Zambian women with syphilis was associated with greater odds of RPR titer seroreduction during pregnancy. Pregnant women with syphilis and HIV may not be at increased risk for a delayed syphilis treatment response compared with women without HIV.

High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study.

BACKGROUND: Syphilis, a disease once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis rates since enhanced syphilis surveillance was initiated in 2013. This study reports epidemiologic, descriptive and treatment data on management of infants prenatally exposed or vertically infected with syphilis across New Zealand as reported by pediatricians. METHODS: Over a 26-month period from April 2018 to May 2020 (inclusive), pediatricians throughout New Zealand notified potential, probable and confirmed cases of congenital syphilis to the New Zealand Pediatric Surveillance Unit. National reporting numbers were concurrently ascertained to demonstrate reporting accuracy. RESULTS: Thirty-two cases were notified, comprised of 25 infants born to women with positive antenatal syphilis serology (5 whom developed congenital syphilis), and 7 infants diagnosed with congenital syphilis after birth where syphilis was not diagnosed in pregnancy. There were 12 cases of congenital syphilis; an incidence rate of 9.4 cases per 100,000 live births. Nine of the 12 infants had clinical features of congenital syphilis. One-third of maternal infections were early syphilis, and the women who gave birth to infected infants were less likely to have received antenatal care, adequate treatment and follow-up monitoring of treatment for syphilis during pregnancy. CONCLUSIONS: This study quantifies an important burden of disease from congenital syphilis in our population. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings support the urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether by affected region or instituted for all, in the context of rising cases.

Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015).

OBJECTIVE: Syphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women's Interagency HIV Study (WIHS) to inform targeted interventions. METHODS: The retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994-2002) and recent (2011-2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis. RESULTS: The study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p<0.01). In adjusted models for the early cohort, factors associated with syphilis included age, black race, low income, hepatitis C seropositivity, drug use, HIV infection and >100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30-39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40-49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection. CONCLUSIONS: Syphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use.

Congenital syphilis: Need for intensification of antenatal screening and clinician awareness.

Congenital syphilis occurs due to trans-placental transmission of Treponema pallidum or rarely, intrapartum contact with infectious lesions. Even though preventable, congenital syphilis occurs sporadically in India, owing to lack of antenatal screening as well as the lack of awareness among clinicians about the burden of syphilis in the community. Since a significant overlap of clinical manifestations exists with many systemic diseases, awareness among clinicians is crucial for an early diagnosis. Renomegaly, nephrotic syndrome and nephritis can all be the signs of renal involvement in congenital syphilis, which can provide clues of the diagnosis. Direct invasion by spirochetes, hypersensitivity reactions and immune complex deposition in glomeruli contribute to the pathogenesis. We report a case of congenital syphilis characterised by delayed diagnosis with renal as well as cutaneous manifestations from missed maternal syphilis during the antenatal period and owing to the lack of antenatal screening.

A Comparative Study of the Epidemiology of Treponemal Infection in the Volta and Oti Regions of Ghana: A Five-Year Multisite Parallel Population-Based Analysis vis-à-vis the Sentinel Survey.

Treponemal infections can be blood-borne with great public health consequences. This study is aimed at comparatively describing the five-year (2013-2017) regional epidemiology of treponemal infection using pregnant women in the sentinel survey and apparently healthy blood donors as a proxy for the general population at four sentinel sites in the Volta and Oti Regions of Ghana. We analyzed retrospective data from 17,744 prospective blood donors aged 18 to 58 years and 7,817 pregnant women in a sentinel survey with ages from 15 to 49 years at Hohoe, Ho, Tongu, and Krachi West sentinel sites in the Volta and Oti Regions. Laboratory data extracted include variables such as age, gender, date of blood donation, and Treponema pallidum chromatographic immunoassay results from the blood banks of the four study sites. The five-year treponemal infection rate among the pregnant women in the sentinel survey and prospective blood donors was 0.79% and 2.38%, respectively. Site-specific infection rate for population-based/sentinel survey was 4.6%/1.1%, 2.0%/0.5%, 1.3%/1.1, and 1.2%/0.3% for Hohoe, Ho, Krachi West, and Tongu, respectively. Significant gender disparity in Treponemal infection rate exists with a male preponderance. The regional infection rate in the sentinel survey is lower compared to the general population. Therefore, the use of pregnant women as a proxy for population estimates could underestimate the burden in the study jurisdiction.

Syphilis testing adherence among women with livebirth deliveries: Indianapolis 2014-2016.

BACKGROUND: The number of congenital syphilis (CS) cases in the United States are increasing. Effective prevention of CS requires routine serologic testing and treatment of infected pregnant women. The Centers for Disease Control and Prevention (CDC) recommends testing all pregnant women at their first prenatal visit and subsequent testing at 28 weeks gestation and delivery for women at increased risk. METHODS: We conducted a cross-sectional cohort study of syphilis testing among pregnant women with a livebirth delivery from January 2014 to December 2016 in Marion County, Indiana. We extracted and linked maternal and infant data from the vital records in a local health department to electronic health records available in a regional health information exchange. We examined syphilis testing rates and factors associated with non-testing among women with livebirth delivery. We further examined these rates and factors among women who reside in syphilis prevalent areas. RESULTS: Among 21260 pregnancies that resulted in livebirths, syphilis testing in any trimester, including delivery, increased from 71.7% in 2014 to 86.6% in 2016. The number of maternal syphilis tests administered only at delivery decreased from 16.6% in 2014 to 4.04% in 2016. Among women living in areas with high syphilis rates, syphilis screening rates increased from 79.6% in 2014 to 94.2% in 2016. CONCLUSION: Improvement in prenatal syphilis screening is apparent and encouraging, yet roughly 1-in-10 women do not receive syphilis screening during pregnancy. Adherence to recommendations set out by CDC improved over time. Given increasing congenital syphilis cases, the need for timely diagnoses and prevention of transmission from mother to fetus remains a priority for public health.

Características sociodemográficas y clínicas de la sífilis gestacional en Cali, 2018 / Sociodemographic and clinical characteristics of gestational syphilis in Cali, 2018

Resumen | Introducción. La sífilis gestacional se considera de interés en salud pública por las repercusiones que tiene en la madre y el hijo. Pese a tener protocolos para su notificación, diagnóstico y manejo, en Colombia se siguen evidenciando limitaciones en su control. Objetivo. Describir las características sociodemográficas, clínicas y de distribución espacial de las pacientes con sífilis gestacional en Cali, Colombia, en el 2018. Materiales y métodos. Se hizo un estudio transversal con 427 casos de sífilis gestacional reportados al Sistema de Vigilancia en Salud Pública (Sivigila). Para el procesamiento estadístico, se utilizó el programa R, versión 3.5.3. Las variables cualitativas se presentan como proporciones y, las cuantitativas, mediante medidas de tendencia central y dispersión, Para la distribución espacial, se usó el programa Qgis 3.0. Resultados. La razón de sífilis gestacional fue de 17 casos por 1.000 vivos (incluidos los mortinatos). El 57,1 % de las pacientes pertenecía al régimen subsidiado de salud y el 16,6 % no estaba asegurado. El 90,4 % de los casos se diagnosticó durante el embarazo; el 47,2% recibió tres dosis de penicilina y el 57,6 % de los contactos recibió tratamiento. Conclusiones. La tasa de sífilis gestacional en Cali en el 2018 fue superior a la nacional y la enfermedad se presentó con mayor frecuencia en mujeres gestantes en condición de vulnerabilidad socioeconómica, lo que coincidió con la distribución espacial en general. Se evidenció la falta de oportunidad en la detección temprana y el manejo de la infección tanto en las pacientes como en sus contactos, lo cual dificulta el control de la enfermedad y refleja la inadecuada aplicación de la ruta integral de atención en salud materno-perinatal.

Abstract | Introduction: Gestational syphilis is considered an event of public health interest given its impact on mother and child. In Colombia, despite having specific protocols for its notification, diagnosis, and management, there are still limitations in its control. Objectives: To describe the sociodemographic and clinical characteristics, as well as the spatial distribution of gestational syphilis in Cali, Colombia, in 2018. Materials and methods: We conducted a cross-sectional study of 427 gestational syphilis cases reported to the Colombian national epidemiological surveillance system (Sivigila). For the statistical processing, we used the R program, version 3.5.3. We expressed qualitative variables as proportions and quantitative ones through central tendency and dispersion measures, and to establish the spatial distribution we used the Qgis program, version 3.0. Results: The prevalence of gestational syphilis was 17 cases per 1,000 live births (including stillbirths); 57.1% of patients belonged to the subsidized healthcare system and 16.6% had no health insurance; 90.4% of cases were diagnosed during pregnancy; 47.2% of the pregnant women received three doses of penicillin, yet only 57.6% of contacts were treated. Conclusions: The prevalence of gestational syphilis in Cali during 2018 exceeded the national rate with a higher frequency among women in socioeconomic vulnerability conditions consistent with the general spatial distribution. There was a lack of opportunity in the early detection and management of the infection both among pregnant women and their contacts, which hinders the control of the disease and reflects the inadequate application of the comprehensive maternal and perinatal health care route guidelines.

The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review.

BACKGROUND: Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10-15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. METHODS: Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. RESULTS: Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. CONCLUSION: Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.

Trends in RPR Seropositivity among Children Younger than 2 Years in South Africa, 2010-2019.

A positive rapid plasma reagin (RPR) result in children under the age of 2 years indicates either passive transplacental transfer of maternal antibodies or active infection with syphilis (possible congenital syphilis). We describe trends in RPR seropositivity in this population using centralized laboratory data. A secondary analysis of laboratory data collected through the National Health Laboratory Service, Corporate Data Warehouse from 2010 to 2019 was conducted. Of the 127 150 children <2 years included in the analysis, 10 969 [8.6%; 95% confidence interval (95% CI) 85-88]) were RPR seropositive. RPR seropositivity increased from 6.5% to 13.0% between 2010 and 2019. Overall, the annual rate of RPR seropositivity was relatively stable between 2010 and 2018 with a range of 89-127/100 000 live births, increasing sharply to 165/100 000 livebirths in 2019. KwaZulu-Natal and North West provinces recorded the largest increases in annual seropositivity rate, while Eastern Cape and Western Cape had the most significant declines. Although this analysis is limited to laboratory results, in the absence of major changes in testing practices, there may be a rise in the burden of antenatal syphilis exposure in utero indicating an increase in maternal syphilis and syphilis transmission in the general population. South Africa needs to intensify Mother-to-Child Transmission of syphilis elimination efforts to reach the WHO target of ≤50 cases per 100 live births by 2030.

"Só sei que é uma doença": conhecimento de gestantes sobre sífilis / "I just know it's a disease": knowledge of pregnant women about syphilis / "Solo sé que es una enfermedad": conocimiento de embarazadas sobre sífilis

Objetivo: Analisar o conhecimento de mulheres que realizaram consultas de pré-natal em relação à sífilis e as orientações recebidas acerca da prevenção de sífilis gestacional. Métodos: Pesquisa qualitativa e descritiva, desenvolvida com oito gestantes, em uma unidade de Atenção Primária à Saúde (APS), de um município de Fronteira Oeste, Rio Grande do Sul, Brasil, por meio da técnica de entrevista semiestruturada, no período de setembro a outubro de 2019. Os achados foram interpretados por meio da análise temática, emergindo duas categorias temáticas: Conhecimento sobre a sífilis e Orientações sobre a prevenção da sífilis na gestação. Resultados: As gestantes investigadas demonstraram conhecimento restrito sobre sífilis e sífilis gestacional. Relataram que as orientações no pré-natal são superficiais. Disseram que a transmissão da sífilis ocorre por via sexual e demonstraram surpresa quanto às complicações da doença para o bebê, evidenciando o desconhecimento sobre a sífilis congênita. Citaram o preservativo como método de prevenção, porém relataram não utilizar quando o parceiro é fixo. Demonstraram conhecimento restrito sobre a interpretação dos testes rápidos, não mencionando a realização do exame não treponêmico como método diagnóstico e confirmatório da doença. Conclusão: A lacuna identificada pelo conhecimento limitado das gestantes investigadas sobre a sífilis e a prevenção da sífilis gestacional pode ser suprida por meio da realização de atividades de educação em saúde, tendo o enfermeiro como agente promotor.

Objective: To analyze the knowledge of women who attended prenatal consultations concerning syphilis and the guidelines received about the prevention of gestational syphilis. Methods: It is qualitative and descriptive research, developed with eight pregnant women, in a unit of Primary Health Care (PHC), in a municipality of Fronteira Oeste, Rio Grande do Sul, Brazil, using the semi-structured interview technique from September to October 2019. The findings were interpreted using thematic analysis, with two thematic categories emerging: Knowledge about syphilis and Guidelines on the prevention of syphilis in pregnancy. Results: The investigated pregnant women demonstrated restricted knowledge about syphilis and gestational syphilis. They reported that the guidelines for prenatal care are superficial. They said that the transmission of syphilis happens through sex and showed surprise about the complications of the disease for the baby, showing the lack of knowledge about congenital syphilis. They mentioned the condom as a prevention method but reported not using it when the partner is fixed. They demonstrated limited knowledge about the interpretation of rapid tests, not to mention the non-treponemal exam as a diagnostic and confirmatory method of the disease. Conclusion: The gap identified by the limited knowledge of pregnant women investigated about syphilis, and the prevention of gestational syphilis can be filled by carrying out health education activities, with the nurse as a promoter.

Objetivo: Analizar el conocimiento de mujeres que tuvieron el prenatal sobre la sífilis y las orientaciones recibidas sobre la prevención de la sífilis gestacional. Métodos: Investigación cualitativa y descriptiva desarrollada con ocho embarazadas de una unidad de Atención Primaria de Salud (APS) de un municipio de la Frontera Oeste, Río Grande de Sur, Brasil a través de la técnica de entrevista semiestructurada en el periodo entre septiembre y octubre de 2019. Se ha interpretado los hallazgos a través del análisis temático del cual se ha identificado dos categorías temáticas a continuación: Conocimiento de la sífilis y Orientaciones sobre la prevención de la sífilis durante el embarazo. Resultados: Las embarazadas investigadas han demostrado poco conocimiento de la sífilis y de la sífilis gestacional. Ellas han relatado que las orientaciones del prenatal son superficiales, que la transmisión de la sífilis se da por la vía sexual y han demostrado sorpresa sobre las complicaciones de la enfermedad para el bebé lo que evidencia la falta de conocimiento de la sífilis congénita. Ellas han citado el condón como el método de prevención, sin embargo, relataron no usarlo cuando tiene más tiempo con su compañero. Las participantes han demostrado poco conocimiento de la interpretación de las pruebas rápidas y no han mencionado la prueba no treponémica como el método diagnóstico y confirmatorio de la enfermedad. Conclusión: Se pude arreglar la laguna del conocimiento limitado de las embarazadas investigadas sobre la sífilis y la prevención de la sífilis gestacional a través de actividades de educación en salud con el enfermero como el agente promotor.

Relación entre los casos de sífilis y la estrategia de salud de familia en el noreste del Brasil / Relação entre os casos de sífilis e a estratégia saúde da família no nordeste brasileiro / Relationship between syphilis cases and family health strategy in northeastern Brazil

OBJETIVOS: Este estudio tiene como objetivo comprender las relaciones entre el progreso de la cobertura de la Estrategia de Salud de Familia en los nueve estados del noreste y las tasas de detección de sífilis en mujeres embarazadas y congénitas entre 2008 y 2017. MÉTODOS: Se trata de un estudio observacional, descriptivo y transversal en el que se correlacionaron las tasas de detección de sífilis de gestación y sífilis congénita en los estados nororientales y en esta región en su conjunto con la respectiva cobertura media anual de la Estrategia de Salud de Familia. Para ello, se realizó la prueba del coeficiente de correlación de Pearson para estas dos variables utilizando el software del Statistical Package for the Social Sciences 25. RESULTADOS: El análisis estadístico de los datos de los estados permitió identificar que, al igual que en los datos agrupados de la región, a medida que aumentó la cobertura de la Estrategia de Salud de Familia, la tasa de detección de casos de sífilis en mujeres embarazadas y congénitas también aumentó significativamente en la mayoría de los estados, y en la región nordeste en su conjunto. CONCLUSIONES: El Sistema Único de Salud a través de la Estrategia de Salud de Familia ha dado lugar a importantes avances relacionados con el seguimiento del embarazo, el puerperio y el desarrollo infantil, así como en el diagnóstico temprano de infecciones como la sífilis. Sin embargo, además del diagnóstico, se necesitan mejoras significativas en el tratamiento y la prevención de estas enfermedades en la región noreste

OBJETIVOS: Este estudo tem por objetivo conhecer as relações existentes entre o avanço da cobertura da Estratégia Saúde da Família nos nove estados nordestinos e as taxas de detecção da sífilis em gestantes e congênita entre os anos de 2008 e 2017. MÉTODOS: Trata-se de um estudo observacional, descritivo e transversal, em que as taxas de detecção para sífilis na gestação e congênita dos estados do Nordeste e desta região como um todo foram correlacionadas com as respectivas médias anuais de cobertura da Estratégia Saúde da Família. Para isso, foi realizado o teste de coeficiente de correlação de Pearson, para essas duas variáveis, através do software Statistical Package for the Social Sciences 25. RESULTADOS: A análise estatística dos dados estaduais possibilitou identificar que, assim como nos dados agrupados da região, à medida que aumentava a cobertura da ESF, a taxa de detecção dos casos de sífilis em gestantes e congênita também crescia significativamente na maioria dos estados, e na região Nordeste integralmente. CONCLUSÕES: O Sistema Único de Saúde através da Estratégia Saúde da Família tem protagonizado grandes avanços relacionados ao acompanhamento da gestação, puerpério e desenvolvimento infantil, como no diagnóstico precoce de infecções, como a sífilis. Entretanto, além do diagnóstico, é preciso melhorias significativas no tratamento e prevenção destas doenças na região Nordeste

OBJECTIVES: This study aims to verify the relationships between the advancing of coverage of the Family Health Strategy in the nine northeastern states and the rates of detection of syphilis in pregnant women and congenital between the years 2008 and 2017. METHODS: Observational, descriptive and cross-sectional study, in which the detection rates for gestational syphilis and congenital in the nine states of the Northeast and this region as a whole were correlated with the respective annual averages Family Health Strategy coverage. For that, Pearson's correlation coefficient test was performed for these two variables, using the Statistical Package for the Social Sciences 25 software. RESULTS: The statistical analysis of the state data made it possible to identify that, as well as in the grouped data of the region, as the Family Health Strategy coverage increased, the detection rate of syphilis cases in pregnant women and congenital also increased significantly in most states, and in the Northeast region entirely. CONCLUSIONS: The Unified Health System through the Family Health Strategy has made great advances related to the monitoring of pregnancy, puerperium and child development as in the early diagnosis of infections like syphilis. However, in addition to the diagnosis, significant improvements are needed in the treatment and prevention of these diseases in the Northeast region

Syphilis Testing Among Female Prisoners in Brazil: Results of a National Cross-sectional Survey.

ABSTRACT: Brazil has the third largest prison population in the world and is also experiencing a high and rising rate of syphilis infection. To establish the gaps in syphilis testing, we examined data from a nationally representative sample of incarcerated women in Brazil. Data originated from a cross-sectional survey designed to represent all regions of Brazil (N = 1,327). Data were collected by Audio Computer-Assisted Self-Interview, including variables in several blocks or domains. 49.2% had a lifetime history of being tested for syphilis. Increased likelihood of syphilis testing was significantly associated with completed elementary education (odds ratio ajustado [AOR] 1.75, 95% confidence interval [CI] 1.28-2.40), completed high school or more (AOR 2.04, 95% CI 1.36-3.06), income below minimum wage (AOR 1.46, 95% CI 1.10-1.94), homelessness (AOR 1.83, 95% CI 1.21-2.76), having heard of the female condom (AOR 1.92, 95% CI 1.25-2.95), received a condom in prison (AOR 1.56, 95% CI 1.11-2.21) or in public health services (AOR 1.50, 95% CI 1.13-1.98), lifetime history of pregnancy (AOR 2.55, 95% CI 1.67-3.89), had a gynecological examination (AOR 1.73, 95% CI 1.05-2.83), and perceived they had some chance (AOR 1.61, 95% CI 1.17-2.20) or a big chance (AOR 1.89, 95% CI 1.31-2.73) that they were likely to have been infected with HIV before entering prison.

New screening approach to detecting congenital syphilis in China: a retrospective cohort study.

BACKGROUND: Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS: Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS: Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS: An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.