Impact of implementation of rapid treponemal testing in prenatal care on incidence and severity of congenital syphilis

Authors

DOI:

https://doi.org/10.15448/1980-6108.2024.1.46468

Keywords:

Congenital syphilis, congenital infections, Epidemiology, Diagnosis, treatment

Abstract

Objective: to compare the incidence of congenital syphilis (CS) before and after the introduction of the rapid treponemal test and to determine whether there were changes in the clinical characteristics and severity of this disease. Methods: a cross-sectional study was conducted in the community of Viamão, Brazil. Reported cases of CS identified by maternal screening with a nontreponemal test (group I) and those identified by screening with a rapid treponemal test (group II) were compared. Data were obtained from the Notifiable Diseases Information System (SINAN). Results: 302 cases of CS were detected in the sample, with an incidence of 7.7 ‰ live births (80 / 10,369) in group I and 23.2 ‰ (222 / 9,538) in group II (p=0.000). After the introduction of the rapid treponemal test, there was a slightly higher proportion of pregnant women (1 (2.0 %) x 14 (8.8 %); p = 0.12) and their sexual partners (6 (11.8 %) x 38 (24.0 %); p = 0.12) who received adequate treatment during prenatal care, there were fewer newborns with clinical manifestations (11 (16.7%) x 12 (6. 2%); p = 0.02) and proven or highly probable CS (16 (24.2%) x 29 (14.8%); p = 0.10). The incidence per group of proven or highly probable CS was 1.5 and 3.0 ‰ live births, and possible CS was 4.7 and 16.6 ‰ (p = 0,10), respectively. Conclusion: screening with the rapid treponemal test was associated with a slight improvement in maternal management and fewer clinically affected neonates, although the incidence of CS increased significantly. This raises doubts about the quality of prenatal care for gestational syphilis.

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Author Biographies

Elizane Giordani, Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, RS, Brazil.

PhD's student in Child Health in the Postgraduate Program at the Pontifical Catholic University of Rio Grande do Sul (PUCRS, in Porto Alegre, RS, Brazil. Specialist in Neonatal Intensive Care by the Brazilian Association of Intensive Care Nursing (ABENTI), in Porto Alegre, RS, Brazil. Specialist in Health Public with an emphasis on the Family from the International University Center (UNINTER). Nurse graduated from the Methodist University Center of the Porto Alegre Institute of the Methodist Church (IPA), in Porto Alegre, RS, Brazil. Doctoral student of the Postgraduate Program in Pediatrics at PUCRS, in Porto Alegre, RS, Brazil.

Manoel Antonio da Silva Ribeiro, School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS

PhD Child Health and Master in Pediatrics from the Postgraduate Program in Pediatrics at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), in Porto Alegre, RS, Brazil. Pediatrician, Neonatologist. Adjunct Professor at the PUCRS School of Medicine, editor-in-chief of the journal Scientia Medica since 2019. Specialist in Health Management: Hospital emphasis by PUCRS, in Porto Alegre, RS, Brazil.

Eleonor Gastal Lago, Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, RS, Brazil.

PhD and Master in Pediatrics from the Postgraduate Program in Pediatrics at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), in Porto Alegre, RS, Brazil. Pediatrician. Was a professor at the PUCRS School of Medicine between 1978 and 2019, retiring as Full Professor, editor-in-chief of the journal Scientia Medica between 2007 and 2019 and coordinator of the Journals Division of PUCRS between 2011 and 2019, in Porto Alegre, RS, Brazil. President of the Brazilian Toxoplasmosis Research Network (Rede Toxo), consultant on congenital toxoplasmosis for the Health Department of the State of Rio Grande do Sul and the Ministry of Health.

Raquel Jaqueline Eder Ribeiro, Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, RS, Brazil

Master’s student in the Postgraduate Program in Medicine and Health Sciences at the School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Graduated in Medicine from the School of Medicine of the PUCRS, Porto Alegre, RS, Brazil.

Manuel Antonio Ruttkay Pereira, Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, RS, Brazil.

Doctor and Master in Pediatrics from the Postgraduate Program in Pediatrics at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), in Porto Alegre, RS, Brazil. Pediatrician, Neonatologist. Adjunct professor at the School of Medicine of PUCRS and adjunct professor at the Faculty of Medicine of the Federal University of Rio Grande do Sul (UFRGS), in Porto Alegre, RS, Brazil.

Jorge Hecker Luz, Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, RS, Brazil.

PhD and Master in Pediatrics from the Postgraduate Program in Pediatrics at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), in Porto Alegre, RS, Brazil. Pediatrician, Neonatologist. Adjunct professor at the School of Medicine of PUCRS, in Porto Alegre, RS, Brazil.

Humberto Holmer Fiori, Pontifical Catholic University of Rio Grande do Sul (PUCRS), School of Medicine, Porto Alegre, RS, Brazil.

PhD and Master in Pediatrics from the Postgraduate Program in Pediatrics at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), in Porto Alegre, RS, Brazil. Pediatrician, Neonatologist. Full Professor at the School of Medicine of PUCRS.

References

Laurence MS. Syphilis. In: Maldonado Y, Nizet V, Barnett ED, Edwards KM, Malley r, editors. Remington and Klein’s infectious diseases of the fetus and newborn infant. 9th ed. Philadelphia: Elsevier Saunders; 2024. p. 427-62.

Lago EG. Current perspectives on prevention of mother-to-child transmission of syphilis. Cureus. 2016;8(3):e525. https://doi.org/10.7759%2Fcureus.525

Centers for Disease Control and Prevention. Sexuality transmitted infections treatment guidelines, 2021. Congenital syphilis [Internet]. 2021 [cited 2024 Mar 14]. Available from: https://www.cdc.gov/std/treatment-guidelines/congenital-syphilis.htm

Stafford IA, Workowski KA, Bachmann LH. Syphilis complicating pregnancy and congenital syphilis. N Engl J Med. 2024;390(3):242-53. https://doi.org/10.1056/nejmra2202762 DOI: https://doi.org/10.1056/NEJMra2202762

Ogundipe OF, Van Den Bergh R, Thierry B, Takarinda KC, Muller CP, Timire C, et al. Better care for babies: the added value of a modified reverse syphilis testing algorithm for the treatment of congenital syphilis in a maternity hospital in Central African Republic. BMC Pediatr. 2019;19(1):284. https://doi.org/10.1186/s12887-019-1622-4 DOI: https://doi.org/10.1186/s12887-019-1622-4

Walensky RP, Jernigan DB, Bunnell R, Layden J, Kent CK, Gottardy AJ, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR. 2021;70(4):1-189. [cited 2024 Mar 15]. Available from: https://www.cdc.gov/mmwr/volumes/70/rr/pdfs/rr7004a1-H.pdf DOI: https://doi.org/10.15585/mmwr.rr7004a1

Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop. 2021;54(Suppl I): e2020597. https://doi.org/10.1590/0037-8682-597-2020 DOI: https://doi.org/10.1590/0037-8682-597-2020

Cooper JM, Sánchez PJ. Congenital syphilis. Semin Perinatol. 2018 Apr 1;42(3):176-84. https://doi.org/10.1053/j.semperi.2018.02.005 DOI: https://doi.org/10.1053/j.semperi.2018.02.005

Brasil, Ministério da Saúde, Secretaria de Ciência Tecnologia Inovação e Insumos Estratégicos em Saúde, Secretaria de Vigilância em Saúde. Protocolo clínico e diretrizes terapêuticas para prevenção da transmissão vertical de HIV, sífilis e hepatites virais. 2ª ed. Brasília: Ministério da Saúde; 2022. 224 p. [cited 2024 Mar 15]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/protocolo_clinico_hiv_sifilis_hepatites.pdf

Romero CP, Marinho DS, Castro R, Aguiar Pereira CC, Silva E, Caetano R, et al. Cost-effectiveness analysis of point-of-care rapid testing versus laboratory-based testing for antenatal screening of syphilis in Brazil. Value Health Reg Issues. 2020;23(C):61-9. https://doi.org/10.1016/j.vhri.2020.03.004 DOI: https://doi.org/10.1016/j.vhri.2020.03.004

Kidd S, Bowen VB, Torrone EA, Bolan G. Use of national syphilis surveillance data to develop a congenital syphilis prevention cascade and estimate the number of potential congenital syphilis cases averted. Sex Transm Dis. 2018;45(9 S):S23-8. https://doi.org/10.1097/olq.0000000000000838 DOI: https://doi.org/10.1097/OLQ.0000000000000838

Oliveira LR, Santos ES, Souto FJD. Syphilis in pregnant women and congenital syphilis: spatial pattern and relationship with social determinants of health in mato grosso. Rev Soc Bras Med Trop. 2020;53:1-7. https://doi.org/10.1590/0037-8682-0316-2020 DOI: https://doi.org/10.1590/0037-8682-0316-2020

Brasil, Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids Tuberculose Hepatites Virais e Infecções Sexualmente Transmissíveis. Boletim epidemiológico - sífilis 2023 [Internet]. Brasília: DF; 2023 [cited 2024 Feb 10]. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2023/boletim-epidemiologico-de-sifilis-numero-especial-out.2023/view

European Center for Disease Prevention and Control. Congenital Syphilis. In: ECDC, editor. ECDC Annual epidemiological report for 2016. Stockholm: ECDC; 2018 [cited 2024 Mar 15]. p. 1-5. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/congenital-syphilis-annual-epidemiological-report-2016.pdf

United Nations Development Program, Institute of Applied Economic Research, João Pinheiro Foundation [Internet]. Atlas of Human Development in Brazil; 2020 [cited 2024 Mar 14]. Available from: http://www.atlasbrasil.org.br/perfil/municipio/432300

Santos MM, Lopes AKB, Roncalli AG, Lima KC. Trends of syphilis in Brazil: A growth portrait of the treponemic epidemic. PLoS One. 2020 Apr 1;15(4): e0231029. https://doi.org/10.1371/journal.pone.0231029 DOI: https://doi.org/10.1371/journal.pone.0231029

Maschio-Lima T, De Lima Machado IL, Zen Siqueira JP, Gottardo Almeida MT. Epidemiological profile of patients with congenital and gestational syphilis in a city in the state of São Paulo, Brazil. Rev Bras Saude Mater Infant. 20191;19(4):865-72. https://doi.org/10.1590/1806-93042019000400007 DOI: https://doi.org/10.1590/1806-93042019000400007

Plotzker RE, Murphy RD, Stoltey JE. Congenital syphilis prevention: Strategies, evidence, and future directions. Sex Transm Dis. 2018;45(9S Suppl1): S29-S37. https://doi.org/10.1097/olq.0000000000000846 DOI: https://doi.org/10.1097/OLQ.0000000000000846

Pan American Health Organization. EMTCT Plus. Framework for elimination of mother-to child transmission of HIV, syphilis, hepatitis b, and chagas [Internet]. Washington, D.C.: PAHO; 2017 [cited 2024 Mar 14]. 27 p. Available from: https://iris.paho.org/handle/10665.2/34306

Lafetá KRG, Martelli Júnior H, Silveira MF, Paranaíba LMR. Sífilis materna e congênita, subnotificação e difícil controle. Rev bras epidemiol. 2016;19(1):63-74. https://doi.org/10.1590/1980-5497201600010006 DOI: https://doi.org/10.1590/1980-5497201600010006

Yeganeh N, Watts HD, Camarca M, Soares G, Joao E, Pilotto JH, et al. Syphilis in HIV-infected mothers and infants: Results from the NICHD/HPTN 040 study. Pediatr Infect Dis J. 2015;34(3):e52-7. https://doi.org/10.1097/inf.0000000000000578 DOI: https://doi.org/10.1097/INF.0000000000000578

Alves PIC, Scatena LM, Haas VJ, Castro SS. Temporal evolution and characterization of congenital syphilis cases in Minas Gerais, Brazil, 2007-2015. Cien Saude Colet. 2020;25(8):2949-60. https://doi.org/10.1590/1413-81232020258.20982018 DOI: https://doi.org/10.1590/1413-81232020258.20982018

Oliveira SIM, Saraiva COPO, França DF, Ferreira MA, Lima LHM, Souza NL. Syphilis notifications and the triggering processes for vertical transmission: a cross-sectional study. Int J Environ Res Public Health. 2020;17(3):984. https://doi.org/10.3390/ijerph17030984 DOI: https://doi.org/10.3390/ijerph17030984

Lago EG, Vaccari A, Fiori RM. Clinical features and follow-up of congenital syphilis. Sex Transm Dis. 2013;40(2):85-94. https://doi.org/10.1097/olq.0b013e31827bd688 DOI: https://doi.org/10.1097/OLQ.0b013e31827bd688

Santos RR, Niquini RP, Bastos FI, Domingues RMSM. Diagnostic and therapeutic knowledge and practices in the management of congenital syphilis by pediatricians in public maternity hospitals in Brazil. Int J Health Serv. 2019;49(2):322-42. https://doi.org/10.1177/0020731417722088 DOI: https://doi.org/10.1177/0020731417722088

Matthias J, Sanon R, Bowen VB, Spencer EC, Peterman TA. Syphilitic reinfections during the same pregnancy-Florida, 2018. Sex Transm Dis. 2021;48(5):e52–5. https://doi.org/10.1097%2FOLQ.0000000000001298 DOI: https://doi.org/10.1097/OLQ.0000000000001298

Rahman MMU, Hoover A, Johnson C, Peterman TA. Preventing congenital syphilis – opportunities identified by congenital syphilis case review boards. Sex Transm Dis. 2019;46(2):139-42. https://doi.org/10.1097/olq.0000000000000909 DOI: https://doi.org/10.1097/OLQ.0000000000000909

Congenital syphils in the USA. Lancet. 2018;392(10154):1168. https://doi.org/10.1016/s0140-6736(18)32360-2 DOI: https://doi.org/10.1016/S0140-6736(18)32360-2

Reis GJ, Barcellos C, Pedroso MM, Xavier DR. Intraurban differentials in congenital syphilis: a predictive analysis by neighborhood in the city of Rio de Janeiro, Brazil. Cad Saude Publica. 2018;34(9):e00105517. https://doi.org/10.1590/0102-311X00105517 DOI: https://doi.org/10.1590/0102-311x00105517

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Published

2024-10-22

How to Cite

Giordani, E., Ribeiro, M. A. da S., Gastal Lago, E., Jaqueline Eder Ribeiro, R., Ruttkay Pereira, M. A., Hecker Luz, J., & Holmer Fiori, H. (2024). Impact of implementation of rapid treponemal testing in prenatal care on incidence and severity of congenital syphilis. Scientia Medica, 34(1), e46468. https://doi.org/10.15448/1980-6108.2024.1.46468

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Vol. 34 No. 1 (2024): Single Volume - Continuous Flow

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