Sífilis congênita como desafio de saúde pública : análise temporal de óbitos no Brasil e experiências de mulheres com sífilis na gestação.

Abstract

Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum, which can also be transmitted from mother to baby during pregnancy, causing serious complications such as miscarriage, premature birth, stillbirth, and congenital sequelae. Even with control measures in place for over a century, the disease continues to be prevalent in Brazil and worldwide, and is considered a serious public health problem. The infection can go unnoticed in its early stages because it is often asymptomatic. However, if left untreated, it can progress to severe forms, affecting the nervous system and the heart. Given this, diagnostic tests must be performed even without symptoms, especially during prenatal care. Primary health care plays an essential role in combating syphilis, being responsible for early detection, adequate treatment, and follow-up of cases, using technical knowledge and available resources to reduce vulnerability to sexually transmitted infections. GENERAL OBJECTIVE: To investigate knowledge, information, and experiences related to syphilis in women treated in the SUS, linking these experiences with the monitoring of congenital syphilis and with the national and municipal epidemiological panorama of the disease. MANUSCRIPT 1: Objective: To analyze the temporal trend of deaths from congenital syphilis in Brazil from 1996 to 2019. Method: This is an ecological trend study. Data obtained by the Department of Informatics of the Unified Health System were used, extracted from the International Classification of Diseases, version 10, code A50. For the analysis of temporal trends, joinpoint regressions were performed, considering the annual percentage change in the number of cases and their respective 95% confidence intervals (95% CI) for national data and data from each region of the country. Results: From 1996 to 2019, Brazil recorded a total of 3,013 deaths from congenital syphilis. The southeast region had the highest number of deaths recorded during the period (n=1,314). The Northeast region recorded 938 deaths, the North region 325, and the South region 296. The Midwest region recorded the lowest number of deaths in the period (n=140). Conclusion: Brazil experienced a period of decline in deaths from congenital syphilis between 1996 and 2008, while between 2008 and 2015, there was an increase. However, since 2015, the country has seen a stabilization in the number of deaths. MANUSCRIPT 2: Objective: This study aims to investigate the knowledge/information and experiences of women who presented with syphilis in a SUS (Brazilian Unified Health System) service in a municipality in Rio Grande do Sul, Brazil. Method: This is a descriptive study with a qualitative approach, using open interviews conducted between May and November 2024 with 23 women whose children were exposed to syphilis or presented with congenital syphilis. The data were analyzed using Bardin's content analysis. Results: The majority of participants (12) reported having no prior knowledge about syphilis, allowing for a greater impact due to a lack of knowledge about the disease. In contrast, other participants (11) stated that they had prior knowledge, demonstrating female empowerment regarding information related to the disease. This suggests that investments in health, education, networking, professional qualifications, and other strategies adopted by the SUS have a positive impact. The guidance received was generally brief, and partner adherence to treatment remained a challenge. Strategies focused on welcoming patients, health education, and humanization proved to be crucial for therapeutic adherence. Conclusion: The study highlights the need for public policies and care practices that promote partner engagement, health education, and comprehensive care for pregnant women, aiming at the prevention of congenital syphilis and the promotion of maternal and child health. FINAL CONSIDERATIONS OF THE DISSERTATION: The study revealed that in a municipality in the valley’s region of Rio Grande do Sul, although there have been advances in the screening and treatment of gestational syphilis, important issues persist regarding care, clinical follow-up, and communication between professionals and users. Approximately Half of the women interviewed reported having prior knowledge about the disease and its treatment, demonstrating the commitment of the municipal health network to ensure access to quality healthcare, maintaining focus and work within the guidelines of the Brazilian Unified Health System (SUS). Adherence to treatment was satisfactory, but partner engagement remains low, compromising the prevention of vertical transmission. The findings reinforce the need for health education, team training, active case finding, male inclusion in care, and improvement of surveillance flows.