Syphilis in pregnancy, congenital syphilis, and factors associated with mother-to-child transmission in Itapeva, São Paulo, 2010 to 2014.

Silva Neto, Sérgio Eleutério da; Silva, Stael Silvana Bagno Eleutério da; Sartori, Ana Marli Christovam

doi:10.1590/0037-8682-0377-2017

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Revista da Sociedade Brasileira de Medicina Tropical

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Short Communication • Rev. Soc. Bras. Med. Trop. 51 (06) • Nov-Dec 2018 • https://doi.org/10.1590/0037-8682-0377-2017 copy

Syphilis in pregnancy, congenital syphilis, and factors associated with mother-to-child transmission in Itapeva, São Paulo, 2010 to 2014.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

This study describes cases of syphilis in pregnancy (SiP) and congenital syphilis (CS) and identifies factors associated with mother-to-child transmission in patients in Itapeva from January 1, 2010 to December 31, 2014.

METHODS:

Using SiP and CS notification forms and medical records, a cross-sectional study involving 149 pregnant women was conducted.

RESULTS:

Annual SiP detection rates ranged from 16.3-31.4/1000 live births. Most women had prenatal care started at the first trimester of pregnancy with ≥6 visits. Mother-to-child transmission rate was 69.7%. CS incidence rates varied from 9.1-22.3/1000 live births.

CONCLUSIONS:

The results suggest low quality of prenatal care.

Keywords:
Congenital syphilis; Syphilis in pregnancy; Vertical transmission; Prenatal care; Risk factors

Characteristics	N	(%)
Age (years) (n=149)
Mean (SD)	24.3 (6.6)
Median (min - max)	24 (14 - 45)
Skin color (n=149)
white	124	(83.2)
black or brown	25	(16.8)
Level of education (n=146 ¹ )
incomplete elementary education	54	(37.0)
incomplete secondary education	49	(33.6)
complete secondary education	40	(27.4)
complete higher education	3	(2.0)
Place of residence (n=149)
rural	10	(6.7)
urban	139	(93.3)
Occupation (n=149)
homemakers	101	(67.8)
other	48	(32.2)
Number of sexual partners (n=113 ¹ )
<3	57	(50.4)
≥3	55	(48.6)
Smoked during pregnancy (n=131 ¹ )	52	(39.7)
Drank alcohol during pregnancy (n=130 ¹ )	26	(20.0)
Used illicit drugs during pregnancy (n=132 ¹ )	18	(13.6)
HIV serology (n=148 ¹ )
positive	2	(1.4)
not done	5	(3.4)
HPV diagnosis during pregnancy (n=97 ¹ )	10	(10.3)
Diabetes mellitus during pregnancy (n=140 ¹ )	6	(4.3)
Hypertension during pregnancy (n=142 ¹ )	10	(7.0)
Had prenatal care (n=149)	141	(94.6)
Gestational age at the first prenatal visit (n=139 ¹ )
first trimester (≤13 weeks)	79	(56.8)
second trimester (14 - 27 weeks)	56	(40.3)
third trimester (≥28 weeks)	4	(2.9)
Number of prenatal visits (n=141 ² )
<6	34	(24.1)
≥6	107	(75.9)
Mean (SD)	7,8 (2,9)
Median (min - max)	8 (1 - 15)
Absences in prenatal visits (n=141 ² )
0	83	(58.9)
≥1	58	(41.1)
Mean (SD)	1.3 (2.0)
Had a non-treponemal syphilis serological test during pregnancy (n=141 ² )	137	(97.2)
Positive result in the first serological test (n=137 ³ )	128	(93.4)
Gestational age at the time of the first syphilis serology (n=137 ³ )
before the diagnosis of pregnancy	3	(2.2)
first trimester (≤13 weeks)	85	(62.0)
second trimester (14 - 27 weeks)	36	(26.3)
third trimester (≥28 weeks)	13	(9.5)
Time between the first prenatal care visit and the first serological test (n=137 ³ )
<15 days	110	(80.3)
16 - 30 days	6	(4.4)
31 - 60 days	7	(5.1)
61 - 90 days	3	(2.2)
>90 days	11	(8.0)
Had a treponemal test during prenatal care (n=149)	116	(77.9)
Gestational age at syphilis diagnosis (n=149)
before pregnancy	3	(2.0)
first trimester (≤13 weeks)	85	(57.0)
second trimester (14 - 27 weeks)	31	(20.8)
third trimester (≥28 weeks)	13	(8.7)
at the time of delivery or curettage	17	(11.4)
Antibody titers in the first positive VDRL (n=149)
≤1:4	64	(43.0)
>1:4	85	(57.0)
Clinical presentation of syphilis (n=105 ¹ )
primary	21	(20.0)
secondary or latent with <1 year's duration	59	(56.2)
latent with >1 year's duration	22	(20.9)
tertiary	3	(2.9)
Received a prescription of treatment during pregnancy (n=132 ⁴ )	128	(97.0)
Time between diagnosis and treatment prescription (n=128 ⁵ ) (days)
≤7	22	(17.2)
8 - 15	18	(14.1)
16 - 30	45	(35.1)
31 - 60	22	(17.2)
61 - 90	8	(6.3)
>90	13	(10.1)
Gestational age at the time of treatment prescription (n=128 ⁵ ) (weeks)
≤13	50	(39.1)
14 - 27	57	(44.5)
>28	21	(16.4)
Prescribed treatment regimen (n=128 ⁵ )
Benzathine penicillin 2,400,000 IU	9	(7.0)
Benzathine penicillin 4,800,000 IU	6	(4.7)
Benzathine penicillin 7,200,000 IU	113	(88.3)
Received the prescribed treatment (n=128 ⁵ )	120	(93.8)
Treatment prescribed was adequate (n=128 ⁵ )	115	(89.8)
First treatment prescribed was ≥30 days before delivery (n=128 ⁵ )	115	(89.8)
Number of serological tests after treatment (n=120 ⁶ )
0	18	(15.0)
1	33	(27.5)
≥2	69	(57.5)
Had monthly VDRL testing after treatment (n=120 ⁶ )	38	(31.7)
Received a retreatment prescription (n=120 ⁶ )	24	(20.0)
Received the prescribed retreatment (n=24 ⁷ )	18	(75.0)
Had a VDRL test after retreatment (n=18 ⁸ )	7	(38.9)
Last treatment prescribed was ≥30 days before delivery (n=128 ⁵ )	107	(83.6)
Partner was treated (n=140 ¹ )	79	(56.4)
Partner’s treatment regimen (n=79 ⁹ )
Benzathine penicillin 2,400,000 IU	8	(10.2)
Benzathine penicillin 4,800,000 IU	5	(6.3)
Benzathine penicillin 7,200,000 IU	66	(83.5)
Partner’s treatment was adequate (n=79 ⁹ )	68	(86.1)
Reason for not treating the partner (n=60 ¹ )
partner had no contact with the pregnant woman	23	(38.3)
partner was not called/communicated with	10	(16.7)
partner did not attend	1	(1.6)
partner refused treatment	7	(11.7)
partner with non-reactive serology test	15	(25.0)
patient changed partner	4	(6.7)

Characteristics	N	(%)
Gestational age at birth (n=143 ¹ )
<24 weeks	2	(1.4)
24 - 30 weeks	9	(6.3)
31 - 36 weeks	33	(23.1)
37 - 38 weeks	34	(23.8)
39 - 42 weeks	63	(44.0)
>42 weeks	2	(1.4)
Birth weight (n=146 ¹ )
normal (≥2,500 g)	94	(64.4)
low birth weight (1,500 - 2,499 g)	41	(28.1)
very low birth weight (1,000 - 1,499 g)	6	(4.1)
extremely low birth weight (<1,000 g)	5	(3.4)
Mean (SD)	2,825.3 (761.2)
Median (min - max)	2,955 (443 - 4,390)
Presence of clinical signs of syphilis at birth (n=142 ¹ )	75	(52.8)
VDRL test results (n=143 ¹ )
≤1:4	66	(46.1)
>1:4	30	(21.0)
negative	36	(25.2)
not done	11	(7.7)
Cerebrospinal fluid analysis (n=145 ¹ )
Normal	31	(21.4)
Altered	45	(31.0)
Not done	69	(47.6)
Received specific treatment for syphilis (n=142 ¹ )	81	(57.0)
Age at the beginning of treatment (n=81 ² )
0 days	74	(91.4)
1 day	5	(6.2)
3 days	1	(1.2)
34 days	1	(1.2)
Drug used for syphilis treatment (n=81 ² )
crystalline penicillin	43	(53.1)
procaine penicillin	2	(2.5)
crystalline penicillin + procaine penicillin	36	(44.4)
Outcome at the time of hospital discharge/notification (n=147)
live	142	(96.6)
death from CS	5	(3.4)
Outcome at two years of age (n=142 ³ )
cure without sequelae	130	(91.6)
healing with sequelae	10	(7.0)
death	2	(1.4)

Variables	Total	CS
	n	n	%	PR	95% CI (PR)	p
Mother’s skin color						0.505
white	118	85	72.0	1
black or brown	23	18	78.3	1.09	0.85 - 1.39
Age (years)						0.250
<25	82	63	76.8	1
≥25	59	40	67.8	0.88	0.71 - 1.09
Mother’s educational attainment (years) (n=139)						0.691
<8	73	52	71.2	1
>8	66	49	74.2	1.04	0.85 - 1.28
Number of sexual partners (n=107)						0.087
<3	52	41	78.8	1
≥3	55	35	63.6	0.81	0.63 - 1.03
Smoking during pregnancy (n=124)						0.001
no	73	44	60.3	1
yes	51	44	86.3	1.43	1.15 - 1.78
Use of alcohol during pregnancy (n=123)						0.399
no	97	67	69.1	1
yes	26	20	76.9	1.11	0.87 - 1.43
Use of illicit drugs during pregnancy (n=125)						0.179
no	92	62	67.4	1
yes	33	26	78.8	1.17	0.93 - 1.47
Gestational age at the first prenatal visit (n=132) (weeks)						0.238
<14	75	51	68.0	1
≥14	57	44	77.2	1.14	0.92 - 1.40
Number of prenatal visits (n=134)						<0.001
≥6	101	66	65.3	1
<6	33	30	90.9	1.39	1.16 - 1.66
Antibody titers in the first positive VDRL						0.053
≤1:4	58	37	63.8	1
>1:4	83	66	79.5	1.25	1.00 - 1.56
Gestational age at diagnosis						0.009
before pregnancy or ≤13 weeks	83	53	63.9	1
14 - 27 weeks	29	25	86.2	1.35	1.09 - 1.68
≥28 weeks or during delivery/curettage	29	25	86.2	1.35	1.09 - 1.68

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[1] Corresponding author: Dra. Ana Marli Christovam Sartori. e-mail:ana.sartori@hc.fm.usp.br