Congenital Syphilis Research Articles

Trends in Congenital Syphilis Incidence and Mortality in Brazil’s Southeast Region: A Time-Series Analysis (2008–2022)

Congenital syphilis (CS) is an important infectious cause of miscarriage, stillbirth, and neonatal morbidity and mortality. Despite the advances in diagnosis and treatment, CS continues to challenge health systems with increasing incidence and mortality rates in recent years worldwide. Given this, the present study aims to comparatively analyze the temporal trends in CS incidence and mortality in Brazil’s Southeast Region from 2008 to 2022. This is an ecological time-series study using secondary data on congenital syphilis from the states of Espírito Santo, Minas Gerais, Rio de Janeiro, and São Paulo. The data was extracted from the Brazilian Health System Informatics Department. Incidence and mortality rates were calculated per 100,000 live births. Joinpoint regression models were employed to identify trends in annual percentage change and average annual percentage change with 95% confidence intervals. The temporal trend of CS incidence in Brazil’s Southeast Region increased 12.8% between 2008 and 2022. Minas Gerais, São Paulo, Espírito Santo, and Rio de Janeiro showed increasing temporal trends of 21.4%, 14.1%, 14.0%, and 10.9%, respectively. The temporal trend of CS mortality in Brazil’s Southeast Region rose 11.9% between 2008 and 2022. Minas Gerais, São Paulo, and Rio de Janeiro exhibited increasing mortality temporal trends of 21.9%, 20.8%, and 10.1%, respectively. In contrast, Espírito Santo showed reduced mortality, with no deaths in 2021 and 2022. The temporal trend of CS incidence increased in all states of Brazil’s Southeast Region between 2008 and 2022, highlighting the need to reassess control measures. The temporal trend of CS mortality also increased during the same period, except in Espírito Santo. Considering that CS is preventable with adequate prenatal care and low-cost measures, these findings can serve as instruments to support strengthening public health policies.

Analysis of the Results of Screening Serological Examination for Syphilis in Patients of a Multidisciplinary Children’s Hospital

Introduction. Currently, the clinical course of syphilis has changed, which leads to a decrease in the alertness of the population. Therefore, it is very important to conduct a screening serological examination of the population in order to detect and reduce the incidence of syphilis in a timely manner.The aim of the study was to study the incidence of syphilis during a screening examination of patients and caregivers of a multidisciplinary children’s hospital.Materials and methods. A retrospective analysis of the results of serological screening for syphilis of 9262 patients and child caregivers of the multidisciplinary children’s hospital of the Regional Children’s Clinical Hospital (Ekaterinburg, Russia), which includes the Regional Perinatal Center, from 1 January 2023 to 30 September 2024.Results. In 2023, 2 cases of acute syphilis were detected in women hospitalized for child care, and in 2024, 1 in a pregnant woman who did not complain and considered themselves healthy and posed an epidemic danger to others and medical personnel. There were also 2 cases of early congenital syphilis in 2024.Discussion. The presence of IgM to Treponema pallidum indicates a recently acquired disease (4–6 weeks after infection). The detection of IgG only in adult patients speaks in favor of a current now or a history of syphilis, and in newborns about the transmission of IgG from mother to child throuConclusion. The high sensitivity of treponemal tests used in screening studies reduces the likelihood of missing hidden forms of syphilis by enzyme immunoassay.gh the transplacental barrier.

Gestational and congenital syphilis in the state of Rio de Janeiro, Brazil, 2021‒2023.

Gestational and congenital syphilis in the state of Rio de Janeiro, Brazil, 2021‒2023.

Positive RPR and TPLA tests cannot confirm congenital syphilis

Positive RPR and TPLA tests cannot confirm congenital syphilis

Oral manifestations of congenital syphilis: a case report

Oral manifestations of congenital syphilis: a case report

Syphilis Exposure During Pregnancy and Childhood Hospital Admissions in Brazil

While the short-term impacts of congenital syphilis are well documented, the long-term outcomes and effects on children exposed to syphilis during pregnancy but without congenital infection detected at birth remain unclear. To compare the rates of all-cause hospitalization in children younger than 5 years between those exposed to syphilis during pregnancy (with and without congenital syphilis) and those unexposed to syphilis during pregnancy. Population-based study using linked data from the Center of Data and Knowledge Integration for Health Birth Cohort, including singleton live births between January 1, 2011, and December 31, 2015. Children were followed up until age 5 years, death, or December 31, 2018, whichever occurred first. Data were made available in 2020 and analyzed between March and September 2024. In this study, syphilis during pregnancy was categorized into 3 groups: (1) maternal syphilis, (2) congenital syphilis, and (3) no exposure, for those without syphilis records. Primary outcomes were: (1) general and age-stratified first hospital admission rates, (2) length of stay for the first hospital admission, and (3) International Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of the first hospitalization. Secondary outcomes included: (1) recurrent hospital admissions and (2) mortality. The study included 8 286 867 singleton births, with 30 039 exposed to maternal syphilis (15 482 [51.5%] male, 7642 [25.4%] Asian, 2442 [8.1%] Black, and 16 930 [56.4%] Pardo [denotes individuals who are White and Indigenous, White and Black, Black and Indigenous, or Black and another race]) and 36 443 with congenital syphilis (18 286 [50.2%] male, 6977 [19.1%] Asian, 3769 [10.3%] Black, 16 930 [56.4%] Pardo). Exposed births were more prevalent in Black, single, and less educated women. Compared with children with no exposure, those with congenital syphilis had an increased risk of first hospitalization (hazard ratio [HR], 6.19; 95% CI, 6.11-6.28), as did those exposed to maternal syphilis (HR, 1.90; 95% CI, 1.86-1.94). The highest risk of first hospitalization was observed in the first month of life, among those with congenital syphilis (HR, 11.53; 95% CI, 11.36-11.70). Although the risk decreased with age, children exposed to syphilis continued to have higher hospitalization rates than the nonexposed group until the age of 36 months. Live-born children exposed to syphilis during pregnancy also had more and longer hospital admissions. Those with congenital syphilis had a lower prevalence of respiratory and digestive diagnoses than those with maternal syphilis and the nonexposed group. In this cohort study, we observed that those children exposed to syphilis during pregnancy, even without congenital syphilis detected at birth, had a higher risk of hospital admission and were hospitalized for longer periods. These findings underscore the need for close monitoring of exposed children and emphasize the importance of preventing syphilis in women of childbearing age.

EFFECT OF THE COVID-19 PANDEMIC ON CONGENITAL SYPHILIS NOTIFICATIONS IN BRAZIL

Syphilis is considered a Sexually Transmitted Infection and systemic infectious-contagious disease caused by the anaerobic bacterium Treponema pallidum, subspecies pallidum. With the advent of the COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2, an impact was observed on the performance of prenatal consultations and exams. In this context, the present study aimed to investigate the effect of the COVID-19 pandemic on congenital syphilis notifications in Brazil. This is a descriptive-exploratory study with data collection conducted between March and June 2023. The information regarding congenital syphilis notifications that occurred between 2018 and 2021 was extracted from the Notifiable Diseases Information System and made available on the platform of the Department of Informatics of the Sistema Único de Saúde. The data were grouped into two biennia: 2018-2019 (pre-pandemic period) and 2020-2021 (pandemic period). Descriptive statistics and percentage variation were used for data analysis. The results showed that between 2018 and 2021, 84,698 cases of congenital syphilis were reported in Brazil, with a higher number of cases in the pre-pandemic period (n= 51,174; 60.4%). There was a downward trend in notifications in Brazil during the health crisis, with a negative percentage variation of 34.4%, and with the Central-West (percentage variation = -5.2%) and North (percentage variation = -4.6%) regions standing out. The sociodemographic and healthcare characteristics were similar between the pre-pandemic and pandemic periods. The study concludes that there was a decrease in reported cases of congenital syphilis, suggesting a potential underreporting in the different macro-regions of Brazil, possibly related to low adherence to prenatal care by pregnant women during the COVID-19 pandemic.

Spatial Distribution and Epidemiological Characterization of Congenital Syphilis in Monterrey, Mexico, 2016-2024.

Congenital syphilis is a preventable infectious disease that is rising in low- and middle-income countries. The CDC classifies congenital syphilis into four clinical scenarios to guide diagnosis and treatment: Scenario 1, proven or highly probable congenital syphilis; Scenario 2, possible congenital syphilis; Scenario 3, less likely congenital syphilis; and Scenario 4, unlikely congenital syphilis. Geolocation is crucial for analyzing the distribution of infectious diseases by pinpointing high-prevalence areas and enabling targeted interventions. This retrospective observational study analyzed Scenario 1 and 2 cases from a tertiary hospital in Monterrey, Mexico (2016 to 2024). Geocoding was performed by converting descriptive location data, such as patients' postal codes, into geographic coordinates (latitude and longitude) using Python v. 3.10.13 (Python Software Foundation, Wilmington, DE). These coordinates were then used in spatial analysis and visualized through kernel density mapping to identify high-incidence zones. Logistic regression identified associations with geographic, socioeconomic, and clinical factors, and odds ratios quantified risks. Data analysis was performed with SPSS version 26 (IBM Corp., Armonk, NY). A total of 167 Scenario 1 and 2 cases were identified, with the highest incidence in 2023 (82.3%, n = 51). The mean maternal age was 23 years; 56.3% of maternal syphilis cases were diagnosed postpartum, 49.7% of cases were late latent syphilis, and 48.5% of patients received no treatment. Higher prevalence was observed in densely populated areas such as Monterrey. This study highlights the utility of geolocation and kernel mapping for designing prevention strategies tailored to high-risk regions. Strengthening prenatal care, early diagnostic testing, and timely treatment is crucial for reducing congenital syphilis rates.

O PERFIL EPIDEMIOLÓGICO DA SÍFILIS CONGÊNITA NO ESTADO DO TOCANTINS DE 2018 À 2023

INTRODUCTION: Congenital syphilis is an STI that has a major impact on the health of newborns. When not treated appropriately during pregnancy, it leads to adverse outcomes for the fetus such as: miscarriage, low birth weight, anatomical malformation, among other factors. associates. OBJECTIVE: To understand the epidemiological profile of congenital syphilis in the state of Tocantins between 2018 and 2023. METHODOLOGY: This work includes an epidemiological approach of an observational and analytical nature, using data provided by the DATHI platform of population syphilis indicators. EXPECTED RESULTS: It is expected to quantify through this study the epidemiological profile of congenital syphilis in Tocantins between the respective years mentioned above and evaluate the incidence of the disease.

Syphilis in pregnant women and congenital syphilis in Japan, 2022-2023: a warning for other countries.

Following a brief decline, syphilis case counts among pregnant women reported through Japan's national surveillance doubled from 2021 to 2023; congenital syphilis case counts/100,000 live births also doubled to >5. The unprecedented trends in Japan highlight the current heterosexual syphilis epidemic's relentlessness, with important implications for other countries.

Abnormal Neurologic and Motor Function in Newborns Treated for Congenital Syphilis.

Background: Congenital syphilis (CS) is a transplacental infection that can lead to many long-term sequelae when not adequately treated; however, knowledge about the motor and neurological signs that newborns (NBs) with CS may present is scarce. Objective: The aim of this study was to describe the results of neurological assessment scales and general movements in NBs with CS in the first days of life. Methods: In this case-series, the Hammersmith Neonatal Neurological Examination (HNNE) and General Movements Assessment (GMA) scales were used to evaluate NBs under treatment for CS in a public Brazilian hospital in the first days of life. Results: The sample consisted of 11 NBs, with a mean birth weight of 3140.5 g, and an Apgar score at 5 min of 8.3. Among the 11 mothers, 4 (36.4%) had fewer than six prenatal visits and 5 (45.5%) did not receive any syphilis treatment. All NB (100%) were asymptomatic, with normal long bone X-rays and cerebrospinal fluid analysis. The mean score on the HNNE was 22 (suboptimal/abnormal). Eight NBs (72.7%) showed abnormalities on GMA scale (with six [54.5%] being mildly abnormal and two [18%] definitely abnormal). Only three NBs (27.3%) returned for outpatient follow-up. Conclusions: Neurological and motor evaluations were abnormal in most of the asymptomatic NBs under treatment for CS in the first days of life, when assessed through specific scales (HNNE and GMA). Most mothers did not receive adequate treatment for syphilis during pregnancy, and there were important deficiencies in post-discharge follow-up. Further studies are needed to confirm these findings and investigate whether the observed abnormalities are linked to biological or environmental factors during pregnancy.

Repercussions of the COVID- 19 pandemic on maternal and congenital syphilis in South Brazil: a time series analysis 2010-2022

BackgroundThe global increase in maternal and congenital syphilis cases over the past decade has been substantial. In south Brazil, preexisting maternal and congenital syphilis epidemics have been worsened since the onset of COVID- 19. We evaluated the impact of the COVID- 19 pandemic on the epidemiological trends of maternal and congenital syphilis in Porto Alegre, Brazil.MethodsWe conducted a retrospective review of hospital records from a large public hospital network, covering the full period of January 1, 2010, to December 31, 2022. Based on historical maternal syphilis and congenital syphilis cases from 2010 to 2019, a Holt-Winters seasonal forecasting model was used to predict maternal syphilis prevalence from 2020 to 2022. A subanalysis of total births, corresponding maternal syphilis prevalence, congenital syphilis cases and infant outcomes was performed for 2017 to 2022 to take a closer look at the years preceding and following the pandemic onset. The diagnoses of maternal and congenital syphilis were determined according to the Brazilian Ministry of Health guidelines.ResultsThe Holt-Winters model predicted relatively stable maternal syphilis prevalence from 2020 to 2022. In contrast, the observed prevalence at delivery was higher than predicted: in 2021 and 2022, forecasting predicted average yearly prevalences of 8.7% and 8.8%, while observed prevalences were 12.5.% and 10.3%. Total births throughout 2017–2022 remained stable with mild decline in the pandemic period. Total maternal syphilis prevalence did not change from 11.1% in 2019 to 2020. However, the percentage of patients diagnosed with syphilis at delivery increased from 14% in 2019 to 65% in 2020. A statistically significant increase in total maternal syphilis prevalence from 11.1% in 2020 to 14.8% in 2021, p ≤ 0.05 was noted. Congenital syphilis diagnoses decreased from 57 to 24% during the pre-pandemic period and increased to 27% in 2022. The incidence of fetal demise in syphilis-positive patients declined throughout the study period from 14% to 6.9% equating roughly 30 cases per year.ConclusionThe COVID- 19 pandemic was a significant setback in recent progress made toward the control of maternal and congenital syphilis in south Brazil. Public health strategies should prioritize reinstatement of interventions for prevention of gestational syphilis.

Serological Responses and Pregnancy Outcomes in Women with Serofast Syphilis: Efficacy of Re-treatment in a Prospective Nested Case-Control Study.

There are inconsistencies in guidelines concerning the necessity for anti-syphilis re-treatment during pregnancy for women who tested seropositive despite having received treatment before pregnancy. While global guidelines indicate that no further treatment is necessary, Chinese guidelines advocate for an additional treatment course. A prospective nested case-control study was conducted to analyze serological responses and pregnancy outcomes in women with serofast syphilis, focusing on the effects of re-treatment. Out of 584 women with serofast syphilis, 537 (92.0%) experienced normal pregnancy outcomes, comparable to the 93.6% in women without syphilis. However, 47 (8.0%) faced adverse pregnancy outcomes (APOs), which included 8 (1.4%) spontaneous abortions, 2 (0.3%) intrauterine fetal deaths, and 37 (6.3%) instances of preterm birth or low birth weight. The rate of APOs showed no significant difference between those treated with benzathine penicillin G and those who were not (adjusted odds ratio [aOR], 0.59 [95% CI, 0.31-1.14]; P = 0.118). Among 462 newborns with follow-up, no congenital syphilis cases were identified. Serological responses were evaluated in 568 women, revealing that 74 (13.0%) experienced seroreversion of nontreponemal antibodies, 52 (9.2%) had a ≥ four-fold decrease in titers, 6 (1.0%) had a ≥ four-fold increase, and 436 (74.7%) maintained stable titers. No significant difference in seroreversion rates was found between the re-treated and non-re-treated groups (aOR, 1.43 [95%CI, 0.76-2.71]; P=0.271). With adequate prenatal care and continuous monitoring of serological and symptomatic changes, it is unnecessary to re-treat serofast women exhibiting stable non-treponemal antibody titers during pregnancy.

The Return of an Old Foe: Syphilis Among Women

Over 10 years, the reported incidence of primary and secondary syphilis increased among women at 6 times the rate compared with men (636% vs. 103%). Untreated syphilis can lead to life-altering complications including permanent vision and hearing loss, congenital syphilis, and increased HIV acquisition. Syphilis diagnosis and staging require current and prior laboratory results, physical examination, and history. The preferred treatment for syphilis is long-acting penicillin G benzathine. Partner testing and treatment are critical to prevent re-infection and further community transmission. Innovative strategies are needed to prevent and treat syphilis among women, especially those without regular access to health care.

Implementing a 24/7 Congenital Syphilis Hotline for California Clinicians: Results from a 13-week Pilot Project.

The National Network of STD Prevention Training Centers launched a 24 hours/7 days a week hotline pilot for consultations on syphilis during pregnancy and congenital syphilis. Most of the 28 urgent requests were from physicians (61%) in hospitals (54%), involving patients in their third trimester or recently born infants (82%).

State Child Abuse and Mandated Reporting Policies for Prenatal Substance Use and Congenital Syphilis Case Rates: United States, 2018-2022.

Objectives. To estimate the association of state policies that define prenatal substance use as child abuse and mandate that health care professionals report prenatal substance use to child protective services with congenital syphilis case rates. Methods. We used 2018 to 2022 US data on congenital syphilis case notifications to the National Notifiable Diseases Surveillance System. We conducted linear regression with a generalized estimating equation approach to compare congenital syphilis case rates in states with a child abuse policy only, a mandated reporting policy only, and both polices to rates in states with neither policy. Results. After adjustment for confounders, the rate of congenital syphilis cases was, on average, 23.5 (95% confidence interval = 2.2, 44.8) cases per 100 000 live births higher in states with both a child abuse policy and a mandated reporting policy for prenatal substance use than in states with neither policy. Rates were similar in states with a child abuse policy only and a mandated reporting policy only compared to states with neither policy. Conclusions. The combination of state child abuse policies and mandated reporting policies for prenatal substance use potentially contributes to higher congenital syphilis case rates. (Am J Public Health. 2025;115(4):566-574. https://doi.org/10.2105/AJPH.2024.307951).

Why do antivenoms still terrify Brazilian doctors? Lessons from the penicillin treatment decentralization.

Why do antivenoms still terrify Brazilian doctors? Lessons from the penicillin treatment decentralization.

Relação entre o tratamento de genitores e o neurodesenvolvimento de lactentes com sífilis congênita em Maternidade em Sergipe, Brasil

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. When it affects pregnant women, especially in the third trimester, it can infect the fetus through vertical transmission, causing congenital syphilis, which in turn, can result in various types of sequelae in the child. When diagnosed in the pregnant woman or her partner, it should be properly treated with benzathine penicillin to prevent transmission. This 2022 epidemiological, prospective, longitudinal, and analytical study investigated the possible relationship between proper treatment of the parents and delays in the neurodevelopment of children using the Denver II test. Conducted in an outpatient clinic directed at children with congenital syphilis in a maternity hospital in Aracaju, it showed an increase in developmental delays for children of inadequately treated parents, indicating a strong possibility of a relationship between the adequacy of parental treatment and infant development, despite literature limitations, requiring further studies on the topic.

Patterns of Congenital Syphilis in a Large Public Hospital: Birthing Parent Risk Factors and Infant Outcomes.

Congenital syphilis (CS) in the United States increased 10-fold in the last decade. At a large public hospital in Los Angeles, the numbers of infants born to birthing parents with untreated syphilis during pregnancy have continued to rise. We compiled a retrospective case-series from all infant rapid plasma reagin (RPR) test results from 2022-2023 summarizing CS diagnosis and relevant diagnostic criteria. Chi-squared and Fisher's exact tests were used to examine associations between birthing parent risk factors and CS diagnosis. Birthing parent syphilis complicated 97 out of 2367 live births (4.1%) at our institution. Approximately 36% (n = 35) of infants born to birthing parents with a history of syphilis (n = 94) were born to a birthing parent with inadequately treated syphilis or concern for reinfection. Infants with exposure to birthing parent syphilis were mostly asymptomatic at birth but had a high frequency of abnormalities in laboratory and radiographic evaluation. Compared to infants with Less Likely or Unlikely CS, birthing parents with infants with Highly Probable or Possible CS were more likely to have methamphetamine use during pregnancy (41% vs. 69%, p = 0.02), cocaine use during pregnancy (2% vs. 14%, p = 0.03), opiate use during pregnancy (7% vs. 37%, p = <0.001), and no prenatal care (7% vs. 40%, p ≤ 0.001). This case series identified birthing parent substance use and no prenatal care as risk factors for Highly Probable or Possible CS, underscoring the vulnerability of this population and informing future work in prevention of this disease.

Efficiency of primary care in Brazilian capitals and management models: 2008-2019.

To analyze efficiency in primary health care in Brazilian state capitals in the period 2008-2019, considering the management model: direct public administration or administration assigned to third parties. This is an evaluative study with an analytical objective, using publicly available secondary data, analyzed cross-sectionally (2019) and longitudinally (2008, 2012, 2016, and 2019). Demographic and socioeconomic data and seven indicators related to primary health care were used to characterize the cities and their primary health care (primary care coverage, hospitalizations for primary care-sensitive conditions, tuberculosis cures, infant, maternal, and premature mortality due to chronic conditions, incidence of congenital syphilis). To these indicators were added health and primary health care expenditures and data envelopment analysis focused on outputs (without admitting a reduction in expenditures) to calculate efficiency in 2008, 2012, 2016, and 2019. The Malmquist index was used to identify possible productivity gains between 2008 and 2019. Four capitals identified as being managed by third parties (São Paulo, Rio de Janeiro, Porto Alegre, and Fortaleza) did not achieve greater efficiency compared to direct public administration, nor did they evolve when comparing their own results over time. In 2019, and in the longitudinal approach, only capitals managed by direct public administration obtained the maximum relative efficiency index in the comparison between capitals. Twelve capitals with direct public administration remained efficient in all years, while those with third-party administration consistently showed weak inefficiency in primary health care, i.e. in the period studied, the relationship between investments in primary health care and results obtained is lower than that achieved by the efficient capitals. We found no evidence of efficiency gains with the adoption of third-party management. It should be noted that productive efficiency does not necessarily mean that health needs are met.