A saúde da mulher e o tratamento da sífilis: narrativas de vida e contribuições para a prática profissional / Women's health and treatment of syphilis: life narratives and contributions for professional practice

Trata-se de estudo descritivo de abordagem qualitativa que utilizou o método narrativa de vida. Definiu como objeto: a experiência vivenciada da mulher em relação ao tratamento da sífilis. As questões norteadoras foram: qual a experiência vivenciada por mulheres que transmitiram sífilis para os seus filhos em relação ao tratamento? Quais as dúvidas mais co-muns das mulheres em relação à sífilis? Que fatores interferem na adesão da mulher ao trata-mento da sífilis? Objetivou: identificar a experiência vivenciada por mulheres que transmitiram sífilis para seus filhos em relação ao tratamento; descrever as dúvidas mais frequentes, apresentadas pelas mulheres relacionadas ao tratamento da sífilis; discutir os fatores que inter-ferem na adesão ao tratamento da sífilis; e propor uma estratégia educativa que favoreça o esclarecimento de dúvidas de mulheres que transmitiram sífilis para os seus filhos, para esti-mular a adesão ao tratamento. O cenário de estudo foi o setor de alojamento conjunto de um Hospital Maternidade Municipal no Rio de Janeiro. As participantes foram 18 mulheres que transmitiram sífilis a seus filhos e estavam internadas no cenário de pesquisa. O estudo teve aprovação do Comitê de Ética e Pesquisa da Secretaria Municipal de Saúde do Rio de Janeiro. A partir da análise temática das narrativas de vida segundo Daniel Bertaux emergiram três categorias que foram discutidas a luz da teoria de transição de Afaf Meleis e do senso comum segundo Rubem Alves. O estudo evidenciou que o pré-natal é eficaz no diagnóstico da sífilis, porém não tem a mesma eficácia na prevenção da sífilis congênita. A sífilis permanece no anonimato para muitas mulheres e o seu diagnóstico traz a revelação de comportamentos con-jugais, familiares e sociais muitas vezes não conhecidos ou indesejáveis. Permanecem nesta esfera muitas dúvidas sobre a sífilis e a sífilis congênita. A enfermagem tem amplo espaço de atuação nesta temática abordando a mulher no pré-natal, parto e puerpério. Segundo a teoria de transição de Afaf Meleis a enfermeira desenvolve planejamento holístico, individualizado e contínuo e tem a competência de ajudar a mulher na realização de uma transição saudável. A transição saudável consistirá na passagem da mulher pelo processo de mudança causado pela gravidez, pela doença dela e de seu filho com respostas positivas atingindo a estabilidade antes perdida ao início do evento crítico. É necessário ainda que sejam desenvolvidas estraté-gias que atendam a mulher na questão da educação sexual para além do período gravídico puerperal.

This is qualitative descriptive study that used the narrative method of life. Defined as an object: the lived experience of women in relation to the treatment of syphilis. The guiding questions were: what is the situation experienced by women who transmitted syphilis to their children in relation to the treatment? What are the most common questions women have about syphilis? What factors influence adherence of women to treatment of syphilis? The objective: to identify the experience lived by women who transmitted syphilis to their children in relation to treatment; describe the most frequently doubts submitted by women related to the treatment of syphilis; discuss the factors that influence adherence to treatment of syphilis; and propose an educational strategy that encourages clarify questions of women who transmitted syphilis to their children, to encourage adherence to treatment. The study setting was the rooming in at Municipal Maternity Hospital in Rio de Janeiro. The participants were 18 women who transmitted syphilis to their children that were hospitalized in the research setting. The study was approved by the Committee on Ethics and Research of the Secretary Municipal of Rio de Janeiro Health. From the thematic analysis of the life narratives according to Daniel Bertaux emerged three categories that were discussed in light of the transition theory Afaf Meleis and common sense said Rubem Alves. The study showed that prenatal care is effective in the diagnosis of syphilis, but does not have the same effectiveness in preventing congenital syphilis. Syphilis remains anonymous for many women and their diagnosis brings the revelation of marital, family and social behavior often not known or undesirable. Remain in this sphere many doubts about syphilis and congenital syphilis. Nursing has ample work space in this theme addressing women in prenatal, parturition and postpartum care. According to Afaf Meleis transition theory the nurse develops holistic, individualized and continuous planning and has the power to help women in achieving a healthy transition. Healthy transition will consist of moving the woman by the process of change caused by pregnancy and for her disease and disease her son with positive responses reaching stability before missing the start of the critical event. It is still necessary that strategies are developed that meet the woman on the issue of sex education beyond the puerperal gravid period.

Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data.

BACKGROUND: The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. METHODS AND FINDINGS: Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. CONCLUSIONS: Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary.

Sífilis congénita en el siglo XXI / Congenital Syphilis in the 21st Century

La sífilis congénita, aunque poco frecuente en la mayoría de los países desarrollados, ha experimentado un ligero resurgimiento en varios países de Europa, entre los que cabe incluir a España. Necesitamos, por lo tanto, familiarizarnos más con sus síntomas y signos, y reconsiderar el diagnóstico de sífilis congénita en pacientes con síntomas poco manifiestos. Además, en aquellos pacientes que presentan en los test diagnósticos títulos bajos o inconsistentes, el diagnóstico de sífilis congénita puede ser difícil o incluso imposible. La piedra angular del control de la sífilis congénita es la detección prenatal en madres y el tratamiento con penicilina, intervención eficaz y rentable. En este artículo se describen con detalle, a partir de los datos aportados por la literatura, las manifestaciones clínicas de la sífilis congénita, así como las distintas formas de su diagnóstico y terapéutica. Asimismo, el presente trabajo se enriquece con datos procedentes de nuestra propia experiencia clínica (AU)

While the prevalence of congenital syphilis continues to be low throughout most of the developed world, there has been a slight resurgence of the disease in several European countries, including Spain. In this context, we need to become more familiar with the signs and symptoms of this disease and consider its diagnosis in patients with only mild clinical manifestations. A definitive diagnosis may be difficult or even impossible in patients whose diagnostic tests reveal low positive titers or inconsistent results. The cornerstone of congenital syphilis control is prenatal screening and the treatment of infected mothers with penicillin, an effective and economical intervention. Based on a review of the literature supplemented by data from our own clinical experience, this article provides a detailed description of the clinical manifestations of congenital syphilis as well as the various diagnostic methods and treatments available (AU)