Syphilis in gestation: barriers in prenatal care for the control of vertical transmission

Abstract Background Gestational syphilis is a mother-to-fetus mother-to-child disease that, if left untreated, can result in numerous negative outcomes for maternal and child health. Objective Evaluate the barriers in prenatal care for the control of vertical transmission of syphilis in pregnant women according to the sociodemographic, reproductive, and care profile in a metropolis of northeastern Brazil. Method This is a descriptive study, conducted from a database of a case-control study for gestational syphilis in public maternity hospitals in the Northeast of Brazil, between 2013 and 2014. Information on follow-up and treatment was obtained through prenatal card records and interviews. The diagnosis of syphilis considered card records, chart notes, and results from the Venereal Disease Research Laboratory (VDRL). Results A total of 1,206 women were included, 91.7% were prenatal and declared to be married, with fewer children and higher educational levels. The VDRL result of prenatal care was noted at 23.9%. Among the 838 women who received the VDRL in prenatal care, 21% were reactants and 70.5% treated the infection. Of these, 69.4% used the scheme for tertiary syphilis and 8.1% were treated with other medications. Conclusion Prenatal care did not reach effectiveness in the prevention and screening of syphilis since women reacting to the infection on maternity admission occurred, albeit to a lesser extent, and the opportunity to achieve control of the disease was lost.

摘要 背景 妊娠梅毒（Gestational syphilis）是一种可发生母婴垂直传播的疾病，若未接受治疗，会对母婴健康造成诸多不良结局。 目的 结合巴西东北部大都市孕妇的社会人口学、生殖及保健特征，评估产前保健中防控梅毒垂直传播所面临的障碍。 方法 本研究为描述性研究，数据来源于2013至2014年巴西东北部公立妇产医院开展的妊娠梅毒病例对照研究数据库。研究通过产前保健手册记录与访谈获取随访及治疗相关信息，梅毒诊断依据产前保健手册记录、病历笔记及性病研究实验室（Venereal Disease Research Laboratory, VDRL）检测结果。 结果 本研究共纳入1206名孕妇，其中91.7%接受过产前保健且自述已婚，生育子女数较少、受教育程度较高。产前保健中VDRL检测的记录率为23.9%。在838名接受产前VDRL检测的孕妇中，21%检测结果呈反应性，其中70.5%接受了感染治疗。在接受治疗的孕妇中，69.4%采用了三期梅毒治疗方案，8.1%使用了其他药物进行治疗。 结论 产前保健未能有效实现梅毒的预防与筛查：仍有部分孕妇在入院分娩时梅毒检测呈反应性（尽管比例较低），错失了疾病防控的关键时机。