Sífilis em parturientes e recém-nascidos atendidos em um hospital universitário de Dourados-MS

Abstract

Syphilis continues to be a major public health problem, especially in pregnant women, due to the risk of transmission to the fetus and central nervous system involvement, causing neurosyphilis. In order to assist in the implementation of strategies to control this disease, a study was carried out to analyze the risk factors for neurosyphilis in newborns. Methods. The study was conducted from July/2017 to December/2017 in a university hospital in Dourados, located in the Center-West region of Brazil. We selected newborns of pregnant women with syphilis admitted for childbirth. In these newborns, treponemal and non-treponemal tests, cerebrospinal fluid collection and long bone radiography were performed. It was defined as a case newborns diagnosed with neurosyphilis (altered cerebrospinal fluid) and control newborns diagnosed with congenital syphilis. Each case was randomly matched with two paired controls. Results. The study included 21 cases of newborns with neurosyphilis and 42 controls of newborns with congenital syphilis. Of pregnant women, 95.2% (60/63) performed prenatal care, where 60% (36/60) started in the first trimester, with 78.3% (47/60) doing the VDRL test, resulting in 74.6% (47/63) diagnosed with syphilis during prenatal care; 80.8% (38/47) were treated with penicillin, and 53.7% (22/41) had their partners treated. Of the newborns, 50.8% (32/63) were hospitalized due to syphilis complications such as prematurity and low birth weight. In the univariate analysis, neurosyphilis was associated with risk behaviors of the mother, such as alcohol use, having a tattoo, not performing serological tests for syphilis during the prenatal and untreated sexual partner. Conclusions. The results of this study demonstrated that prenatal coverage is not sufficient to guarantee the control of neurosyphilis. The failure to provide services during prenatal care occurs due to the late diagnosis of syphilis in pregnant woman and inadequate follow-up of sexual partner. Further, syphilis treatment should be primarily prioritized by health managers so that more effective prevention and control measures are available to pregnant women.