A magnitude da sífilis em parturientes: da subnotificação à transmissão vertical

Abstract

The World Health Organization reported 1.9 million infected pregnant women worldwide, with 66.5% of unfavorable fetal outcomes occurring in cases of untreated syphilis. Congenital syphilis contributes significantly to infant mortality, accounting for 305,000 perinatal deaths annually. In the last ten years, the child mortality rate for syphilis has increased by 150% in Brazil. In 2015, Rio de Janeiro and Mato Grosso do Sul were the most affected states of the country and reached a syphilis rate in pregnant women of 2.2%.The objective of this study was to estimate the prevalence of syphilis in parturients in two hospitals in the metropolitan region of Rio de Janeiro, to evaluate the notification, to describe the profile of these parturients, the assistance received and the vertical transmission. Cross-sectional study with data collected in laboratories, medical records and questionnaires of the parturients in Núcleo Perinatal do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE/UERJ) and in Hospital Estadual da Mãe de Mesquita (HEM) between 2012 and 2014. Inclusion criteria used was VDRL and positive treponemal test at hospital internment. The associations between the variables and the outcomes were evaluated through the test χ2 and Student's t-test. The prevalence of syphilis in HUPE was 4,1% in 2012, 3,0% in 2013 and 5,0% in 2014 and in the HEM 6,8% in 2013 and 5,0% in 2014. The notification coverage of the HUPE was 15,6% in 2012, 25,0% in 2013 and 48,1% in 2014 and in HEM 2,6% in 2013 and 6,5% in 2014. In HUPE the mean age of the infected parturients was 26 years old, were mostly non-white (81%), single (82.1%) and with low education level (57.7%). In terms of assistance, 92.4% attended prenatal care, 87.3% were tested for syphilis in the pregnant, 72.2% treated the disease, 19.0% had their partners treated, and 51.1% received counseling on condom The incidence of congenital syphilis (CS) was 22,0 / 1.000 live births (LB) in 2012, 17,0/1.000 LB in 2013 and 44,8 / 1.000 LB in 2014. The underreporting of CS in the period was 7.7%. Vertical transmission occurred in 65.8% with 32.9% of unfavorable fetal outcomes and 5.0% perinatal death. It was found that in 34.6% of CS cases the maternal VDRL titers were ≤1 / 4. The chance of adverse fetal outcomes was greater when these titers were ≥1 / 8. The estimated prevalence in the two hospitals in the state, is higher than the prevalences described in the state and in the country and reveal the severity, the upward trend of the disease and the fragility of the notification systems and the health services in the management of these parturients. They serve as a warning about the real epidemiological situation of the disease in the state.