Prevalência, diagnóstico laboratorial e características clínicas da sífilis na gestação e sífilis congênita em maternidades de Salvador, Bahia

Abstract

INTRODUCTION: Syphilis has shown an increase in the number of cases in Brazil, despite laboratory diagnosis and treatment being available. Congenital syphilis (CS) raises great concern due to the risk of spontaneous abortions, stillbirths, and the risk of sequelae in newborn’s growth and development. The city of Salvador, Brazil, has shown an increase in the number of cases in recent years. OBJECTIVE: to carry out epidemiological monitoring of cases of congenital syphilis in two maternity hospitals in Salvador and to apply a molecular test in the laboratory diagnosis of syphilis in CSF samples from newborns suspected of having CS. MATERIAL AND METHODS: The study consisted of two stages, carried out in two maternity hospitals in Salvador, Brazil. At the José Maria de Magalhães Netto Maternity Hospital (MRPJMMN), a retrospective study was conducted, which evaluated CS case notification forms between 2016 and 2019, analyzing the absolute and relative frequency of cases per year and describing sociodemographic data, laboratory and clinical examinations of mothers and newborns. At the Maria da Conceição de Jesus Maternity Hospital (MMCJ), a cross-sectional study was carried out between 2022 and 2023 that included parturients who presented positive serology for syphilis and their newborns. Biological samples of cerebrospinal fluid (CSF) of newborns suspected of having CS were collected to perform an amplification test for the T. pallidum polA gene. RESULTS: in the study of the MRPJMMN maternity hospital, high frequencies of CS cases were described in the four years evaluated, totaling 879 reported cases of CS. Among newborns, 249 (28.3%) presented symptoms, with jaundice being the most prevalent (235; 26.9%). The majority of newborns received treatment and discharge, and three cases (0.3%) resulted in CS-associated deaths. In the MMCJ maternity study, 259 mothers and newborns were included. Among these, 55 newborns had a CSF sample evaluated by non-treponemal testing and molecular testing. Although 41 of these newborns (74.5%) were positive in non-treponemal blood tests, all had negative results in tests performed on CSF. Comparing a group of 66 mothers not adequately treated for syphilis during pregnancy and their children (G1), with 133 adequately treated (G2), it was observed that the children of adequately treated mothers had a higher median birth weight than the untreated group (2955g in G1, 3120g in G2, p=0.0443), greater median length (47.5cm in G1, 48cm in G2, p=0.0712), shorter hospitalization period (medians: 11 days in G1, 3 days in G2, p=0.0007) and lower death outcome (13.6% of cases in G1, 2.9% in G2, p=0.0111). CONCLUSION: The results point to the importance of surveillance of CS cases in Salvador and the need for complete prenatal treatment, warning of the need for concentrated efforts to detect cases and raise awareness among the population at risk.