The resurgence of syphilis in Australia.

BACKGROUND: Syphilis infections have been increasing in Australia over the past decade. This phenomenon has been associated with a re-emergence of congenital syphilis. OBJECTIVE: The aim of this article is to describe recent epidemiological trends of syphilis infection in Australia, including demographics in which infection rates are rising, such as women of reproductive age. This article also provides an overview of the clinical course and the principles of management for syphilis. DISCUSSION: Considered by some as a disease of bygone eras, the resurgence of syphilis in Australia requires clinicians to be alert to this infection once again. Increased testing, prompt management and thorough contact tracing are all required to reverse this trend. Congenital syphilis is a potentially devastating yet preventable consequence of rising infections among women of reproductive age. Universal syphilis screening is recommended for all pregnant women at the initial antenatal visit and is now also recommended in the third trimester in several Australian jurisdictions.

Trends and Characteristics in Maternal Syphilis Rates During Pregnancy: United States, 2016-2022.

After reaching historic lows in 2000 and 2001, rates of primary and secondary syphilis in the overall U.S. population have increased nearly every year through 2022 (1). For 2017-2022, rates of syphilis for women of reproductive age and congenital syphilis (a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy) increased by more than 250% (1,2). Congenital syphilis can cause adverse pregnancy outcomes such as fetal and neonatal death, low birthweight, preterm birth, and brain and nerve disorders (2). This report presents trends in maternal syphilis rates in women giving birth in the United States for 2016-2022 by selected maternal demographic and health factors.

Informe sífilis SE 01 a 24/2024 - Goiás / Report syphilis SE 01 to 24/2024 - Goiás

A sífilis é uma doença crônica causada pelo agente etiológico Treponema pallidum, curável exclusiva do ser humano, tem o trtamento garantido pelo Sistema Único de Saúde (SUS) e está na lista de agravos e doenças de notificação compulsória. Este informe traz os dados da sífilis notificados em Goiás de acordo com o Sistema de Informação de Agravos de Notificação (SINAN)

Syphilis is a chronic disease caused by the etiological agent Treponema pallidum, curable exclusively in humans, treatment guaranteed by the Unified Health System (SUS) and is on the list of diseases and diseases of compulsory notification. This report provides data on syphilis reported in Goiás according to the Notifiable Diseases Information System (SINAN)

Clinical-Demographic and Laboratory Profile of the Mother-Child Binomial With Syphilis in a Tertiary-Level Hospital in Mexico.

BACKGROUND: Congenital syphilis (CS) remains a major public health problem, and its incidence is increasing worldwide. METHODS: Retrospective, observational, and descriptive study of cases with CS and their mothers at a tertiary-level hospital in Mexico from 2017 to 2022. Medical records of patients with CS and a structured collection of epidemiological, clinical, and laboratory data were analyzed and classified in the Centers for Disease Control scenarios as confirmed, probable, less probable, or unlikely. RESULTS: One hundred eighty cases were diagnosed with a compatible definition of congenital syphilis, and we identified 43 (21.21%) confirmed proven. Among those proven cases, 15.6% had hematological, 13.3% skin, 12.2% liver, 6.7% pulmonary, 6.6% neurological, 5.8% eye, 5.6% bone, and 0.6% hearing involvements. According to the clinical stages of maternal syphilis, 119 (66.1%) were in the late latent phase, 49 (27.2%) in the early latent phase, 7 (3.9%) in the secondary stage, and 5 (2.8%) in the primary stage. Mothers with tertiary syphilis were not detected. CONCLUSION: Regardless of negative antenatal screening, health care workers should consider the diagnosis of congenital syphilis. Infants are still undiagnosed at birth, and only a tiny percentage exhibits symptoms. The wide range of clinical manifestations of this preventable infection can be misdiagnosed for various other diseases, causing diagnostic delays that can have serious consequences.

The Congenital Syphilis Prevention Cascade: Reimagining a Missed Prevention Opportunities Framework for Effective Intervention.

ABSTRACT: Congenital syphilis (CS) rates have risen in the United States since 2013. Prevention of CS requires testing and treatment of pregnant and pregnancy-capable persons at high risk for syphilis. We developed a CS Prevention Cascade to assess how effectively testing and treatment interventions reached pregnant persons with a CS outcome.

Resurgence of congenital syphilis: new strategies against an old foe.

Congenital syphilis is a major global cause of fetal loss, stillbirth, neonatal death, and congenital infection. In 2020, the global rate of congenital syphilis was 425 cases per 100 000 livebirths-substantially higher than WHO's elimination target of 50 cases per 100 000 livebirths. Case rates are rising in many high-income countries, but remain low compared with those in low-income and middle-income settings. This Review aims to summarise the current epidemiology and knowledge on transmission and treatment of syphilis in pregnancy, and proposes measures to reduce the rising incidence seen worldwide. We also describe emerging diagnostic and treatment tools to prevent vertical transmission and improve management of congenital syphilis. Finally, we outline a programme of public health priorities, which include research, clinical, and preventive strategies.

[Syphilis in Argentina]. / Sífilis en Argentina.

Syphilis is a disease preventable through sexual protection barriers, and curable with a simple treatment. Despite this, between 2010 and 2019, its incidence almost tripled in Argentina, reaching 56.1/100 000. The most affected are young people (15-24 years old), with a higher percentage of women, especially among pregnant women, in whom it increased from 2.3% to 5.8%, with a peak of 7.7% between 15 and 24 years old. Cases of secondary or tertiary syphilis, detected by control tests, are on the rise. The increase in syphilis is linked to HIV. For this reason, rapid detection tests must be carried out jointly at the first level of care, which facilitates access to the diagnosis and treatment of positive cases, with the corresponding guidance and control. Treatment with penicillin, for which no resistance has been found, is the key component of control. Doxycillin is also used (not in pregnant women), or ceftriaxone. The resistance of Treponema pallidum to azithromycin is increasing, so its use should be avoided. In 2022, 696 cases of congenital syphilis were reported. The national rate is 1.3 per 1000 live births. The majority of reported cases come from the public sector. Maternal syphilis is, in low-income areas, the most common cause of stillbirths. Strict application of existing regulations, strengthening the primary care system, and prevention during pregnancy can contribute to controlling and eliminating the syphilis problem in Argentina.

La sífilis es una enfermedad prevenible mediante barreras de protección sexual, y curable por un sencillo tratamiento. A pesar de esto, entre 2010 y 2019, su incidencia casi se triplicó en Argentina, alcanzando 56.1/100 000. Los más afectados son los jóvenes (15-24 años), con mayor porcentaje de mujeres, especialmente entre las embarazadas, en que aumentó de 2.3% a 5.8%, con un pico de 7.7% entre 15 y 24 años. Los casos de sífilis secundaria o terciaria, detectados por pruebas de control, están en aumento. El aumento de sífilis va unido al HIV. Por ello las pruebas rápidas de detección deben hacerse conjuntamente en el primer nivel de atención, lo que facilita el acceso al diagnóstico y al tratamiento de los casos positivos, con la orientación y control correspondientes. El tratamiento con penicilina, para la que no se ha hallado resistencia, es el componente clave del control. También se usa doxicilina (no en embarazadas), o ceftriaxona. Está aumentando la resistencia del Treponema pallidum a la azitromicina, por lo que debe evitarse su empleo. En 2022 se notificaron 696 casos de sífilis congénita. La tasa de nacional es 1.3 por 1000 nacidos vivos. La mayoría de los casos notificados provienen del sector público. La sífilis materna es, en áreas de bajos recursos, la causa más común de nacidos muertos. La aplicación estricta de las normas existentes, el fortalecimiento del sistema de atención primaria, y la prevención durante el embarazo, pueden contribuir a controlar y eliminar el problema de la sífilis en Argentina.

Vital Signs: Missed Opportunities for Preventing Congenital Syphilis - United States, 2022.

Introduction: Congenital syphilis cases in the United States increased 755% during 2012-2021. Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and maternal and infant morbidity; these outcomes can be prevented through appropriate screening and treatment. Methods: A cascading framework was used to identify and classify missed opportunities to prevent congenital syphilis among cases reported to CDC in 2022 through the National Notifiable Diseases Surveillance System. Data on testing and treatment during pregnancy and clinical manifestations present in the newborn were used to identify missed opportunities to prevent congenital syphilis. Results: In 2022, a total of 3,761 cases of congenital syphilis in the United States were reported to CDC, including 231 (6%) stillbirths and 51 (1%) infant deaths. Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis. Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions. Conclusions and implications for public health practice: Addressing missed opportunities for prevention, primarily timely testing and appropriate treatment of syphilis during pregnancy, is important for reversing congenital syphilis trends in the United States. Implementing tailored strategies addressing missed opportunities at the local and national levels could substantially reduce congenital syphilis.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study.

BACKGROUND: The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE: to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS: an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS: A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS: The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.

Congenital syphilis: performance of primary care services in São Paulo, 2017.

OBJECTIVE: To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo. METHODS: Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated. RESULTS: 2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain "diagnosis and treatment of acquired syphilis" had the highest performance (89.8%), followed by "infrastructure and basic resources" (79.5%), "prevention of congenital syphilis in prenatal care" (73.3%) and "educational actions and prevention of sexually transmitted infections" (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements. CONCLUSIONS: The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.

Congenital syphilis in Switzerland: a retrospective cohort study, 2010 to 2019.

AIMS OF THE STUDY: We previously reported a re-emergence of syphilis from 2006 to 2009 with detection of congenital syphilis in Switzerland. This study aimed to reassess the incidence of children exposed to maternal syphilis during pregnancy and congenital syphilis in a following 10-year period in the canton of Zurich, the most populous canton in Switzerland with the highest incidences of syphilis. METHODS: Children were identified both by reviewing medical records at the four major neonatal and paediatric hospitals providing acute care in the canton of Zurich and by the serological database of the syphilis reference laboratory. Inclusion criteria for children were (a) date of birth in the period 2010-2019, (b) place of birth in the canton of Zurich, (c) evaluation for syphilis due to positive syphilis pregnancy screening and (d) age <1 year at diagnosis. Results were compared with epidemiological data provided by the Federal Office of Public Health (FOPH). RESULTS: We identified and evaluated 17 children after potential exposure to maternal syphilis. Residual antibodies of a past infection were found in 11 mothers. Six children were identified as having had real exposure to asymptomatic maternal syphilis. From an epidemiological perspective, the distribution of the cases followed a similar pattern as confirmed syphilis cases in women of childbearing age reported to the FOPH. No cases of congenital syphilis were observed. CONCLUSIONS: In contrast to the rise in syphilis infections, this study identified no cases of congenital syphilis in the canton of Zurich, Switzerland, in the period 2010-2019. Syphilis pregnancy screening may have prevented congenital syphilis by diagnosing and allowing adequate treatment of asymptomatic maternal syphilis.

Risk Factors Associated with Congenital Syphilis, Georgia, 2008-2015.

Background: Congenital syphilis (CS) is associated with significant perinatal morbidity and mortality. The study objectives were to compare risk factors among women with syphilis infection whose pregnancies did and did not result in CS cases and to evaluate other geographic and socioeconomic characteristics of county of residence as a measure of healthcare inequity. Methods: This study linked maternal and congenital syphilis data from the Georgia Department of Public Health (DPH), 2008-2015. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline was followed. Demographic, behavioral, and case characteristics were compared among women with syphilis infection who did and did not have an infant with CS. Chi-square, Fisher's exact, and multivariate regression analyses were performed using STATA 14.2 (College Station, TX). Results: Of 505 women with syphilis infection, 23% had an infant with CS, while 77% did not. After adjusting for race/ethnicity, factors associated with CS outcome were age greater than 35 years (adjusted odds ratio (aOR) 3.88; 95% confidence interval (CI) 1.01-14.89), hospital/emergency department diagnosis of syphilis (aOR 3.43; 95% CI 1.54-7.62), and high-risk behaviors such as exchanging sex for money or drugs (aOR 3.25; 95% CI 1.18-8.98). There were no associations between characteristics of county of residence and CS outcome. Conclusions: This study highlights risk factors that may be associated with CS incidence and the adverse pregnancy outcomes associated with CS. Further work is needed to study improved data collection systems, contributing factors related to CS as well as prevention measures in the United States.

Text mining analysis to understand the impact of online news on public health response: case of syphilis epidemic in Brazil.

Background: To effectively combat the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) created a National Rapid Response to Syphilis with actions aimed at bolstering epidemiological surveillance of acquired, congenital syphilis, and syphilis during pregnancy complemented with communication activities to raise population awareness and to increase uptake of testing that targeted mass media outlets from November 2018 to March 2019 throughout Brazil, and mainly areas with high rates of syphilis. This study analyzes the volume and quality of online news content on syphilis in Brazil between 2015 and 2019 and examines its effect on testing. Methods: The collection and processing of online news were automated by means of a proprietary digital health ecosystem established for the study. We applied text data mining techniques to online news to extract patterns from categories of text. The presence and combination of such categories in collected texts determined the quality of news that were analyzed to classify them as high-, medium-and low-quality news. We examined the correlation between the quality of news and the volume of syphilis testing using Spearman's Rank Correlation Coefficient. Results: 1,049 web pages were collected using a Google Search API, of which 630 were categorized as earned media. We observed a steady increase in the number of news on syphilis in 2015 (n = 18), 2016 (n = 26), and 2017 (n = 42), with a substantial rise in the number of news in 2018 (n = 107) and 2019 (n = 437), although the relative proportion of high-quality news remained consistently high (77.6 and 70.5% respectively) and in line with similar years. We found a correlation between news quality and syphilis testing performed in primary health care with an increase of 82.32, 78.13, and 73.20%, respectively, in the three types of treponemal tests used to confirm an infection. Conclusion: Effective communication strategies that lead to dissemination of high quality of information are important to increase uptake of public health policy actions.

Research progress on the mechanism of Treponema pallidum breaking through placental barrier.

Congenital syphilis, a significant cause of fetal mortality worldwide, is a congenital infectious disease instigated by the vertical transmission of Treponema pallidum during pregnancy. Clinical manifestations include preterm delivery, stillbirth, neonatal skin lesions, skeletal abnormalities, and central nervous system aberrations. The ongoing increase in the incidence of congenital syphilis, coupled with complexities in diagnosis, necessitates a detailed understanding of its pathogenesis for the development of improved diagnostic approaches, and to interrupt the route of vertical transmission. Drawing from the broader body of research associated with vertical transmission pathogens, we aim to clarify the potential mechanisms by which Treponema pallidum breaches the placental barrier to infect the fetus.

Congenital syphilis in Switzerland: a marker of inequality? A mini-review.

Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals.

The prevalence of risk for hearing impairment in newborns with congenital syphilis in a newborn hearing screening program (NHS).

Objective: To study the prevalence of risk for hearing impairment in neonates with congenital syphilis in a newborn hearing screening program. Study design: The study design is retrospective, documentary, and is cross-sectional. The sample consisted of newborns who were born between January 2019 and December 2021 and who underwent neonatal hearing screening in a public maternity hospital. Demographic data and the presence and specification of risk indicators for hearing impairment (RIHL) were collected. In retest cases, the results and the final score were also collected. For data analysis, the Kruskal-Wallis and Conover-Iman post-hoc tests were used, comparing the groups that passed and failed the hearing screening that had RIHL, using a significance level of p of <0.5. Results: Among the RIHL observed in the sample, prematurity was more frequent in newborns who passed the screening (55.26%) than in those who failed the test (45.67%). Congenital syphilis was the ninth most frequent RIHL (8.04%) among the newborns who passed the test and the 15th factor (3.03%), with the highest occurrence in those who failed the hearing screening. When comparing the two groups (pass and fail), we found significant differences (p < 0.05) between them. Conclusion: Congenital syphilis was the ninth risk indicator for the most common hearing impairment and, in isolation, did not present a risk for failure in neonatal hearing screening. Notably, congenital syphilis can cause late hearing loss during child development. Thus, there is an indication of audiological monitoring of these neonates.