Weaknesses in primary health care favor the growth of acquired syphilis

Acquired syphilis is a sexually transmitted
infection that affects the general population and has been growing in recent
years in many countries. A study was developed aiming to analyze the trends of
acquired syphilis associated with sociodemographic aspects and primary health
care in Brazil, in the period from 2011 to 2018. This study used secondary data
from the national notification systems of the 5570 Brazilian cities and a
database of 37,350 primary health care teams, as well as socioeconomic and
municipal demographic indicators. The trends of acquired syphilis at the
municipal level were calculated from the log-linear regression, crossing them
with variables of primary health care and sociodemographic indicators. Finally,
a multiple model was built from logistic regression. The increase in trends of
acquired syphilis was associated with better availability of the rapid test
(PR=1.06; 1.03-1.09); lower availability of male condoms (PR=1.08; 1.05-1.12);
lower availability of female condoms (PR=1.06; 1.04-1.09); lower availability
of benzathine penicillin (PR=1.06; 1.03-1.09); partial coverage of the teams in
primary health care (PR=1.17; 1.11-1.16); limited application of penicillin in
primary health care (PR=1.05; 1.03-1.08); higher proportion of teams classified
as Poor/Regular in primary health care (PR=1.08; 1.05-1.12); higher proportion
of women aged 10 to 17 years who had children (PR=1.03; 1.01-1.05); higher HDI
(PR=1.13; 1.11-1.16); higher proportion of people aged 15 to 24 years who do
not study, do not work and are vulnerable (PR=1.05; 1.02-1.07); and population
size with more than 100,000 inhabitants (PR=1.25; 1.21-1.27). The following
variables remained in the multiple model: not all primary health care teams
apply penicillin; higher proportion of primary health care teams with poor/regular
scores; population size >100000 inhabitants; partially available female
condom. Thus, the weakness of primary health care linked to population size may
have favored the growth of the acquired syphilis epidemic in Brazilian cities.