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1.
Rev. enferm. UERJ ; 28: e50487, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1145487

RESUMEN

Objetivo: analisar a ocorrência de sífilis gestacional e congênita à luz da vulnerabilidade, no período de 2008 a 2018, no Mato Grosso do Sul. Método: estudo transversal, retrospectivo, de caráter analítico e abordagem quantitativa, com base em dados secundários coletados no Sistema de Informações e Agravos de Notificação. Resultados: houve aumento progressivo de sífilis gestacional e congênita ao longo dos 11 anos, com predomínio em populações vulneráveis e associação (p< 0.05) da ocorrência de sífilis congênita com as variáveis "escolaridade", "faixa etária" e "cor da pele". Verificou-se a influência de fatores comportamentais e relacionados aos serviços de saúde, dentre eles o diagnóstico tardio da sífilis e a baixa adesão do tratamento entre estas gestantes e seus parceiros sexuais. Conclusão: a sífilis gestacional e congênita tiveram causas multifatoriais e podem ser combatidas com ações em saúde que considerem os aspectos que potencializam a vulnerabilidade social, individual e programática da população.


Objective: to examine the occurrence of gestational and congenital syphilis in the light of vulnerability in Mato Grosso do Sul, from 2008 to 2018. Method: this retrospective, analytical, quantitative, cross-sectional study was based on secondary data collected from Brazil's Notifiable Disease Information System. Results: gestational and congenital syphilis increased steadily over the eleven years, predominantly in vulnerable groups. The occurrence of congenital syphilis was found to associate (p < 0.05) with the variables "education", "age group" and "skin color". Behavioral and health service-related factors ­ among them, late diagnosis of syphilis and poor treatment adherence by pregnant women and their sexual partners ­ were found to influence the association. Conclusion: gestational and congenital syphilis had multifactorial causes and can be combated with health measures that address aspects that heighten this population's social, individual and programmatic vulnerability.


Objetivo: examinar la ocurrencia de sífilis gestacional y congénita a la luz de la vulnerabilidad en Mato Grosso do Sul, de 2008 a 2018. Método: este estudio retrospectivo, analítico, cuantitativo y transversal se basó en datos secundarios recopilados del Sistema de Información de Enfermedades Notificables de Brasil. Resultados: la sífilis gestacional y congénita aumentó de manera sostenida durante los once años, predominantemente en grupos vulnerables. Se encontró que la ocurrencia de sífilis congénita se asocia (p < 0.05) con las variables "educación", "grupo de edad" y "color de piel". Se encontró que factores relacionados con el comportamiento y los servicios de salud, entre ellos, el diagnóstico tardío de la sífilis y la mala adherencia al tratamiento por parte de las mujeres embarazadas y sus parejas sexuales, influyen en la asociación. Conclusión: la sífilis gestacional y congénita tuvo causas multifactoriales y se puede combatir con medidas de salud que aborden aspectos que aumentan la vulnerabilidad social, individual y programática de esta población.


Asunto(s)
Humanos , Femenino , Embarazo , Niño , Adolescente , Adulto , Adulto Joven , Sífilis Congénita/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Vulnerabilidad en Salud , Atención Prenatal , Sífilis Congénita/prevención & control , Brasil/epidemiología , Incidencia , Prevalencia , Estudios Transversales , Notificación de Enfermedades/estadística & datos numéricos , Salud Materna , Servicios de Salud Materna
2.
BMC Infect Dis ; 20(1): 684, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32948128

RESUMEN

BACKGROUND: Untreated male partners are a critical source of maternal re-infection. Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal re-infection. This study aimed to analyze the current situation and related factors of contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners. METHOD: Data of syphilis-seropositive pregnant women and their male partners attending clinic for syphilis-screening were obtained from the Shenzhen Program for Prevention of Congenital Syphilis. Contact tracing rate of syphilis-seropositive pregnant women and syphilis prevalence among male partners were counted, and related factors were also analyzed using a random-effects logistic regression model. RESULT: Of the 1299 syphilis-seropositive pregnant women, 74.1% (963/1299) had their male partners receiving syphilis-screening and 19.1% (184/963) of male partners were syphilis-infected. For pregnant women, being divorced (adjusted odds ratio [AOR] =0.39; 95%CI: 0.17-0.87), seeking for emergency services at their first antenatal clinics visits (AOR = 0.58; 95%CI: 0.44-0.77), reporting willingness to notify partner(AOR = 7.65; 95%CI: 4.69-12.49), multi-partners (AOR = 1.38; 95%CI:1.03-1.86) and having a history of drug abuse (AOR = 0.37; 95%CI: 0.14-1.00)were independently associated with successful contact tracing. For male partners, of minority ethnicity (AOR = 4.15; 95%CI: 1.66-10.34), age at first sex>20(AOR = 0.57; 95%CI: 0.37-0.87), reporting multi-partners (AOR = 1.60; 95%CI: 1.04-2.46), having a history of drug abuse (AOR = 4.07; 95%CI: 1.31-12.64) were independently associated with syphilis-infection. In addition, pregnant women with TRUST titer ≥1:8 (AOR = 2.81; 95%CI: 1.87-4.21), having a history of adverse pregnancy outcomes (AOR = 1.70; 95%CI: 1.14-2.53), reporting multi-partners (AOR = 0.43; 95%CI: 0.29-0.64) and reporting the current partner as the source of syphilis (AOR = 5.05; 95%CI: 2.82-9.03) were independently associated with partners' syphilis-infection. CONCLUSION: Contact tracing is feasible and effective in identifying syphilis-infected partners among syphilis-seropositive pregnant women. Contact tracing is associated with many factors such as women's marital status, services at their first antenatal clinics visit and willingness of partner notification. Partners' ethnicity, age at first sex, multi-partners and history of drug abuse as well as women's levels of TRUST titer were associated with partners' syphilis-infection.


Asunto(s)
Trazado de Contacto , Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis/transmisión , Adolescente , Adulto , Instituciones de Atención Ambulatoria , China/epidemiología , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Modelos Logísticos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Oportunidad Relativa , Embarazo , Resultado del Embarazo , Mujeres Embarazadas , Prevalencia , Parejas Sexuales , Sífilis/epidemiología , Sífilis Congénita/prevención & control , Sífilis Congénita/transmisión , Adulto Joven
3.
MMWR Morb Mortal Wkly Rep ; 69(22): 661-665, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32497029

RESUMEN

Congenital syphilis is an infection with Treponema pallidum in an infant or fetus, acquired during pregnancy from a mother with untreated or inadequately treated syphilis. Congenital syphilis can cause miscarriage, stillbirth, or early infant death, and infected infants can experience lifelong physical and neurologic problems. Although timely identification and treatment of maternal syphilis during pregnancy can prevent congenital syphilis (1,2), the number of reported congenital syphilis cases in the United States increased 261% during 2013-2018, from 362 to 1,306. Among reported congenital syphilis cases during 2018, a total of 94 resulted in stillbirths or early infant deaths (3). Using 2018 national congenital syphilis surveillance data and a previously developed framework (4), CDC identified missed opportunities for congenital syphilis prevention. Nationally, the most commonly missed prevention opportunities were a lack of adequate maternal treatment despite the timely diagnosis of syphilis (30.7%) and a lack of timely prenatal care (28.2%), with variation by geographic region. Congenital syphilis prevention involves syphilis prevention for women and their partners and timely identification and treatment of pregnant women with syphilis. Preventing continued increases in congenital syphilis requires reducing barriers to family planning and prenatal care, ensuring syphilis screening at the first prenatal visit with rescreening at 28 weeks' gestation and at delivery, as indicated, and adequately treating pregnant women with syphilis (2). Congenital syphilis prevention strategies that implement tailored public health and health care interventions to address missed opportunities can have substantial public health impact.


Asunto(s)
Servicios de Salud Materna/organización & administración , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Sífilis Congénita/prevención & control , Sífilis/diagnóstico , Sífilis/terapia , Diagnóstico Precoz , Femenino , Investigación sobre Servicios de Salud , Humanos , Recién Nacido , Embarazo , Sífilis Congénita/epidemiología , Tiempo de Tratamiento , Estados Unidos/epidemiología
4.
J Glob Health ; 10(1): 010504, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32280458

RESUMEN

Background: Countdown to 2030 (CD2030) tracks progress in the 81 countries that account for more than 90% of under-five child deaths and 95% of maternal deaths in the world. In 2017, CD2030 identified syphilis screening and treatment during antenatal care (ANC) as priority indicators for monitoring. Methods: Country-reported data in the UNAIDS Global AIDS Monitoring System (GAM) system were used to evaluate four key syphilis indicators from CD2030 countries: (1) maternal syphilis screening and (2) treatment coverage during ANC, (3) syphilis seroprevalence among ANC attendees, and (4) national congenital syphilis (CS) case rates. A cascade analysis for CD2030 countries with coverage data for the number of women attending at least 4 antenatal care visits (ANC4), syphilis testing, seroprevalence and treatment was performed to estimate the number of CS cases that were attributable to missed opportunities for syphilis screening and treatment during antenatal care. Results: Of 81 countries, 52 (64%) reported one or more values for CS indicators into the GAM system during 2016-2017; only 53 (65%) had maternal syphilis testing coverage, 41 (51%) had screening positivity, and 40 (49%) had treatment coverage. CS case rates were reported by 13 (16%) countries. During 2016-2017, four countries reported syphilis screening and treatment coverage of ≥95% consistent with World Health Organization (WHO) targets. Sufficient data were available for 40 (49%) of countries to construct a cascade for data years 2016 and 2017. Syphilis screening and treatment service gaps within ANC4 resulted in an estimated total of 103 648 adverse birth outcomes with 41 858 of these occurring as stillbirths among women attending ANC4 (n = 31 914 408). Women not in ANC4 (n = 25 619 784) contributed an additional 67 348 estimated adverse birth outcomes with 27 198 of these occurring as stillbirths for a total of 69 056 preventable stillbirths attributable to syphilis in these 40 countries. Conclusion: These data and findings can serve as an initial baseline evaluation of antenatal syphilis surveillance and service coverage and can be used to guide improvement of delivery and monitoring of syphilis screening and treatment in ANC for these priority countries.


Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Sífilis/diagnóstico , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tamizaje Masivo , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , Sífilis/epidemiología , Sífilis/prevención & control , Sífilis Congénita/diagnóstico , Sífilis Congénita/epidemiología , Sífilis Congénita/prevención & control , Organización Mundial de la Salud
5.
Pediatr Int ; 62(3): 330-336, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31886919

RESUMEN

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.


Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Sífilis Congénita/epidemiología , Sífilis Congénita/prevención & control , Centros de Atención Terciaria , Adolescente , Adulto , Antibacterianos/uso terapéutico , Femenino , Humanos , Recién Nacido , Penicilinas/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo , Atención Prenatal , Estudios Retrospectivos , Sífilis/epidemiología , Sífilis/terapia , Sífilis Congénita/tratamiento farmacológico , Tailandia/epidemiología , Adulto Joven
6.
Rev. enferm. UFPE on line ; 14: [1-7], 2020. ilus, graf, tab
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1096987

RESUMEN

Objetivo: analisar o manejo da sífilis gestacional durante a assistência pré-natal. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, desenvolvido por meio de uma pesquisa sistemática na BVS com os descritores em saúde, nas bases de dados LILACS, MEDLINE e BDENF durante o mês de junho. Selecionaram-se artigos originais na íntegra; em português, inglês e espanhol; publicados entre 2017 a 2019. Utilizou-se o CASP para análise de elegibilidade dos estudos, apresentando-os em forma de figuras e analisando-os-de maneira descritiva. Resultados: encontraram-se 303 artigos e, após filtrá-los com os critérios de elegibilidade, sete artigos foram selecionados para esta revisão. Conclusão: certifica-se de que o manejo da sífilis gestacional foi realizado inadequadamente na maioria dos estudos analisados devido ao diagnóstico e ao tratamento tardios, não adesão ao tratamento, pela gestante e pelo parceiro, número reduzido de consultas pré-natais, insegurança profissional de realizar os esquemas terapêuticos e problemas organizacionais dos serviços de saúde. Percebe-se a necessidade de implementar medidas mais eficazes no contexto profissional e melhoria dos serviços de saúde para a realização do manejo adequado.(AU)


Objective: to analyze the management of gestational syphilis during prenatal care. Method: this is a bibliographic study, type integrative review, developed through a systematic search in the VHL with the health descriptors, in the databases LILACS, MEDLINE and BDENF during the month of June. Original articles in full were selected; in Portuguese, English and Spanish; published between 2017 and 2019. CASP was used to analyze the eligibility of studies, presenting them in the form of figures and analyzing them in a descriptive manner. Results: 303 articles were found and, after filtering them with the eligibility criteria, seven articles were selected for this review. Conclusion: it makes sure that the management of gestational syphilis was performed inappropriately in most studies analyzed due to late diagnosis and treatment, non-adherence to treatment, by the pregnant woman and her partner, reduced number of prenatal consultations, professional insecurity of carry out the therapeutic schemes and organizational problems of health services. It is perceived the need to implement more effective measures in the professional context and improvement of health services to carry out the appropriate management.(AU)


Objetivo: analizar el manejo de la sífilis gestacional durante la atención prenatal. Método: es un estudio bibliográfico, tipo revisión integradora, desarrollado a través de una búsqueda sistemática en la BVS con los descriptores de salud, en las bases de datos LILACS, MEDLINE y BDENF durante el mes de junio. Se seleccionaron artículos originales completos; en portugués, inglés y español; publicado entre 2017 y 2019. Se utilizó el CASP para analizar la elegibilidad de los estudios, presentándolos en forma de cifras y analizándolos de manera descriptiva. Resultados: se encontraron 303 artículos y, después de filtrarlos con los criterios de elegibilidad, se seleccionaron siete artículos para esta revisión. Conclusión: se asegura de que el manejo de la sífilis gestacional se realizó de manera inapropiada en la mayoría de los estudios analizados debido a un diagnóstico y tratamiento tardíos, la no adherencia al tratamiento, por parte de la mujer embarazada y su pareja, un número reducido de consultas prenatales, inseguridad profesional de llevar a cabo los esquemas terapéuticos y los problemas organizacionales de los servicios de salud. Se percibe la necesidad de implementar medidas más efectivas en el contexto profesional y la mejora de los servicios de salud para llevar a cabo la gestión adecuada.(AU)


Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Atención Prenatal , Atención Primaria de Salud , Sífilis Congénita/prevención & control , Sífilis , Mujeres Embarazadas , Enfermería Obstétrica , MEDLINE , LILACS
7.
Acta Paul. Enferm. (Online) ; 33: eAPE20190028, 2020. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1130565

RESUMEN

Resumo Objetivo: Construir e validar a cartilha educativa intitulada "Como prevenir a transmissão da sífilis de mãe para filho? Vamos aprender!". Métodos: Pesquisa metodológica, associada a um estudo quase experimental, conduzida de acordo com as seguintes fases: elaboração da cartilha educativa; validação de aparência e conteúdo com 22 juízes e 11 mulheres com diagnóstico de sífilis na gestação; e a avaliação dos efeitos no Conhecimento, Atitude e Prática de 41 gestantes antes e após a leitura da cartilha educativa durante. Resultados: Validou-se a cartilha quanto à aparência e conteúdo, com o Índice de Validade de Conteúdo (IVC) Global de 0,96, Alfa de Cronbach total de 0,955 e validação dos juízes pelo Suitability Assessment of Materials considerada "superior". Quanto à validação pelo público-alvo, obteve 100% de concordância e um IVC global de 1,00. O Flesch Legibility Test considerou a leitura Muito Fácil ou Fácil. Verificou-se um aumento da porcentagem de mulheres classificadas com um conhecimento, atitude e prática adequados após a leitura da cartilha. Essa mudança na prática foi estatisticamente significativa (p=0,002), demonstrando que a leitura da cartilha educativa se mostrou efetiva para promover mudanças comportamentais. Conclusão: O material construído é confiável e validado por especialistas e pelo público-alvo, como também eficaz para promover a melhoria do CAP das gestantes visando à prevenção da transmissão vertical da sífilis.


Resumen Objetivo: Elaborar y validar una cartilla educativa titulada "¿Cómo prevenir la transmisión de la sífilis de madre a hijo? ¡Vamos a aprender!". Métodos: Investigación metodológica, asociada a un estudio cuasi experimental, llevada a cabo de acuerdo con las siguientes fases: elaboración de la cartilla educativa, validación de la apariencia y contenido por 22 jueces y 11 mujeres con diagnóstico de sífilis en el embarazo, y evaluación de los efectos en el conocimiento, las actitudes y la práctica de 41 mujeres embarazadas antes y después de la lectura de la cartilla educativa. Resultados: Se validó la cartilla con relación a la apariencia y contenido, con un Índice de Validez de Contenido (IVC) global de 0,96, un alfa de Cronbach total de 0,955 y la validación de los jueces mediante el Suitability Assessment of Materials fue considerada "superior". Respecto a la validación del público destinatario, se obtuvo un 100 % de concordancia y un IVC global de 1,00. A través del Flesch Legibility Test, la lectura se consideró "muy fácil" o "fácil". Se verificó un aumento del porcentaje de mujeres clasificadas con conocimiento, actitud y práctica adecuados después de la lectura de la cartilla. En la práctica, este cambio fue estadísticamente significativo (p=0,002), lo que evidencia que la lectura de la cartilla educativa demostró ser efectiva para promover cambios de comportamiento. Conclusión: El material elaborado es confiable y fue validado por especialistas y por el público destinatario, así como también es eficaz para promover la mejora de los CAP de las mujeres embarazadas con el objetivo de prevenir la transmisión vertical de la sífilis.


Abstract Objective: To construct and validate the educational booklet entitled "How to prevent the transmission of syphilis from mother to child? Let's learn!". Methods: Methodological, quasi-experimental study conducted according to the following steps: development of the educational booklet; face and content validation with 22 judges and 11 women diagnosed with syphilis during pregnancy; and evaluation of the effects on the Knowledge, Attitude and Practice (KAP) of 41 pregnant women before and after reading the educational booklet. Results: The booklet was submitted to face and content validation with an Overall Content Validity Index (CVI) of 0.96, a total Cronbach's alpha of 0.955. The validation of judges by the Suitability Assessment of Materials was considered "superior". As for validation by the target audience, it obtained 100% concordance and an overall CVI of 1.00. According to the Flesch Reading Ease (FRE) test, reading was considered Very Easy or Easy. There was an increase in the percentage of women classified as having appropriate knowledge, attitude and practice after reading the booklet. This change in practice was statistically significant (p=0.002), demonstrating that reading the educational booklet proved to be effective in promoting behavioral changes. Conclusion: The material constructed is reliable and validated by specialists and the target audience and effective in promoting the improvement of the KAP of pregnant women with the aim to prevent vertical transmission of syphilis.


Asunto(s)
Sífilis Congénita/prevención & control , Educación en Salud , Transmisión Vertical de Enfermedad Infecciosa , Tecnología Educacional , Investigación Metodológica en Enfermería
8.
Interface (Botucatu, Online) ; 24: e190559, 2020. ilus
Artículo en Portugués | LILACS | ID: biblio-1101222

RESUMEN

Historicamente, as campanhas na mídia e materiais educativos para grupos diversos integram as ações de prevenção à Aids e outras infecções sexualmente transmissíveis (IST). Informado pelas críticas ao uso do Modelo Informacional de Comunicação presente nessas iniciativas, o artigo analisa 14 materiais sobre prevenção das IST/Aids voltados para gestantes, produzidos entre 1995-2017, no Brasil. Foram identificados elementos do contexto de produção (restrito e amplo) e foi examinado o dispositivo de enunciação dessas peças comunicacionais. Segundo os achados, os materiais reiteram a testagem no pré-natal como responsabilidade da mulher. São escassas as informações sobre uso do preservativo na gestação, o papel do parceiro na prevenção e a perspectiva da integralidade no cuidado à saúde. Conclui-se que, na comunicação para mulheres, é necessário contemplar os fatores socioculturais (classe social, cor/raça e normas de gênero) que condicionam a vulnerabilidade ao HIV/Aids e sífilis.(AU)


Históricamente, las campañas en los medios y los materiales educativos para grupos diversos integran las acciones de prevención al Sida y otras enfermedades de transmisión sexual (ETS). Informado por las críticas al uso del Modelo de Información de Comunicación presente en esas iniciativas, el artículo analiza 14 materiales sobre prevención de las ETS/Sida enfocados en gestantes, producidos entre 1995/2017 en Brasil. Se identificaron elementos del contexto de producción (restringido y amplio) y se examinó el dispositivo de enunciación de esas piezas de comunicación. De acuerdo con los hallazgos, los materiales reiteran la realización de test en el prenatal como responsabilidad de la mujer. Son escasas las informaciones sobre uso del preservativo en la gestación, el papel del compañero en la prevención y la perspectiva de la integralidad en el cuidado de la salud. Se concluye que en la comunicación para las mujeres es necesario incluir los factores socioculturales (clase social, color/raza, normas de género) que condicionan la vulnerabilidad al VIH/Sida y sífilis.(AU)


Historically media campaigns and educational materials for diverse groups have been part of actions for the prevention of Aids and other sexually transmitted infections (STI). Informed by the criticism regarding the use of the informational communication model in these communicative strategies, the article analyses STI/Aids prevention's messages in 14 educational materials aimed at pregnant women, produced between 1995-2017 in Brazil. Elements of the production context were identified and the enunciation device of these materials was examined. According to the findings, the materials reiterate prenatal testing as a woman's responsibility. Information on condom use during pregnancy, the role of the partner in prevention and the perspective of comprehensiveness in health care are scarce. The results point to the need to develop communication actions for women that include sociocultural factors (social class, race, gender norms) which condition vulnerability to HIV/Aids and Syphilis.(AU)


Asunto(s)
Humanos , Sífilis Congénita/prevención & control , Infecciones por VIH/prevención & control , Mujeres Embarazadas , Materiales Educativos y de Divulgación , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Género y Salud
9.
Obstet Gynecol Surv ; 74(9): 557-564, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31830301

RESUMEN

Importance: Since 2013, the United States has seen a rise in cases of congenital syphilis, culminating in a relative increase of 153% from 2013 to 2017 and 918 reported cases in 2017. In all, 50% to 80% of pregnant women with syphilis experience an adverse pregnancy outcome including stillbirth or spontaneous abortion. Objective: This article aims to review the current evidence and recommendations for management of syphilis in pregnancy. Evidence Acquisition: Original research articles, review articles, and guidelines on syphilis were reviewed. Results: In pregnancy, routine screening for syphilis is recommended on initiation of prenatal care. In high-risk populations, repeat testing is recommended in the early third trimester and at delivery. Penicillin remains the recommended treatment in pregnancy. After treatment, nontreponemal titers should be repeated at minimum during the early third trimester and at delivery to assess for serologic response. In high-risk populations, titers should be repeated monthly. Conclusion and Relevance: Routine screening in pregnancy is essential for identification of syphilis infection and prevention of congenital syphilis. Subsequent adequate treatment with penicillin therapy more than 30 days before delivery and at the correct dosages depending on the stage of infection should be incorporated into clinical practice.


Asunto(s)
Antibacterianos/uso terapéutico , Penicilinas/uso terapéutico , Complicaciones Infecciosas del Embarazo , Sífilis Congénita/prevención & control , Sífilis , Aborto Espontáneo , Femenino , Humanos , Tamizaje Masivo , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Factores de Riesgo , Mortinato , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis Congénita/etiología , Ultrasonografía Prenatal
10.
Sex Reprod Health Matters ; 27(1): 69-82, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31884900

RESUMEN

Guidelines can help healthcare practitioners manage syphilis in pregnancy and prevent perinatal death or disability. We conducted systematic reviews to locate guidance documents describing management of syphilis in pregnancy, 2003-2017. We compared country and regional guidelines with current World Health Organization (WHO) guidelines. We found 64 guidelines with recommendations on management of syphilis in pregnancy representing 128 of the 195 WHO member countries, including the two WHO guidelines published in 2016 and 2017. Of the 62 guidelines, 16 were for countries in Africa, 21 for the Americas, two for Eastern Mediterranean, six for Europe and 17 for Asia or the Pacific. Fifty-seven (92%) guidelines recommended universal syphilis screening in pregnancy, of which 46 (81%) recommended testing at the first antenatal care visit. Also, 46 (81%) recommended repeat testing including 21 guidelines recommended this during the third pregnancy trimester and/or at delivery. Fifty-nine (95%) guidelines recommended benzathine penicillin G (BPG) as the first-line therapy for syphilis in pregnancy, consistent with WHO guidelines. Alternative regimens to BPG were listed in 42 (68%) guidelines, primarily from Africa and Asia; only 20 specified that non-penicillin regimens are not proven-effective in treating the fetus. We identified guidance recommending use of injectable penicillin in exposed infants for 112 countries. Most guidelines recommended universal syphilis testing for pregnant women, repeat testing for high-risk women and treatment of infected women with BPG; but several did not. Updating guidance on syphilis testing and treatment in pregnancy to reflect global norms could prevent congenital syphilis and save newborn lives.


Asunto(s)
Salud Global , Guías como Asunto , Complicaciones Infecciosas del Embarazo , Sífilis , Antibacterianos/uso terapéutico , Femenino , Humanos , Lactante , Mortalidad Infantil , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis Congénita/prevención & control , Organización Mundial de la Salud
12.
Gac Med Mex ; 155(5): 464-472, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31695231

RESUMEN

Introduction: Congenital syphilis continues to be a public health problem in Mexico. Objective: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. Method: Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. Results: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. Conclusions: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.


Asunto(s)
Algoritmos , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/diagnóstico , Serodiagnóstico de la Sífilis , Sífilis Congénita/diagnóstico , Femenino , Regulación Gubernamental , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , México , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Sífilis Congénita/prevención & control
18.
PLoS One ; 14(2): e0211720, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30811406

RESUMEN

BACKGROUND: In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. METHODS: Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. RESULTS: The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57-0.81%) resulting in a global CS rate of 473 (385-561) per 100,000 live births and 661,000 (538,000-784,000) total CS cases, including 355,000 (290,000-419,000) adverse birth outcomes (ABO) and 306,000 (249,000-363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs- 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63-0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000-432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. CONCLUSIONS: Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.


Asunto(s)
Costo de Enfermedad , Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis Congénita/epidemiología , Sífilis/complicaciones , Femenino , Salud Global/estadística & datos numéricos , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del Embarazo/epidemiología , Prevalencia , Mortinato/epidemiología , Sífilis/epidemiología , Sífilis/prevención & control , Sífilis Congénita/prevención & control
20.
BMC Health Serv Res ; 19(1): 65, 2019 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-30678672

RESUMEN

BACKGROUND: Although there are public policies for eradicating congenital syphilis, they do not seem to be a routine in most health services. The objective of this study was to evaluate the management of sexual partners of pregnant women with syphilis in primary health care in northeastern Brazil. METHODS: This is a qualitative assessment carried out from February to October 2014 in the city of Fortaleza, Ceará, northeastern region of Brazil, through the observation of six primary health care centers and interviews with 21 professionals, six coordinators, nine women diagnosed with syphilis during antenatal care and four sexual partners. The data were submitted to thematic content analysis. RESULTS: Important flaws were identified at the primary health centers studied regarding the management of syphilis during pregnancy. Accessing testing and treatment is difficult, and there are no standardized strategies to notify the partner. The responsibility for notifying them is transferred to the women, and counseling does not offer proper guidance nor sufficient emotional support to help them. CONCLUSION: The management of pregnant women and their sexual partners in our region does not comply with global recommendations. Professional qualification, sensitization, and standardization of health professionals' conduct are necessary. Offering support to health professionals on their clinical practices by means of a supervision process may contribute to the adoption of the recommended guidelines and to the promotion of care based on privacy, respect, confidentiality of information, and awareness of the problems faced by women as a result of syphilis diagnosis.


Asunto(s)
Complicaciones Infecciosas del Embarazo/prevención & control , Parejas Sexuales , Sífilis/prevención & control , Adolescente , Adulto , Brasil , Trazado de Contacto , Prestación de Atención de Salud/normas , Erradicación de la Enfermedad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Persona de Mediana Edad , Embarazo , Mujeres Embarazadas/psicología , Atención Prenatal/normas , Investigación Cualitativa , Sífilis Congénita/prevención & control , Adulto Joven
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