The recrudescence of congenital syphilis: a warning

Congenital syphilis is caused by Treponema pallidum transmission from an infected pregnant woman to the fetus. Most newborns with congenital syphilis are infected in the womb during pregnancy, but contamination may also occur through contact with active genital lesions at delivery(¹).

According to the World Health Organization (WHO) in 2013, 1.9 million pregnant women were infected with syphilis worldwide. Although the eradication of congenital syphilis is a global priority (WHO), regional (Pan American Health Organization / PAHO) and national (Ministry of Health) in the last ten years there was a progressive increase in the incidence rate of congenital syphilis in Brazil(²,³).

The epidemiological bulletin of the Brazilian Ministry of Health on syphilis launched in 2015 brings alarming data. One of the most worrying news realizes that in 2004 the infection rate was 1.7 cases per 1,000 live births. In 2013 the rate increased to 4.7, an increase of over 100% in less than 10 years. Just to compare, in 2011 in Canada, the same rate was 0.8 infected children per 1,000 live births that is six times lower than in Brazil. Accompanying these indices the infant mortality rate for syphilis also increased over the past 10 years from 2.2 deaths per 100,000 live births in 2004 to 5.5 in 2013 in Brazil(³,⁴).

Apart from these data, there is evidence to suggest that hearing loss is the most common congenital sensory disability worldwide. This way we get an overview of the problem in our country. According to WHO, there are worldwide 360 million people with debilitating deafness and 50% of the cases could have been prevented, such as occurs with syphilis(⁵).

A variety of clinical presentations related to hearing impairment, vestibular and neurological as well as the clinical polymorphism and potential sequel resulting from congenital syphilis warrant attention in the face of epidemiological data recently presented by the Brazilian Ministry of Health.

Unilateral or bilateral progressive hearing loss with no defined etiology as well as central and peripheral vestibular disorders may be related to congenital syphilis. We should also point out that in addition to syphilis other diseases like toxoplasmosis, cytomegaloviruses, herpes infection, AIDS and gestational rubella are differential diagnoses to be remembered(⁶).

Therefore the union of efforts among the different levels of public administration is essential in order to promote improved care process and education initiatives to professionals who conduct prenatal, neonatal hearing screening and clinical follow-up of these children. Only these initiatives could mitigate the damage and consolidate more efficiently prevention and treatment of this disease.

REFERÊNCIAS

• ¹
  Kwak J, Lamprecht C. A review of the guidelines for the evaluation and treatment of congenital syphilis. Pediatr Ann. 2015;44(5):e108-14. http://dx.doi.org/10.3928/00904481-20150512-10
  » http://dx.doi.org/10.3928/00904481-20150512-10
• ²
  Pan American Health Organization. 2014 update: elimination of mother-to-child transmission of HIV and syphilis in the Americas. Washington, DC: Unit of HIV, Hepatitis, Tuberculosis, and Sexually Transmitted Diseases; 2014 [citado em 11 nov 2015]. Disponível em: http://www.unicef.org/lac/Elimination_MTCT_in_the_Americas_2014_ENG.pdf
  » http://www.unicef.org/lac/Elimination_MTCT_in_the_Americas_2014_ENG.pdf
• ³
  Sífilis 2015. Bol Epidemiol. 2015 [citado em 9 nov 2015];4(1). Disponível em: http://www.aids.gov.br/sites/default/files/anexos/publicacao/2015/57978/_p_boletim_sifilis_2015_fechado_pdf_p__18327.pdf
  » http://www.aids.gov.br/sites/default/files/anexos/publicacao/2015/57978/_p_boletim_sifilis_2015_fechado_pdf_p__18327.pdf
• ⁴
  Infectious Diseases and Immunization Committee. Congenital syphilis: no longer just of historical interest. Paediatr Child Health. 2009;14(5):337.
• ⁵
  World Health Organization. Deafness and hearing loss. Geneva: World Health Organization; 2015 [citado em 9 nov 2015]. Disponível em: http://www.who.int/mediacentre/factsheets/fs300/en/
  » http://www.who.int/mediacentre/factsheets/fs300/en/
• ⁶
  Rashid U, Yaqoob U, Bibi N, Bari A. Symptomatic early congenital syphilis: a common but forgotten disease. J Coll Physicians Surg Pak. 2015;25(Suppl 2):S137-9. http://dx.doi.org/10.2015/JCPSP.S137S139.
  » http://dx.doi.org/10.2015/JCPSP.S137S139

Publication Dates

• Publication in this collection
  Oct-Dec 2015