Congenital syphilis in Marabá (State of Pará, Brazil): epidemiological analysis of a decade

Abstract

Congenital syphilis (CS) is a systemic infect contagious disease, sexually transmitted, easily diagnosed, with effective and low cost treatment. Thus, the existence of a paradox is detached, once infectious diseases of greater complexity have already been controlled. In its congenital form, syphilis in Brazil constitutes a sentry event of high magnitude that presents unfavorable indicators in terms of its control. In the State of Pará, Marabá is the municipality with the highest number of cases in the past years. The aimed of this study was describing a clinical-epidemiological profile of congenital syphilis in Marabá, from 2006 to 2015. This was a descriptive, retrospective and documental study which analyzed secondary data from SINAN/SMS/SVS/DATASUS/Marabá/PA. Between 2006 and 2015, 323 cases of CS were notified in Marabá. The incidence of congenital syphilis of 6.5 cases per 1,000 live births from 2006-2015 is 6.5 the Ministry of Health goal; from 2012 to 2015 the rates were 8, 9.8, 26.3 and 11.3/1,000, respectively. Most pregnant women performed prenatal (88.6%), was between 20 and 24 years old (62.2%), 26.6% did not finish Middle School. Most partners, 67.5%, of the pregnants diagnosed with did not perform treatment; in 55% of cases, the maternal syphilis diagnosis happened during labor/curettage. Congenital syphilis in Marabá overcame the highest incidence in 2014, with 26.3 cases per 1,000 live births. This great value in 2014 may be a result of the campaign "It's possible to born without syphilis in Pará", released by the Secretary of State for Health of Pará at the end of 2013, since in periods of huge campaigns there is an increase of notifications, due to easier access to the diagnosis of the disease. In the year of 2015, an incidence of 11.3 cases per 1,000 live births was observed, this abrupt decrease, compared to 2014, corroborates with the influence of the campaigns in the detection of new cases. The cases of congenital syphilis notified in the Municipality of Marabá demonstrated failures in the prenatal service, particularly in the time of verification of gestational syphilis and in the treatment of the partners. However, most cases had a positive outcome, with a low number of pre and perinatal deaths due to CS. According to the section of Epidemiological Surveillance of Marabá, many factors are responsible for the high incidence of congenital syphilis in the municipality, among them the lack of clarification of the pregnants/mothers about syphilis, a low demand by the prenatal care and the low attendance of partners, what unfeasible the effective control of this disease, as well as the precarious training of health professionals, who give little importance to the disease and show difficulty to interpret lab results. The correct notification (if there is a higher quality in the reports, the number will be closer to the real), investigation of cases, appropriate treatment and implementation of measures to prevent new cases of congenital syphilis will contribute to the reduction of cases in Marabá.