Increased incidence of syphilis: professionals must be aware of diagnosis and prevention

Publicação: 9 de November de 2018

2016 registered 87,593 cases of acquired syphilis, 20,474 cases of congenital syphilis and 37,436 cases of syphilis in pregnant women

There has been an unexpected increase in acquired syphilis cases in Brazil, but cases of congenital syphilis are the of greatest concern

On October 19 Brazil celebrated the “National Day of Syphilis Combat”, but unfortunately, there is not much to celebrate. As silent as it is dangerous, the disease is spreading and worrying physicians and authorities. According to the 2017 Syphilis Epidemiological Bulletin, from the Ministry of Health (MoH), 2016 registered 87,593 cases of acquired syphilis, 20,474 cases of congenital syphilis and 37,436 cases of syphilis in pregnant women. In Piauí State, for example, 272 pregnant women were reported to have syphilis in 2016. This number rose to 341 the next year and to 447 until October 2018. Figures point that the number of cases among pregnant women have increased by 60% in two years.

The Coordinator of Communicable Diseases in the State of Piauí, Dr. Karinna Amorim, says a medication shortage three years ago may have contributed to the increase in the number of cases. “However, even after solving this problem, the disease spread is still increasing. So, the increase can also be related to the society’s lack of awareness about the syphilis situation, that is still neglected. “Society must perceive the epidemic we are living and adopt joint measures against syphilis, besides creating mechanisms to support specific vulnerabilities demands. It is urgent to intensify efforts to control the disease, which despite being easy do diagnose and having a low-cost treatment, is still a great challenge”, she says.

According to the World Health Organization (WHO), 2017 analysis showed that more than 20 countries, including the United States, Canada, South Africa, Australia and Brazil, are facing a shortage of benzathine penicillin.

Syphilis still defies public prevention policies

Dr. Karinna points out that despite the progress achieved, the disease lingers as a challenge, while the need is for mutual efforts and policy prioritization. “I’m impressed and concerned about how people think syphilis doesn’t exist anymore, and others think it has no cure”, she says.

The Coordinator explained that since syphilis has essentially a sexual transmission, the role of health professionals in the field of prevention is often limited, because the disease is related to behavioral factors and individual and social vulnerabilities. “People must have self-perception of vulnerability, so they can feel responsible for their health. As subjects of rights, they should be aware and realize whenever they are at risk, so this reflection can induce safer behaviors, as using condoms during sexual intercourse or performing routine examination for early detection of the disease”, she says.

In recent years there has been an unexpected increase in cases of acquired syphilis in the country, but the cases of congenital syphilis are currently of greatest concern to medicine. Data from the WHO indicate that 25% of pregnant women who have the disease have miscarriages or give birth to stillborn babies. In Brazil, this is the second most common cause of death, second only to deaths by genetic malformation. According to the 2017 Syphilis Epidemiological Bulletin from the MoH, in Latin America and the Caribbean, it is estimated that between 166,000 and 344,000 children are born with congenital syphilis.

“We must acknowledge congenital syphilis as a severe public health problem. This is a fragile prenatal indicator, it is understood that this monitoring is not adequate, that is, pregnant women are not having early diagnostic tests, much less they are treating themselves”, says Dr. Karinna. To her, it is necessary to improve access to diagnostic tests – especially to rapid tests – and facilitating timely treatment in the same place diagnosis is confirmed.

Ocular syphilis also grows in Brazil

A study published in August in the journal Nature Scientific Reports calls attention to a worrying increase in cases of ocular syphilis. For example, at the Clinics Hospital at the Ribeirão Preto Medical School (HCFMRP), of the São Paulo University, until 2012 only one case of ocular syphilis was identified per year. In 2013 this number rose to eight. The increase also happened in other parts in the world, such as United States and Europe. Recent reports describe cohorts up to 85 patients with ocular syphilis in the United States, Europe and Australia. The discoveries are a reflection of the resurgence of this infectious disease around the world.

To Dr. Karinna, this owes to lack of information and awareness. “As previously warned, syphilis is a disease neglected both by the population, who don’t seek means of prevention and diagnostic and by health professionals, who do not suspect and therefore do not investigate how widespread ocular syphilis is, while incorrect diagnosis delays treatment and can lead to permanent sight damage”, she says.

Strategic actions to reduce syphilis in the country

In October 2016, the Pan American Health Organization (PAHO) reinforced support for Brazil in the fight against syphilis with the “Letter of Intent” that established strategic actions to reduce congenital syphilis in the Country within one year. According to Dr. Karinna, since then we had excellent short-term results, and she believes others are still to come. “Much has to be done to control the epidemic, but we had visible advances, especially regarding diagnosis and treatment”, she says.

Despite being a disease prevalent in developing countries, especially due to individual, social and programmatic vulnerabilities, syphilis is emerging, mainly in industrialized countries. “However, since currently there is a worldwide outbreak of the disease, other populations would also experience this moment of epidemic. It is believed to be related to social and cultural aspects”, finishes the Coordinator of Communicable Diseases of the State of Piauí.