Lessons learned in the management of congenital syphilis - "Towards the elimination in 2012," São Paulo State, Brazil
C.S.B. Domingues1, L.H. Matida1, S.E.C. Gomes1, V. Cervantes1, I.A. Paula1, M. Moreira2, M.C. Gianna1, Study Group on Mother-to-Child Transmission of HIV/Syphilis, São Paulo, Brazil
1State Program of STD/AIDS, São Paulo, Brazil, 2National Agency of Health, Rio de Janeiro, Brazil
Issues: To evaluate strategies established by the Plan for Congenital Syphilis Elimination of the São Paulo State STD/AIDS Program (PEDST/AIDS-SP) in 2007, with a goal of less than one case per thousand live births by 2012.
Description: The PEDST/AIDS-SP prepared the Plan along with various sectors from the state government health board, such as epidemiological and sanitary surveillance, central laboratory, women and children health programs, primary care and Municipal Council Departments of Health. Civil society participated in the development of information for individuals (posters, folders). Technical Notes preparation:
(i) recommendation for sexual partner's participation in prenatal care,
(ii) standardization of diagnostic tests for syphilis (treponemal and non treponemal test),
(iii) recommendation of penicillin administration at all public health services.
The private health sector has recommended syphilis testing in all pregnant women. Medical societies issued ordinances and created awareness among physicians to request VDRL testing for pregnant women. The government pledged funds in the State budget for syphilis testing in pregnant women and sexual partners. From 2005-2008, 3,149 cases of syphilis during pregnancy (PS) and 3,370 cases of congenital syphilis (CS) were reported; incidence rates of CS remained stable at 1.4 / 1,000 live births. The number of maternities and municipalities that reported a case of CS per year increased (from 42 in 2005 to 210 municipalities in 2008).
Lessons learned: CS recognized as a public health problem and subject to elimination; awareness of public and private network health professionals. CS has become a sentinel event and each case should be investigated by regional morbidity and mortality committees.
Next steps: Challenges:
(i) implement strategies for the involvement of sexual partners (men's responsibility as a "pregnant person"),
(ii) increase partner treatment,
(iii) change behavior, safe sex practices,
(iv) guarantee treatment with penicillin.
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