Detection of gestational and congenital syphilis in Paraná state, Brazil, 2007-2021: a time series analysis

Oliveira, Giovana Gomes de; Palmieri, Isadora Gabriella Silva; Lima, Lucas Vinícius de; Pavinati, Gabriel; Santos, Vitória Maytana Alves dos; Luz, Kelly Cristina Suzue Iamaguchi; Magnabosco, Gabriela Tavares

doi:10.1590/s2237-96222024v33e2024188.en

Abstract

Objective:

To describe temporal trends in the detection rates of gestational and congenital syphilis, by maternal age and health macro-region of the state of Paraná, Brazil, 2007-2021.

Methods:

This was a time-series study using surveillance data; the trend analysis was performed by means of joinpoint regression, and average annual percent change (AAPC) and 95% confidence intervals (95%CI) were estimated.

Results:

An increase in statewide detection of gestational syphilis (AAPC = 21.7; 95%CI 17.7; 32.8) and congenital syphilis (AAPC = 14.8; 95%CI 13.0; 19.7) was found; an increase was also found in the health macro-regions, with the Northwest (gestational, AAPC = 26.1; 95%CI 23.4; 31.6) and North (congenital, AAPC = 23.8; 95%CI 18.8; 48.9) macro-regions standing out; statewide rising trends were observed for young women [gestational, AAPC = 26.2 (95%CI 22.4; 40.6); congenital, AAPC = 19.4 (95%CI 17.6; 21.8)] and adult women [gestational, AAPC = 21.3 (95%CI 16.9; 31.9); congenital, AAPC = 13.7 (95%CI 11.9; 19.3)].

Conclusion:

Maternal and child syphilis detection rates increased in the state, regardless of maternal age and health macro-region.

Keywords:
Syphilis; Pregnancy; Mother-to-Child Transmission of Infectious Diseases; Syphilis, Congenital; Time Series Studies; Public Health Surveillance

Study contributions

Main results

Increasing trends were found for the detection rates of gestational and congenital syphilis in Paraná state and its health macro-regions, including in the analysis stratified by maternal age group; however, there was a decline during the COVID-19 period.

Implications for services

There is a need for strategic and immediate action by the state health services, focusing on expanding access and linkage to care, in order to ensure maternal and child well-being and reverse the rising trends observed.

Perspectives

Prevention and control actions towards the elimination of syphilis are needed to overcome these obstacles, directing efforts towards strengthening health education, early detection and appropriate treatment for pregnant women and their partners.

Keywords:
Syphilis; Pregnancy; Mother-to-Child Transmission of Infectious Diseases; Syphilis, Congenital; Time Series Studies; Public Health Surveillance

Resumen

Objetivo:

Describir las tendencias temporales en las tasas de detección de sífilis gestacional y congénita, por grupo de edad materna y macrorregión de salud de Paraná, 2007-2021.

Métodos:

Estudio de series temporales utilizando datos de vigilancia; se realizó análisis de tendencia mediante regresión segmentada, estimando cambios porcentuales anuales promedio (CPAP) e intervalos de confianza del 95% (IC_95%).

Resultados:

Se identificaron aumentos en la detección estatal de sífilis gestacional (CPAP = 21,7; IC_95% 17,7;32,8) y congénita (CPAP = 14,8; IC_95% 13,0;19,7); las macrorregiones mostraron incrementos, destacándose la Noroeste (gestacional, CPAP = 26,1; IC_95% 23,4;31,6) y la Norte (congénita, CPAP = 23,8; IC_95% 18,8;48,9); las tendencias estatales fueron crecientes para mujeres jóvenes [gestacional, CPAP = 26,2 (IC_95% 22,4;40,6); congénita, CPAP = 19,4 (IC_95% 17,6;21,8)] y adultas [gestacional, CPAP = 21,3 (IC_95% 16,9;31,9); congénita, CPAP = 13,7 (IC_95% 11,9;19,3)].

Conclusión:

Las tasas de detección de sífilis materno-infantil estuvieron en aumento en el estado, independientemente de la edad materna y la macrorregión de salud.

Palabras-clave:
Sífilis; Embarazo; Transmisión Vertical de Enfermedad Infecciosa; Sífilis Congénita; Estudios de Series Temporales; Vigilancia en Salud Pública

INTRODUCTION

Syphilis, a sexually transmitted infection, remains a challenge for public health policies in Brazil due to its gestational and congenital forms, which account for a significant portion of infection cases recorded nationally.¹1. Freitas FLS, Benzaken AS, Passos MRL, Coelho ICB, Miranda AE. Protocolo brasileiro para infecções sexualmente transmissíveis 2020: sífilis adquirida. Epidemiol Serv Saude. 2021;30(spe1):e2020616. doi: 10.1590/S1679-4974202100004.esp1.
https://doi.org/10.1590/S1679-4974202100... ^),(²2. Uku A, Albujasim Z, Dwivedi T, Ladipo Z, Konje JC. Syphilis in pregnancy: the impact of “the great imitator”. Eur J Obstet Gynecol Reprod Biol. 2021;259:207-10. doi: 10.1016/j.ejogrb.2021.01.010.
https://doi.org/10.1016/j.ejogrb.2021.01... For example, the Ministry of Health reported 74,095 cases of syphilis among pregnant women and 27,019 among children in 2021 nationwide; in the state of Paraná, especially, 3,223 cases of the infection among pregnant women and 868 among children, were recorded, in the same period.³3. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Boletim epidemiológico de sífilis - número especial - out. 2022 [Internet]. Brasília: Ministério da Saúde; 2022 [citado 2024 Jan 26]. 55 p. Disponível em: Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de-sifilis-numero-especial-out-2022/view .
https://www.gov.br/saude/pt-br/centrais-...

Programmatic factors such as late initiation of prenatal care, fewer than six prenatal visits and screening failure during pregnancy, are associated with the incidence of these types of infection.⁴4. Uchôa TLA, Araújo EC, Silva RAR, Valois R, Azevedo Junior WS, Nascimento VGC, et al. Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon. Front Public Health. 2022;10:930150. doi: 10.3389/fpubh.2022.930150.
https://doi.org/10.3389/fpubh.2022.93015... ^)-(⁶6. Guerra JVV, Paula HC, Silva SAP, Torres FSR, Alves VH, Pereira AV. Fatores de risco para sífilis em mulheres: revisão integrativa. Rev APS. 2021;24(3);628-50. doi: 10.34019/1809-8363.2021.v24.16882.
https://doi.org/10.34019/1809-8363.2021.... In addition, maternal sociodemographic and behavioral characteristics, such as inconsistent condom use, low monthly income, history of sexually transmitted infection substance use, and aged 35 years and older, are described as predictors of gestational and congenital syphilis.⁴4. Uchôa TLA, Araújo EC, Silva RAR, Valois R, Azevedo Junior WS, Nascimento VGC, et al. Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon. Front Public Health. 2022;10:930150. doi: 10.3389/fpubh.2022.930150.
https://doi.org/10.3389/fpubh.2022.93015... ^),(⁵5. Kachikis A, Schiff MA, Moore K, Chapple-McGruder T, Arluck J, Hitti J. Risk factors associated with congenital syphilis, Georgia, 2008-2015. Infect Dis Obstet Gynecol. 2023;2023:3958406. doi: 10.1155/2023/3958406.
https://doi.org/10.1155/2023/3958406... ^),(⁷7. Thornton C, Chaisson LH, Bleasdale SC. Characteristics of pregnant women with syphilis and factors associated with congenital syphilis at a Chicago hospital. Open Forum Infect Dis. 2022;9(5):ofac169. doi: 10.1093/ofid/ofac169.
https://doi.org/10.1093/ofid/ofac169... ^),(⁸8. Carvalho SS, Oliveira BR, Sá EA. Estratégias e ações no pré-natal para sífilis congênita: revisão de literatura. RBPS. 2020;22(2):150-6. doi: 10.47456/rbps.v22i2.25258.
https://doi.org/10.47456/rbps.v22i2.2525...

In Paraná, the main challenges for the control of maternal and child syphilis are related to women aged 20 to 39 years and with low level of education, whose sexual partners are not treated⁹9. Souza MLA, Lima LV, Pavinati G, Uema RTB, Nogueira IS, Magnabosco GT. Caracterização e geoespacialização da sífilis gestacional e congênita no Paraná, Brasil, 2012-2020. Rev Baiana Saude Publica. 2023;47(2):53-68. doi: 10.22278/2318-2660.2023.v47.n2.a3808.
https://doi.org/10.22278/2318-2660.2023.... - possibly due to weaknesses in prenatal care.¹⁰10. Fernades LPMR, Souza CL, Oliveira MV. Missed opportunities in treating pregnant women’s sexual partners with syphilis: a systematic review. Rev Bras Saude Matern Infant. 2021;21(2):361-8. doi: 10.1590/1806-93042021000200002.
https://doi.org/10.1590/1806-93042021000... In 2023, the state received the “bronze seal” of practices towards the elimination of mother-to-child transmission of syphilis,¹¹11. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Guia para certificação da eliminação da transmissão vertical de HIV e/ou sífilis [Internet]. Brasília: Ministério da Saúde; 2023 [citado 2024 Jan 26]. 36 p. Disponível em: Disponível em: https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2023/guia-certificacao-da-eliminacao-da-tv-_-eletronico-_-1a-ed-atualizada.pdf/view .
https://www.gov.br/aids/pt-br/central-de... primarily following the implementation of the Paraná’s Mother Network in 2012, aiming at the early detection and linkage of pregnant women to prenatal care.¹²12. Governo do Estado (PR). Secretaria de Estado da Saúde. Divisão de Atenção à Saúde da Mulher. Linha guia - atenção materno infantil: gestação [Internet]. 8. ed. Curitiba: Secretaria de Estado da Saúde; 2022 [citado 2024 Jan 26]. 81 p. (Linha de Cuidado Materno Infantil do Paraná; v. 1). Disponível em: Disponível em: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2022-03/linha_guia_mi-_gestacao_8a_ed_em_28.03.22.pdf .
https://www.saude.pr.gov.br/sites/defaul...

Taking into consideration that maternal characteristics, such as age, and contextual factors, such as place of residence and healthcare access, are relevant to epidemiology and can be considered in monitoring syphilis indicators - especially when targeting the elimination of mother-to-child transmission - this study aimed to describe temporal trends in the detection rates of gestational and congenital syphilis, by maternal age group and health macro-region of the state of Paraná, Brazil, between 2007 and 2021.

METHODS

Study design and ethical aspects

This time-series study involve the use of aggregated data organized over time, regarding the annual detection rates of gestational and congenital syphilis in the state of Paraná. Given that this study design included aggregate and anonymized data, the research project was exempted from the approval of a Research Ethics Committee, in accordance with the National Health Council, Resolutions No. 466 dated December 12, 2012, and No. 674, dated May 6, 2022.

Setting

Paraná is the most populous state in the Southern region of Brazil, with a population of 11,444,380 inhabitants and a high human development index of 0.769 in 2021.¹³13. Instituto Brasileiro de Geografia e Estatística. Cidades e estados: Paraná [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2021 [citado 2024 Jan 26]. Disponível em: Disponível em: https://www.ibge.gov.br/cidades-e-estados/pr.html .
https://www.ibge.gov.br/cidades-e-estado... In the context of implementing programs and actions and healthcare service provision, the state of Paraná is organized in a decentralized manner into four health macro-regions: East - subdivided into seven health regions -, West, Northwest and North - these with five regions each.¹⁴14. Governo do Estado (PR). Secretaria de Estado da Saúde. Regionais de saúde [Internet]. Curitiba: Secretaria de Estado da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://www.saude.pr.gov.br/Pagina/Regionais-de-Saude .
https://www.saude.pr.gov.br/Pagina/Regio...

Participants and data source

Gestational and congenital syphilis records for the period from 2007 to 2021 were analyzed, taking into consideration data availability in the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação - SINAN) as of October 20, 2023, accessed through the Brazilian National health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde - DATASUS);¹⁵15. Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde [Internet]. Brasília: Ministério da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://datasus.saude.gov.br/ .
https://datasus.saude.gov.br/... data on the population of live births were also used, obtained from the Live Birth Information System (Sistema de Informações sobre Nascidos Vivos - SINASC), also via DATASUS.¹⁵15. Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde [Internet]. Brasília: Ministério da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://datasus.saude.gov.br/ .
https://datasus.saude.gov.br/...

Variables and statistical methods

The annual detection rates of gestational and congenital syphilis were calculated according to recommendations and criteria defined by the Ministry of Health:³3. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Boletim epidemiológico de sífilis - número especial - out. 2022 [Internet]. Brasília: Ministério da Saúde; 2022 [citado 2024 Jan 26]. 55 p. Disponível em: Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de-sifilis-numero-especial-out-2022/view .
https://www.gov.br/saude/pt-br/centrais-... the total number of cases in pregnant women and children (numerator), according to the year of diagnosis, was divided by the total number of live births (denominator), in the same location and period; and the result was multiplied by 1,000. Rates were estimated by maternal age group [in years: ≤ 19 (young women); ≥ 20 (adult women)], given potential differences in trends between these groups; the denominator was related to maternal age recorded in SINASC.

Trend analysis was performed using segmented linear regression (joinpoint), with a maximum of two inflection points due to the number of years analyzed.¹⁶16. National Cancer Institute (USA). Surveillance Research Program. Statistical Methodology and Applications Branch. Joinpoint Regression Program - version 5.0.2 - May 2023 [Internet]. Bethesda: National Cancer Institute; c2023 [cited 2023 May 05]. Available from: Available from: https://surveillance.cancer.gov/help/joinpoint .
https://surveillance.cancer.gov/help/joi... Detection rates were considered as the dependent variable, and years of the series as the independent variable. The grid selection method was applied, transforming the dependent variable into the natural logarithm and adjusting the models to the standard errors of the rates and first-order autocorrelation, assessed according to the data.¹⁶16. National Cancer Institute (USA). Surveillance Research Program. Statistical Methodology and Applications Branch. Joinpoint Regression Program - version 5.0.2 - May 2023 [Internet]. Bethesda: National Cancer Institute; c2023 [cited 2023 May 05]. Available from: Available from: https://surveillance.cancer.gov/help/joinpoint .
https://surveillance.cancer.gov/help/joi...

In the analysis of the series, we calculated the annual percent change (APC), which provided the increasing (positive) or decreasing (negative) trends at each joinpoint, the average annual percent change (AAPC), which consisted of the geometric mean of the APC, and 95% confidence intervals (95%CI), which indicated the significance of the APC or AAPC when they were different from zero.¹⁶16. National Cancer Institute (USA). Surveillance Research Program. Statistical Methodology and Applications Branch. Joinpoint Regression Program - version 5.0.2 - May 2023 [Internet]. Bethesda: National Cancer Institute; c2023 [cited 2023 May 05]. Available from: Available from: https://surveillance.cancer.gov/help/joinpoint .
https://surveillance.cancer.gov/help/joi... The analyses were performed using the Joinpoint Regression Program^® (version 5.0.2).

RESULTS

Between 2007 and 2021, a total of 13,861 cases of gestational syphilis and 6,643 cases of congenital syphilis were reported in the state of Paraná, representing detection rates, during the period, of 6.0/1,000 live births and 2.9/1,000 live births, respectively. The East (6.6/1,000 live births) and West (6.9/1,000 live births) health macro-regions showed higher average detection rates of syphilis in pregnant women than the state as a whole (Figure 1A); for congenital syphilis, only the East health macro-region (3.4/1,000 live births) showed a higher average rate than Paraná (Figure 1B).

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Figure 1
Detection rates of (A) gestational syphilis and (B) congenital syphilis per 1,000 live births, according to health macro-regions, Paraná state, Brazil, 2007-2021

Increasing trends were found for the detection of gestational syphilis (AAPC = 21.7; 95%CI 17.7; 32.8) and congenital syphilis (AAPC = 14.8; 95%CI 13.0; 19.7) in Paraná state, between 2007 and 2021. The health macro-regions of the state, taken individually, also recorded an increase, with the Northwest standing out, showing an annual increase of 26.1% (95%CI 23.4; 31.6) in gestational syphilis and 24.1% (95%CI 18.2; 56.1) in congenital syphilis; and the North, with an annual increase of 24.2% (95%CI 19.3; 39.5) in gestational syphilis and 23.8% (95%CI 18.8; 48.9) in congenital syphilis (Table 1).

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Table 1
Temporal trend of the detection rates of gestational syphilis and congenital syphilis per 1,000 live births, according to health macro-regions, Paraná state, Brazil, 2007-2021

Among young women, during the same period, increasing trends were found in the detection of gestational syphilis (AAPC = 26.2; 95%CI 22.4; 40.6) and congenital syphilis (AAPC = 19.4; 95%CI 17.6; 21.8) in the state as a whole; Moreover, all health macro-regions recorded an increase in the detection of gestational and congenital syphilis in the age group up to 19 years. Among adult women aged 20 years and older, similarly increasing trends were observed for gestational syphilis (AAPC = 21.3; 95%CI 16.9; 31.9) and congenital (AAPC = 13.7; 95%CI 11.9; 19.3) in Paraná; also in this age group, the health macro-regions followed the statewide pattern (Table 2).

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Table 2
Temporal trend in the detection rates of gestational syphilis and congenital syphilis per 1,000 live births by maternal age group, according to health macro-regions, Paraná state, Brazil, 2007-2021

DISCUSSION

A pattern of increasing detection rates of gestational and congenital syphilis was observed in the state of Paraná in the period prior to 2019, regardless of the health macro-region and maternal age group. There was also a significant downward trend in almost all macro-regions evaluated during the years of the COVID-19 pandemic, possibly due to weaknesses related to detection and reporting in that emergency scenario.¹⁷17. Furlam TO, Pereira CCA, Frio GS, Machado CJ. Efeito colateral da pandemia de Covid-19 no Brasil sobre o número de procedimentos diagnósticos e de tratamento da sífilis. Rev Bras Estud Popul. 2022;39:e0184. doi: 10.20947/S0102-3098a0184.
https://doi.org/10.20947/S0102-3098a0184...

Present study has limitations inherent to secondary data, which are usually subject to underreporting, incompleteness, inconsistency and under-detection. This occurs mainly due to the possibility that any greater or lower detection or number of notifications, entrusted to health professionals, may lead to a significant or attenuated increase in rate trends. Strategies aimed at improving the quality and completeness of records may benefit future research and evidence-based decision-making.

Time series studies, using data from the SINAN, have highlighted increasing trends in maternal and child syphilis. In the state of Goiás, from 2007 to 2017, there was an increase in the occurrence among pregnant women (APC = 18.0; 95%CI 15.3; 20.8), as well as in congenital syphilis rates (APC = 16.8; 95%CI 20.1; 33.8).¹⁸18. Nunes PS, Guimarães RA, Rosado LEP, Marinho TA, Aquino EC, Turchi MD. Temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás, Brazil, 2007-2017: an ecological study. Epidemiol Serv Saude . 2021;30(1):e2019371. doi: 10.1590/S1679-49742021000100002.
https://doi.org/10.1590/S1679-4974202100... Similarly, in Minas Gerais, an increasing trend was observed for detecting cases during pregnancy (APC = 36.7; 95%CI 32.5; 41.0) and congenital syphilis cases (APC = 32.8; 95%CI 28.0; 37.8), between 2009 and 2019.¹⁹19. Amorim EKR, Matozinhos FP, Araújo LA, Silva TPR. Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study. Epidemiol Serv Saude . 2021;30(4):e2021128. doi: 10.1590/S1679-49742021000400006.
https://doi.org/10.1590/S1679-4974202100...

Several factors may account for the positive variations in syphilis in pregnant women, including: improvement in surveillance systems and services, contributing to case notification and registration;²⁰20. Soares MAS, Aquino R. Completeness and characterization of gestational syphilis and congenital syphilis records in Bahia, Brazil, 2007-2017. Epidemiol Serv Saude . 2021;30(4):e20201148. doi: 10.1590/S1679-49742021000400018.
https://doi.org/10.1590/S1679-4974202100... ^)-(²²22. Dantas JC, Marinho CSR, Pinheiro YT, Silva RAR. Temporal trend of gestational syphilis between 2008 and 2018 in Brazil: association with socioeconomic and health care factors. Int J Environ Res Public Health. 2022;19(24):16456. doi: 10.3390/ijerph192416456.
https://doi.org/10.3390/ijerph192416456... expanding the supply for rapid tests, enhancing access to diagnosis;²²22. Dantas JC, Marinho CSR, Pinheiro YT, Silva RAR. Temporal trend of gestational syphilis between 2008 and 2018 in Brazil: association with socioeconomic and health care factors. Int J Environ Res Public Health. 2022;19(24):16456. doi: 10.3390/ijerph192416456.
https://doi.org/10.3390/ijerph192416456... strengthening prenatal care actions in the state through the implementation of the Paraná’s Mother Network;¹²12. Governo do Estado (PR). Secretaria de Estado da Saúde. Divisão de Atenção à Saúde da Mulher. Linha guia - atenção materno infantil: gestação [Internet]. 8. ed. Curitiba: Secretaria de Estado da Saúde; 2022 [citado 2024 Jan 26]. 81 p. (Linha de Cuidado Materno Infantil do Paraná; v. 1). Disponível em: Disponível em: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2022-03/linha_guia_mi-_gestacao_8a_ed_em_28.03.22.pdf .
https://www.saude.pr.gov.br/sites/defaul... and increased socioeconomic inequalities, making women who experience worse conditions more susceptible.²⁰20. Soares MAS, Aquino R. Completeness and characterization of gestational syphilis and congenital syphilis records in Bahia, Brazil, 2007-2017. Epidemiol Serv Saude . 2021;30(4):e20201148. doi: 10.1590/S1679-49742021000400018.
https://doi.org/10.1590/S1679-4974202100... ^)-(²²22. Dantas JC, Marinho CSR, Pinheiro YT, Silva RAR. Temporal trend of gestational syphilis between 2008 and 2018 in Brazil: association with socioeconomic and health care factors. Int J Environ Res Public Health. 2022;19(24):16456. doi: 10.3390/ijerph192416456.
https://doi.org/10.3390/ijerph192416456...

Without disregarding the improvement of public policies for maternal and child care in Paraná,²³23. Santos DR, Viera CS, Guimarães ATB, Toso BRGO, Ferrari RAP. Avaliação da eficácia do Programa Rede Mãe Paranaense. Saude Debate. 2020;44(124):70-85. doi: 10.1590/0103-1104202012405.
https://doi.org/10.1590/0103-11042020124... aimed at the elimination of mother-to-child transmission - and recognized with the achievement of the “bronze seal” - the findings of this study raise an alert to the increasing incidence of congenital syphilis. This situation may be due to, among other factors, screening failures during prenatal visits,²⁴24. Vescovi JS, Schuelter-Trevisol F. Increase of incidence of congenital syphilis in Santa Catarina state between 2007-2017: temporal trend analysis. Rev Paul Pediatr. 2020;38:e2018390. doi: 10.1590/1984-0462/2020/38/2018390.
https://doi.org/10.1590/1984-0462/2020/3... ^)-(²⁶26. Kimball A, Torrone E, Miele K, Bachmann L, Thorpe P, Weinstock H, et al. Missed opportunities for prevention of congenital syphilis - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(22):661-5. doi: 10.15585/mmwr.mm6922a1.
https://doi.org/10.15585/mmwr.mm6922a1... delayed diagnosis of maternal infection²⁴24. Vescovi JS, Schuelter-Trevisol F. Increase of incidence of congenital syphilis in Santa Catarina state between 2007-2017: temporal trend analysis. Rev Paul Pediatr. 2020;38:e2018390. doi: 10.1590/1984-0462/2020/38/2018390.
https://doi.org/10.1590/1984-0462/2020/3... ^)-(²⁶26. Kimball A, Torrone E, Miele K, Bachmann L, Thorpe P, Weinstock H, et al. Missed opportunities for prevention of congenital syphilis - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(22):661-5. doi: 10.15585/mmwr.mm6922a1.
https://doi.org/10.15585/mmwr.mm6922a1... and inadequate treatment management, either in the pregnant woman or her partner.²⁴24. Vescovi JS, Schuelter-Trevisol F. Increase of incidence of congenital syphilis in Santa Catarina state between 2007-2017: temporal trend analysis. Rev Paul Pediatr. 2020;38:e2018390. doi: 10.1590/1984-0462/2020/38/2018390.
https://doi.org/10.1590/1984-0462/2020/3... ^)-(²⁶26. Kimball A, Torrone E, Miele K, Bachmann L, Thorpe P, Weinstock H, et al. Missed opportunities for prevention of congenital syphilis - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(22):661-5. doi: 10.15585/mmwr.mm6922a1.
https://doi.org/10.15585/mmwr.mm6922a1...

The predominance of gestational and congenital syphilis in the East and West health macro-regions of Paraná has already been reported.⁹9. Souza MLA, Lima LV, Pavinati G, Uema RTB, Nogueira IS, Magnabosco GT. Caracterização e geoespacialização da sífilis gestacional e congênita no Paraná, Brasil, 2012-2020. Rev Baiana Saude Publica. 2023;47(2):53-68. doi: 10.22278/2318-2660.2023.v47.n2.a3808.
https://doi.org/10.22278/2318-2660.2023.... ^),(²⁷27. Cortez MP, Scholze AR, Oliveira RR, Moreira RC, Araújo KHP, Melo EC. Spatio-temporal evolution of gestational and congenital syphilis in the state of Paraná. Cienc Cuid Saude. 2023;22:1-10. doi: 10.4025/cienccuidsaude.v22i0.66013.
https://doi.org/10.4025/cienccuidsaude.v... East macro-region encompasses Curitiba, the capital of the state of Paraná, and its metropolitan region, which is more densely populated, while West macro-region is the border region between the state of Paraná, Brazil, Argentina and Paraguay. This factor should be taken into account when interpreting the calculated rates, since lower socioeconomic status has been associated with a higher likelihood of getting syphilis in the state.²⁷27. Cortez MP, Scholze AR, Oliveira RR, Moreira RC, Araújo KHP, Melo EC. Spatio-temporal evolution of gestational and congenital syphilis in the state of Paraná. Cienc Cuid Saude. 2023;22:1-10. doi: 10.4025/cienccuidsaude.v22i0.66013.
https://doi.org/10.4025/cienccuidsaude.v...

It can be concluded that the state of Paraná showed an increase in the detection rates of gestational and congenital syphilis, regardless of maternal age. This increase was more significant in the Northwest and North health macro-regions of the state. However, there was a decline during the COVID-19 pandemic. These findings highlight the need for strengthening health education actions,²⁸28. Rigo FL, Romanelli RMC, Oliveira IP, Anchieta LM. Assistance and educational factors associated to congenital syphilis in a referral maternity: a case-control study. Rev Bras Saude Mater Infant. 2021;21(1):127-37. doi: 10.1590/1806-93042021000100007.
https://doi.org/10.1590/1806-93042021000... expanding testing and treatment for pregnant women and their partners,²⁹29. Figueiredo DCMM, Figueiredo AM, Souza TKB, Tavares G, Vianna RPT. Relação entre oferta de diagnóstico e tratamento da sífilis na atenção básica sobre a incidência de sífilis gestacional e congênita. Cad Saude Publica. 2020;36(3):e00074519. doi: 10.1590/0102-311X00074519.
https://doi.org/10.1590/0102-311X0007451... and improving access to and close relationship to effective maternal and child care.³⁰30. McDonald R, O’Callaghan K, Torrone E, Barbee L, Grey J, Jackson D, et al. Vital signs: missed opportunities for preventing congenital syphilis - United States, 2022. MMWR Morb Mortal Wkly Rep . 2023;72(46):1269-74. doi: 10.15585/mmwr.mm7246e1.
https://doi.org/10.15585/mmwr.mm7246e1...

REFERENCES

¹
Freitas FLS, Benzaken AS, Passos MRL, Coelho ICB, Miranda AE. Protocolo brasileiro para infecções sexualmente transmissíveis 2020: sífilis adquirida. Epidemiol Serv Saude. 2021;30(spe1):e2020616. doi: 10.1590/S1679-4974202100004.esp1.
» https://doi.org/10.1590/S1679-4974202100004.esp1
²
Uku A, Albujasim Z, Dwivedi T, Ladipo Z, Konje JC. Syphilis in pregnancy: the impact of “the great imitator”. Eur J Obstet Gynecol Reprod Biol. 2021;259:207-10. doi: 10.1016/j.ejogrb.2021.01.010.
» https://doi.org/10.1016/j.ejogrb.2021.01.010
³
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Boletim epidemiológico de sífilis - número especial - out. 2022 [Internet]. Brasília: Ministério da Saúde; 2022 [citado 2024 Jan 26]. 55 p. Disponível em: Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de-sifilis-numero-especial-out-2022/view
» https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de-sifilis-numero-especial-out-2022/view
⁴
Uchôa TLA, Araújo EC, Silva RAR, Valois R, Azevedo Junior WS, Nascimento VGC, et al. Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon. Front Public Health. 2022;10:930150. doi: 10.3389/fpubh.2022.930150.
» https://doi.org/10.3389/fpubh.2022.930150
⁵
Kachikis A, Schiff MA, Moore K, Chapple-McGruder T, Arluck J, Hitti J. Risk factors associated with congenital syphilis, Georgia, 2008-2015. Infect Dis Obstet Gynecol. 2023;2023:3958406. doi: 10.1155/2023/3958406.
» https://doi.org/10.1155/2023/3958406
⁶
Guerra JVV, Paula HC, Silva SAP, Torres FSR, Alves VH, Pereira AV. Fatores de risco para sífilis em mulheres: revisão integrativa. Rev APS. 2021;24(3);628-50. doi: 10.34019/1809-8363.2021.v24.16882.
» https://doi.org/10.34019/1809-8363.2021.v24.16882
⁷
Thornton C, Chaisson LH, Bleasdale SC. Characteristics of pregnant women with syphilis and factors associated with congenital syphilis at a Chicago hospital. Open Forum Infect Dis. 2022;9(5):ofac169. doi: 10.1093/ofid/ofac169.
» https://doi.org/10.1093/ofid/ofac169
⁸
Carvalho SS, Oliveira BR, Sá EA. Estratégias e ações no pré-natal para sífilis congênita: revisão de literatura. RBPS. 2020;22(2):150-6. doi: 10.47456/rbps.v22i2.25258.
» https://doi.org/10.47456/rbps.v22i2.25258
⁹
Souza MLA, Lima LV, Pavinati G, Uema RTB, Nogueira IS, Magnabosco GT. Caracterização e geoespacialização da sífilis gestacional e congênita no Paraná, Brasil, 2012-2020. Rev Baiana Saude Publica. 2023;47(2):53-68. doi: 10.22278/2318-2660.2023.v47.n2.a3808.
» https://doi.org/10.22278/2318-2660.2023.v47.n2.a3808
¹⁰
Fernades LPMR, Souza CL, Oliveira MV. Missed opportunities in treating pregnant women’s sexual partners with syphilis: a systematic review. Rev Bras Saude Matern Infant. 2021;21(2):361-8. doi: 10.1590/1806-93042021000200002.
» https://doi.org/10.1590/1806-93042021000200002
¹¹
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Guia para certificação da eliminação da transmissão vertical de HIV e/ou sífilis [Internet]. Brasília: Ministério da Saúde; 2023 [citado 2024 Jan 26]. 36 p. Disponível em: Disponível em: https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2023/guia-certificacao-da-eliminacao-da-tv-_-eletronico-_-1a-ed-atualizada.pdf/view
» https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2023/guia-certificacao-da-eliminacao-da-tv-_-eletronico-_-1a-ed-atualizada.pdf/view
¹²
Governo do Estado (PR). Secretaria de Estado da Saúde. Divisão de Atenção à Saúde da Mulher. Linha guia - atenção materno infantil: gestação [Internet]. 8. ed. Curitiba: Secretaria de Estado da Saúde; 2022 [citado 2024 Jan 26]. 81 p. (Linha de Cuidado Materno Infantil do Paraná; v. 1). Disponível em: Disponível em: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2022-03/linha_guia_mi-_gestacao_8a_ed_em_28.03.22.pdf
» https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2022-03/linha_guia_mi-_gestacao_8a_ed_em_28.03.22.pdf
¹³
Instituto Brasileiro de Geografia e Estatística. Cidades e estados: Paraná [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2021 [citado 2024 Jan 26]. Disponível em: Disponível em: https://www.ibge.gov.br/cidades-e-estados/pr.html
» https://www.ibge.gov.br/cidades-e-estados/pr.html
¹⁴
Governo do Estado (PR). Secretaria de Estado da Saúde. Regionais de saúde [Internet]. Curitiba: Secretaria de Estado da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://www.saude.pr.gov.br/Pagina/Regionais-de-Saude
» https://www.saude.pr.gov.br/Pagina/Regionais-de-Saude
¹⁵
Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde [Internet]. Brasília: Ministério da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://datasus.saude.gov.br/
» https://datasus.saude.gov.br/
¹⁶
National Cancer Institute (USA). Surveillance Research Program. Statistical Methodology and Applications Branch. Joinpoint Regression Program - version 5.0.2 - May 2023 [Internet]. Bethesda: National Cancer Institute; c2023 [cited 2023 May 05]. Available from: Available from: https://surveillance.cancer.gov/help/joinpoint
» https://surveillance.cancer.gov/help/joinpoint
¹⁷
Furlam TO, Pereira CCA, Frio GS, Machado CJ. Efeito colateral da pandemia de Covid-19 no Brasil sobre o número de procedimentos diagnósticos e de tratamento da sífilis. Rev Bras Estud Popul. 2022;39:e0184. doi: 10.20947/S0102-3098a0184.
» https://doi.org/10.20947/S0102-3098a0184
¹⁸
Nunes PS, Guimarães RA, Rosado LEP, Marinho TA, Aquino EC, Turchi MD. Temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás, Brazil, 2007-2017: an ecological study. Epidemiol Serv Saude . 2021;30(1):e2019371. doi: 10.1590/S1679-49742021000100002.
» https://doi.org/10.1590/S1679-49742021000100002
¹⁹
Amorim EKR, Matozinhos FP, Araújo LA, Silva TPR. Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study. Epidemiol Serv Saude . 2021;30(4):e2021128. doi: 10.1590/S1679-49742021000400006.
» https://doi.org/10.1590/S1679-49742021000400006
²⁰
Soares MAS, Aquino R. Completeness and characterization of gestational syphilis and congenital syphilis records in Bahia, Brazil, 2007-2017. Epidemiol Serv Saude . 2021;30(4):e20201148. doi: 10.1590/S1679-49742021000400018.
» https://doi.org/10.1590/S1679-49742021000400018
²¹
Heringer ALDS, Kawa H, Fonseca SC, Brignol SMS, Zarpellon LA, Reis AC. Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016. Rev Panam Salud Publica. 2020;44:e3. doi: 10.26633/RPSP.2020.8.
» https://doi.org/10.26633/RPSP.2020.8
²²
Dantas JC, Marinho CSR, Pinheiro YT, Silva RAR. Temporal trend of gestational syphilis between 2008 and 2018 in Brazil: association with socioeconomic and health care factors. Int J Environ Res Public Health. 2022;19(24):16456. doi: 10.3390/ijerph192416456.
» https://doi.org/10.3390/ijerph192416456
²³
Santos DR, Viera CS, Guimarães ATB, Toso BRGO, Ferrari RAP. Avaliação da eficácia do Programa Rede Mãe Paranaense. Saude Debate. 2020;44(124):70-85. doi: 10.1590/0103-1104202012405.
» https://doi.org/10.1590/0103-1104202012405
²⁴
Vescovi JS, Schuelter-Trevisol F. Increase of incidence of congenital syphilis in Santa Catarina state between 2007-2017: temporal trend analysis. Rev Paul Pediatr. 2020;38:e2018390. doi: 10.1590/1984-0462/2020/38/2018390.
» https://doi.org/10.1590/1984-0462/2020/38/2018390
²⁵
Dantas JC, Marinho CSR, Pinheiro YT, Ferreira MÂF, Silva RAR. Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: an ecological study. Front Pediatr. 2023;11:1109271. doi: 10.3389/fped.2023.1109271.
» https://doi.org/10.3389/fped.2023.1109271
²⁶
Kimball A, Torrone E, Miele K, Bachmann L, Thorpe P, Weinstock H, et al. Missed opportunities for prevention of congenital syphilis - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(22):661-5. doi: 10.15585/mmwr.mm6922a1.
» https://doi.org/10.15585/mmwr.mm6922a1
²⁷
Cortez MP, Scholze AR, Oliveira RR, Moreira RC, Araújo KHP, Melo EC. Spatio-temporal evolution of gestational and congenital syphilis in the state of Paraná. Cienc Cuid Saude. 2023;22:1-10. doi: 10.4025/cienccuidsaude.v22i0.66013.
» https://doi.org/10.4025/cienccuidsaude.v22i0.66013
²⁸
Rigo FL, Romanelli RMC, Oliveira IP, Anchieta LM. Assistance and educational factors associated to congenital syphilis in a referral maternity: a case-control study. Rev Bras Saude Mater Infant. 2021;21(1):127-37. doi: 10.1590/1806-93042021000100007.
» https://doi.org/10.1590/1806-93042021000100007
²⁹
Figueiredo DCMM, Figueiredo AM, Souza TKB, Tavares G, Vianna RPT. Relação entre oferta de diagnóstico e tratamento da sífilis na atenção básica sobre a incidência de sífilis gestacional e congênita. Cad Saude Publica. 2020;36(3):e00074519. doi: 10.1590/0102-311X00074519.
» https://doi.org/10.1590/0102-311X00074519
³⁰
McDonald R, O’Callaghan K, Torrone E, Barbee L, Grey J, Jackson D, et al. Vital signs: missed opportunities for preventing congenital syphilis - United States, 2022. MMWR Morb Mortal Wkly Rep . 2023;72(46):1269-74. doi: 10.15585/mmwr.mm7246e1.
» https://doi.org/10.15585/mmwr.mm7246e1

ASSOCIATED ACADEMIC WORK
Article derived from the undergraduate dissertation entitled Temporal trend of gestational and congenital syphilis cases in the state of Paraná between 2007 and 2021, submitted by Giovana Gomes de Oliveira to the Nursing Department of the Universidade Estadual de Maringá, in 2023.
FUNDING
This study received financial support from the Programa Institucional de Apoio à Inclusão Social, Pesquisa e Extensão Universitária da Fundação Araucária/Universidade Estadual de Maringá, awarded to the author Giovana Gomes de Oliveira, and from the Coordination for the Improvement of Higher Education Personnel/Ministry of Education of Brazil, awarded to the authors Isadora Gabriella Silva Palmieri, Lucas Vinícius de Lima and Gabriel Pavinati.

Publication Dates

Publication in this collection
10 June 2024
Date of issue
2024

History

Received
29 Feb 2024
Accepted
08 Apr 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Freitas FLS, Benzaken AS, Passos MRL, Coelho ICB, Miranda AE. Protocolo brasileiro para infecções sexualmente transmissíveis 2020: sífilis adquirida. Epidemiol Serv Saude. 2021;30(spe1):e2020616. doi: 10.1590/S1679-4974202100004.esp1.
» https://doi.org/10.1590/S1679-4974202100004.esp1

[2] ²
Uku A, Albujasim Z, Dwivedi T, Ladipo Z, Konje JC. Syphilis in pregnancy: the impact of “the great imitator”. Eur J Obstet Gynecol Reprod Biol. 2021;259:207-10. doi: 10.1016/j.ejogrb.2021.01.010.
» https://doi.org/10.1016/j.ejogrb.2021.01.010

[3] ³
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Boletim epidemiológico de sífilis - número especial - out. 2022 [Internet]. Brasília: Ministério da Saúde; 2022 [citado 2024 Jan 26]. 55 p. Disponível em: Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de-sifilis-numero-especial-out-2022/view
» https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de-sifilis-numero-especial-out-2022/view

[4] ⁴
Uchôa TLA, Araújo EC, Silva RAR, Valois R, Azevedo Junior WS, Nascimento VGC, et al. Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon. Front Public Health. 2022;10:930150. doi: 10.3389/fpubh.2022.930150.
» https://doi.org/10.3389/fpubh.2022.930150

[5] ⁵
Kachikis A, Schiff MA, Moore K, Chapple-McGruder T, Arluck J, Hitti J. Risk factors associated with congenital syphilis, Georgia, 2008-2015. Infect Dis Obstet Gynecol. 2023;2023:3958406. doi: 10.1155/2023/3958406.
» https://doi.org/10.1155/2023/3958406

[6] ⁶
Guerra JVV, Paula HC, Silva SAP, Torres FSR, Alves VH, Pereira AV. Fatores de risco para sífilis em mulheres: revisão integrativa. Rev APS. 2021;24(3);628-50. doi: 10.34019/1809-8363.2021.v24.16882.
» https://doi.org/10.34019/1809-8363.2021.v24.16882

[7] ⁷
Thornton C, Chaisson LH, Bleasdale SC. Characteristics of pregnant women with syphilis and factors associated with congenital syphilis at a Chicago hospital. Open Forum Infect Dis. 2022;9(5):ofac169. doi: 10.1093/ofid/ofac169.
» https://doi.org/10.1093/ofid/ofac169

[8] ⁸
Carvalho SS, Oliveira BR, Sá EA. Estratégias e ações no pré-natal para sífilis congênita: revisão de literatura. RBPS. 2020;22(2):150-6. doi: 10.47456/rbps.v22i2.25258.
» https://doi.org/10.47456/rbps.v22i2.25258

[9] ⁹
Souza MLA, Lima LV, Pavinati G, Uema RTB, Nogueira IS, Magnabosco GT. Caracterização e geoespacialização da sífilis gestacional e congênita no Paraná, Brasil, 2012-2020. Rev Baiana Saude Publica. 2023;47(2):53-68. doi: 10.22278/2318-2660.2023.v47.n2.a3808.
» https://doi.org/10.22278/2318-2660.2023.v47.n2.a3808

[10] ¹⁰
Fernades LPMR, Souza CL, Oliveira MV. Missed opportunities in treating pregnant women’s sexual partners with syphilis: a systematic review. Rev Bras Saude Matern Infant. 2021;21(2):361-8. doi: 10.1590/1806-93042021000200002.
» https://doi.org/10.1590/1806-93042021000200002

[11] ¹¹
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Guia para certificação da eliminação da transmissão vertical de HIV e/ou sífilis [Internet]. Brasília: Ministério da Saúde; 2023 [citado 2024 Jan 26]. 36 p. Disponível em: Disponível em: https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2023/guia-certificacao-da-eliminacao-da-tv-_-eletronico-_-1a-ed-atualizada.pdf/view
» https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2023/guia-certificacao-da-eliminacao-da-tv-_-eletronico-_-1a-ed-atualizada.pdf/view

[12] ¹²
Governo do Estado (PR). Secretaria de Estado da Saúde. Divisão de Atenção à Saúde da Mulher. Linha guia - atenção materno infantil: gestação [Internet]. 8. ed. Curitiba: Secretaria de Estado da Saúde; 2022 [citado 2024 Jan 26]. 81 p. (Linha de Cuidado Materno Infantil do Paraná; v. 1). Disponível em: Disponível em: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2022-03/linha_guia_mi-_gestacao_8a_ed_em_28.03.22.pdf
» https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2022-03/linha_guia_mi-_gestacao_8a_ed_em_28.03.22.pdf

[13] ¹³
Instituto Brasileiro de Geografia e Estatística. Cidades e estados: Paraná [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2021 [citado 2024 Jan 26]. Disponível em: Disponível em: https://www.ibge.gov.br/cidades-e-estados/pr.html
» https://www.ibge.gov.br/cidades-e-estados/pr.html

[14] ¹⁴
Governo do Estado (PR). Secretaria de Estado da Saúde. Regionais de saúde [Internet]. Curitiba: Secretaria de Estado da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://www.saude.pr.gov.br/Pagina/Regionais-de-Saude
» https://www.saude.pr.gov.br/Pagina/Regionais-de-Saude

[15] ¹⁵
Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde [Internet]. Brasília: Ministério da Saúde ; c2023 [citado 2024 Jan 26]. Disponível em: Disponível em: https://datasus.saude.gov.br/
» https://datasus.saude.gov.br/

[16] ¹⁶
National Cancer Institute (USA). Surveillance Research Program. Statistical Methodology and Applications Branch. Joinpoint Regression Program - version 5.0.2 - May 2023 [Internet]. Bethesda: National Cancer Institute; c2023 [cited 2023 May 05]. Available from: Available from: https://surveillance.cancer.gov/help/joinpoint
» https://surveillance.cancer.gov/help/joinpoint

[17] ¹⁷
Furlam TO, Pereira CCA, Frio GS, Machado CJ. Efeito colateral da pandemia de Covid-19 no Brasil sobre o número de procedimentos diagnósticos e de tratamento da sífilis. Rev Bras Estud Popul. 2022;39:e0184. doi: 10.20947/S0102-3098a0184.
» https://doi.org/10.20947/S0102-3098a0184

[18] ¹⁸
Nunes PS, Guimarães RA, Rosado LEP, Marinho TA, Aquino EC, Turchi MD. Temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás, Brazil, 2007-2017: an ecological study. Epidemiol Serv Saude . 2021;30(1):e2019371. doi: 10.1590/S1679-49742021000100002.
» https://doi.org/10.1590/S1679-49742021000100002

[19] ¹⁹
Amorim EKR, Matozinhos FP, Araújo LA, Silva TPR. Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study. Epidemiol Serv Saude . 2021;30(4):e2021128. doi: 10.1590/S1679-49742021000400006.
» https://doi.org/10.1590/S1679-49742021000400006

[20] ²⁰
Soares MAS, Aquino R. Completeness and characterization of gestational syphilis and congenital syphilis records in Bahia, Brazil, 2007-2017. Epidemiol Serv Saude . 2021;30(4):e20201148. doi: 10.1590/S1679-49742021000400018.
» https://doi.org/10.1590/S1679-49742021000400018

[21] ²¹
Heringer ALDS, Kawa H, Fonseca SC, Brignol SMS, Zarpellon LA, Reis AC. Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016. Rev Panam Salud Publica. 2020;44:e3. doi: 10.26633/RPSP.2020.8.
» https://doi.org/10.26633/RPSP.2020.8

[22] ²²
Dantas JC, Marinho CSR, Pinheiro YT, Silva RAR. Temporal trend of gestational syphilis between 2008 and 2018 in Brazil: association with socioeconomic and health care factors. Int J Environ Res Public Health. 2022;19(24):16456. doi: 10.3390/ijerph192416456.
» https://doi.org/10.3390/ijerph192416456

[23] ²³
Santos DR, Viera CS, Guimarães ATB, Toso BRGO, Ferrari RAP. Avaliação da eficácia do Programa Rede Mãe Paranaense. Saude Debate. 2020;44(124):70-85. doi: 10.1590/0103-1104202012405.
» https://doi.org/10.1590/0103-1104202012405

[24] ²⁴
Vescovi JS, Schuelter-Trevisol F. Increase of incidence of congenital syphilis in Santa Catarina state between 2007-2017: temporal trend analysis. Rev Paul Pediatr. 2020;38:e2018390. doi: 10.1590/1984-0462/2020/38/2018390.
» https://doi.org/10.1590/1984-0462/2020/38/2018390

[25] ²⁵
Dantas JC, Marinho CSR, Pinheiro YT, Ferreira MÂF, Silva RAR. Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: an ecological study. Front Pediatr. 2023;11:1109271. doi: 10.3389/fped.2023.1109271.
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	Location	Period	APC^a (95%CI^b)	AAPC^c (95%CI^b)
Gestational syphilis	Paraná	2007-2016	41.4 (30.7;112.3)	21.7 (17.7;32.8)
		2016-2019	13.3 (5.7;43.0)
		2019-2021	-30.9 (-44.2;-11.5)
	East	2007-2016	37.7 (13.8;81.7)	20.5 (16.9;27.4)
		2016-2019	11.5 (-5.1;47.7)
		2019-2021	-25.9 (-41.2;-3.5)
	West	2007-2019	33.4 (30.9;44.4)	18.7 (14.6;26.6)
	West	2019-2021	-41.1 (-58.8;-16.7)	18.7 (14.6;26.6)
	Northwest	2007-2015	55.2 (48.8;72.3)	26.1 (23.4;31.6)
		2015-2019	19.2 (12.5;25.6)
		2019-2021	-38.6 (-45.7;-32.1)
	North	2007-2016	54.9 (45.2;117.6)	24.2 (19.3;39.5)
		2016-2019	2.2 (-7.7;55.1)
		2019-2021	-38.4 (-53.0;-14.5)
Congenital syphilis	Paraná	2007-2015	32.8 (29.1;48.0)	14.8 (13.0;19.7)
		2015-2019	11.5 (6.2;19.8)
		2019-2021	-32.4 (-40.4;-20.0)
	East	2007-2017	27.2 (23.6;33.5)	13.9 (11.2;17.3)
	East	2017-2021	-13.6 (-24.8;-5.1)	13.9 (11.2;17.3)
	West	2007-2019	28.2 (23.8;44.7)	13.3 (6.8;24.2)
	West	2019-2021	-46.1 (-68.8;-14.6)	13.3 (6.8;24.2)
	Northwest	2007-2015	44.4 (-3.3;595.4)	24.1 (18.2;56.1)
		2015-2019	13.5 (6.0;83.5)
		2019-2021	-18.8 (-36.9;3.5)
	North	2007-2015	44.1 (2.2;381.1)	23.8 (18.8;48.9)
		2015-2019	12.5 (4.9;85.5)
		2019-2021	-18.2 (-34.1;2.6)

	Location	Period	APC^a (95%CI^b)	AAPC^c (95%CI^b)
Gestational syphilis (≤ 19 years old)	Paraná	2007-2016	49.6 (44.5;155.2)	26.2 (22.4;40.6)
		2016-2019	19.1 (11.5;44.6)
		2019-2021	-36.0 (-52.1;-16.0)
	East	2007-2018	41.6 (37.8;50.9)	24.6 (21.4;30.4)
	East	2018-2021	-22.1 (-32.5;-7.1)	24.6 (21.4;30.4)
	West	2007-2019	43.2 (40.4;58.9)	25.3 (21.1;36.3)
	West	2019-2021	-43.7 (-62.2;-16.9)	25.3 (21.1;36.3)
	Northwest	2007-2016	53.0 (49.9;65.7)	26.6 (23.9;31.6)
		2016-2019	15.4 (9.1;32.8)
		2019-2021	-38.2 (-48.4;-24.4)
	North	2007-2014	76.5 (56.4;532.2)	28.5 (20.0;62.7)
		2014-2019	18.6 (7.6;36.8)
		2019-2021	-48.2 (-70.3;-20.3)
Gestational syphilis (≥ 20 years old)	Paraná	2007-2016	39.7 (18.0;113.3)	21.3 (16.9;31.9)
		2016-2019	13.3 (5.8;45.7)
		2019-2021	-28.7 (-42.7;-8.2)
	East	2007-2017	34.4 (29.1;47.6)	21.7 (16.8;28.7)
	East	2017-2021	-5.0 (-27.2;7.3)	21.7 (16.8;28.7)
	West	2007-2019	30.9 (28.6;38.8)	17.1 (13.8;22.6)
	West	2019-2021	-39.9 (-54.3;-18.7)	17.1 (13.8;22.6)
	Northwest	2007-2014	65.2 (55.7;87.4)	29.1 (26.1;34.7)
		2014-2019	23.2 (18.4;27.8)
		2019-2021	-38.7 (-45.1;-32.7)
	North	2007-2015	66.4 (54.2;120.9)	28.5 (23.2;43.8)
		2015-2019	9.7 (1.5;33.1)
		2019-2021	-37,4 (-53,5;-16,5)
Congenital syphilis (≤ 19 years old)	Paraná	2007-2014	41.0 (37.3;49.0)	19.4 (17.6;21.8)
		2014-2019	20.8 (16.6;24.9)
		2019-2021	-35.4 (-43.1;-28.8)
	East	2007-2011	61.7 (35.8;291.7)	23.6 (16.1;37.6)
		2011-2018	23.7 (14.6;35.7)
		2018-2021	-13.7 (-51.0;2.1)
	West	2007-2019	36.3 (32.4;50.0)	17.8 (10.5;28.4)
	West	2019-2021	-50.9 (-72.0;-16.2)	17.8 (10.5;28.4)
	Northwest	2007-2019	34.9 (31.1;48.2)	19.3 (13.9;29.0)
	Northwest	2019-2021	-42.9 (-62.3;-13.2)	19.3 (13.9;29.0)
	North	2007-2019	24.3 (19.4;56.4)	10.5 (2.1;28.4)
	North	2019-2021	-45.5 (-73.2;9.4)	10.5 (2.1;28.4)
Congenital syphilis (≥ 20 years old)	Paraná	2007-2016	29.9 (27.1;50.0)	13.7 (11.9;19.3)
		2016-2019	5.3 (-0.1;24.2)
		2019-2021	-29.8 (-38.7;-18.6)
	East	2007-2017	26.2 (23.6;30.8)	13.0 (11.1;15.5)
	East	2017-2021	-14.3 (-20.1;-7.7)	13.0 (11.1;15.5)
	West	2007-2019	27.3 (24.1;39.4)	14.4 (8.5;23.1)
	West	2019-2021	-39.7 (-61.8;-12.4)	14.4 (8.5;23.1)
	Northwest	2007-2016	42.4 (33.9;67.6)	26.0 (21.4;36.0)
	Northwest	2016-2021	1.1 (-12.5;10.7)	26.0 (21.4;36.0)
	North	2007-2015	36.0 (2.3;443.7)	14.0 (8.3;37.8)
		2015-2019	9.0 (-0.7;66.2)
		2019-2021	-38.4 (-60.3;-6.1)

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Saúde Pública

Detection of gestational and congenital syphilis in Paraná state, Brazil, 2007-2021: a time series analysis

Detección de sífilis gestacional y congénita en Paraná, Brasil, 2007-2021: análisis de series temporales

Abstract

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INTRODUCTION

METHODS

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REFERENCES

ASSOCIATED ACADEMIC WORK

FUNDING

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History