Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study

Amorim, Evlhin Karolline Ramos; Matozinhos, Fernanda Penido; Araújo, Laydson Adrian; Silva, Thales Philipe Rodrigues da

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 30 (4) • 2021 • https://doi.org/10.1590/S1679-49742021000400006 copy

Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the trend of notifications of gestational and congenital syphilis in Minas Gerais, Brazil, from 2009 to 2019.

Methods:

This was an ecological time series study which took the state of Minas Gerais as its unit of analysis, based on data reported on the Notifiable Health Conditions Information System (SINAN). The Prais-Winsten autoregressive model was used to verify trends.

Results:

20,348 cases of gestational syphilis and 11,173 cases of congenital syphilis were reported. Average percentage annual increase was 36.7% (95%CI 32.5;41.0), for gestational syphilis incidence rates, and 32.8% (95%CI 28.0;37.8) for congenital syphilis incidence rates (p<0.001).

Conclusion:

The temporal trend analysis showed that gestational and congenital syphilis incidence rates had significant increasing trends, which may be related to inadequate treatment or failure to treat syphilis during pregnancy.

Keywords:
Syphilis; Congenital Syphilis; Pregnant Women; Epidemiological Monitoring; Sexually Transmitted Diseases; Time Series Studies.

Sociodemographic characteristics	n	%
Gestational syphilis
Maternal age (years) (n=20,347)
10-14	229	1.1
15-19	5,197	25.5
20-29	10,754	52.9
30-39	3,779	18.6
≥40	388	1.9
Schooling (n=20,347)
Illiterate	68	0.3
1^st to 4^th grade incomplete	593	2.9
4^th grade complete	551	2.7
5^th to 8^th grade incomplete	3,404	16.7
Complete elementary education	1,965	9.7
Incomplete high school education	2,527	12.4
Complete high school education	3,027	14.9
Incomplete higher education	196	1.0
Complete higher education	161	0.8
Unknown^a	7,855	38.6
Race/skin color (n=20,348)
White	4,820	23.7
Black	3,229	15.9
Yellow	224	1.1
Brown	9,760	48.0
Indigenous	25	0.1
Unknown^a	2,290	11.2
Congenital syphilis
Child’s age (n=11,173)
Less than 7 days	10,718	95.9
7-27 days	192	1.7
28-364 days	210	1.9
1 year	27	0.2
2-4 years	15	0.1
5-12 years	11	0.1
Maternal age (years) (n=11,173)
10-14	90	0.8
15-19	2,635	23.6
20-29	5,834	52.2
30-39	2,196	19.7
≥4	223	2.0
Unknown^a	195	1.7
Maternal schooling (n=11,173)
Illiterate	60	0.5
1^st to 4^th grade incomplete	340	3.0
4^th grade complete	238	2.1
5^th to 8^th grade incomplete	1,816	16.3
Complete elementary education	1,174	10.5
Incomplete high school education	1,169	10.5
Complete high school education	1,525	13.6
Incomplete higher education	88	0.8
Complete higher education	78	0.7
Not applicable	86	0.8
Unknown^a	4,599	41.2
Maternal race/skin color (n=11,173)
White	2,042	18.3
Black	1,511	13.5
Yellow	68	0.6
Brown	5,933	53.1
Indigenous	16	0.1
Unknown^a	1,603	14.3

Clinical characteristics	n	%
Gestational syphilis (n=20,348)
Clinical classification
Primary syphilis	6,869	33.8
Secondary syphilis	1,441	7.1
Tertiary syphilis	1,184	5.8
Latent syphilis	3,676	18.1
Unknown^a	7,178	35.3
Gestational age
1^st trimester	5,628	27.7
2^nd trimester	5,146	25.3
3^rd trimester	8,020	39.4
Unknown^a	1,554	7.6
Congenital syphilis (n=11,173)
Time at which maternal syphilis diagnosed
During prenatal period	7,015	62.8
Congenital syphilis (n=11,173)
Time at which maternal syphilis diagnosed
At childbirth/curettage	2,893	25.9
After childbirth	840	7.5
Not performed	75	0.7
Unknown^a	350	3.1
Maternal treatment regimen
Adequate	601	5.4
Inadequate	6,664	59.6
Not performed	2,721	24.4
Unknown^a	1,187	10.6
Sex partner treated
Yes	2,030	18.2
No	6,820	61.0
Unknown^a	2,323	20.8

Year
Sociodemographic and clinical variables	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019
Gestational syphilis cases	n=306	n=362	n=550	n=871	n=1,138	n=1,698	n=2,410	n=2,605	n=3,667	n=4,851	n=1,890
Gestational syphilis cases according to period in which syphilis was diagnosed
1^st trimester	15.7	16.6	20.2	22.2	23.2	22.0	22.2	25.2	31.3	33.0	33.9
2^nd trimester	28.4	31.5	31.1	28.1	26.8	24.7	25.0	25.9	25.1	22.9	26.0
3^rd trimester	46.7	45.8	39.6	41.8	40.9	43.1	43.5	40.9	37.3	37.0	34.9
Unknown^a	9.2	6.1	9.1	7.9	9.1	10.2	9.3	8.0	6.3	7.1	5.2
Gestational syphilis cases by pregnant women’s age range (years) at the time syphilis was diagnosed
10-14	0.3	1.1	1.8	1.0	1.5	1.6	1.2	1.3	0.9	1.0	1.0
15-19	21.9	19.6	23.3	23.1	26.3	28.6	26.2	25.2	27.3	25.0	23.3
20-29	55.6	56.1	49.1	46.4	51.9	49.1	51.7	53.9	52.8	54.4	56.2
30-39	18.6	21.3	21.5	27.3	18.8	18.8	19.1	18.2	17.0	17.8	17.5
≥40	3.6	1.9	4.3	2.2	1.5	1.9	1.8	1.5	2.0	1.8	2.0
Gestational syphilis cases according to clinical classification of gestational syphilis at the time syphilis was diagnosed
Primary syphilis	36.8	33.4	34.2	29.6	32.3	37.3	34.1	31.9	35.3	33.9	31.4
Secondary syphilis	8.3	6.9	9.3	8.5	6.9	6.5	7.8	9.2	7.2	5.7	5.6
Tertiary syphilis	3.5	3.6	4.4	4.9	5.5	6.1	5.5	5.4	6.0	6.4	6.6
Latent syphilis	8.0	11.9	10.9	8.8	7.0	9.0	10.7	14.6	20.8	25.7	31.1
Unknown^a	43.3	44.2	41.2	48.2	48.3	41.1	41.9	38.9	30.7	28.3	25.3
Congenital syphilis cases	n=197	n=230	n=312	n=508	n=642	n=947	n=1,422	n=1,473	n=1,813	n=2,443	n=1,186
Congenital syphilis cases according to prenatal follow-up information on the mother
Yes	84.8	83.9	76.9	75.0	78.4	83.3	84.3	86.2	88.1	89.4	88.4
No	13.2	12.6	17.0	19.3	16.0	13.7	10.3	9.5	9.7	8.8	8.9
Unknown^a	2.0	3.5	6.1	5.7	5.6	3.0	5.4	4.3	2.2	1.8	2.7
Congenital syphilis cases according to maternal treatment regimen
Adequate	4.6	5.7	4.8	4.1	4.7	3.7	5.0	4.1	7.1	5.8	6.4
Inadequate	47.2	50.4	43.9	51.0	52.6	62.9	60.1	62.1	61.1	63.3	59.3
Not performed	32.0	28.7	29.2	26.0	27.1	22.0	24.0	25.1	25.3	22.6	22.2
Unknown^a	16.2	15.2	22.1	18.9	15.6	11.4	10.9	8.7	6.5	8.3	12.1

Demographic and clinical variables	% average annual percent change (95%CI)^a	p-value^b	Trend^c
Gestational syphilis incidence rate (2009-2018)	36.7 (32.5;41.0)	<0.001	Rising
Congenital syphilis incidence rate (2009-2018)	32.8 (28.0;37.8)	<0.001	Rising
Gestational syphilis cases by gestational age at diagnosis of syphilis
1^st trimester	7.8 (5.5;10.1)	<0.001	Rising
2^nd trimester	-2.3 (-3.6;-1.0)	0.004	Falling
3^rd trimester	-2.4(-3.8;-1.0)	0.005	Falling
Gestational age unknown^d	-3.2 (-7.8;1.5)	0.161	Stationary
Gestational syphilis cases by pregnant women’s age range (years) at the time syphilis was diagnosed
10-14	4.2 (-6.8;16.6)	0.433	Stationary
15-19	1.4 (-1.3;4.2)	0.285	Stationary
20-29	0.3 (-1.4;2.1)	0.673	Stationary
30-39	-2.3 (-4.6;0.1)	0.058	Stationary
≥40	-5.4 (-10.0;-0.5)	0.037	Falling
Gestational syphilis cases according to clinical classification of gestational syphilis at the time syphilis was diagnosed
Primary syphilis	-0.5 (-2.0;1.1)	0.519	Stationary
Secondary syphilis	-3.1 (-6.6;0.5)	0.087	Stationary
Tertiary syphilis	6.1 (3.3;9.0)	0.001	Rising
Latent syphilis	13.8 (3.2;25.5)	0.016	Rising
Diagnosis unknown^d	-4.0 (-7.6;-0.2)	0.042	Falling
Congenital syphilis cases according to prenatal follow-up information on the mother
Yes	0.7 (-0.8;2.3)	0.304	Stationary
No	-5.0 (-10.3;0.7)	0.083	Stationary
Unknown^d	-2.7 (-13.6;9.6)	0.622	Stationary
Congenital syphilis cases according to maternal treatment regimen
Adequate	2.7 (-1.3;6.9)	0.168	Stationary
Inadequate	3.2 (1.5;5.0)	0.003	Rising
Not performed	-3.0 (-4.4;-1.7)	0.001	Falling
Unknown^d	-6.2(-13.3;1.4)	0.101	Stationary

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Thales Philipe Rodrigues da Silva - Av. Alfredo Balena, No. 190, Santa Efigênia, Belo Horizonte, MG, Brazil. CEP: 30130-100 E-mail: thalesphilipe27@hotmail.com