Lessons about the reliability of congenital syphilis and vertical HIV transmission data learned from case reviews in Uruguay: a cross-sectional study

Abstract

BackgroundIn Uruguay it is mandatory to review all cases of positive HIV or reactive syphilis tests in pregnancy and peripartum. We compared the rates of mother-to-child transmission of syphilis and HIV detected by case reviews to those obtained from the usual surveillance system and described the characteristic of vertical transmission cases.MethodsThis is a cross-sectional study performed with secondary data obtained from official government sources, for all the country cases of maternal to child transmission of HIV and syphilis from 2012 to 2017, with descriptive analyses. For congenital syphilis analyses, the following pregnancy characteristics were investigated: number of antenatal checks, gestational age at pregnancy diagnosis, gestational age at syphilis test and diagnosis, adequate treatment, and treatment of partners. Sociodemographic characteristics included type of health care (public/private), maternal age, distribution of ethnic minorities, maximum educational attainment, presence of partner, planned pregnancy, drug and alcohol use, domestic violence, previous maternal diagnosis of syphilis, and previous children with congenital syphilis.ResultsCoverage of syphilis case reviews increased from 82% in 2014 to 97.4% in 2017. For HIV, this coverage reached 100% in 2017 and elimination of mother to child transmission was achieved. A marked decline in congenital syphilis was noted in the public health care sector, especially in the capital Montevideo, whereas the private sector has remained below the elimination target. Variables related with congenital syphilis in exposed children were late pregnancy diagnosis, < 5 antenatal checks, delayed diagnosis of gestational syphilis, lower rate of correct treatment for gestational syphilis, untreated partner, low maternal schooling, unplanned pregnancy, history of syphilis, and having other children with syphilis.ConclusionThe use of case reviews provided knowledge regarding the accurate number of mother-to-child transmission cases and the evolution of elimination of mother to child transmission in the country. The results suggest that rates must be adjusted, providing an opportunity to improve the reliability of surveillance data, and point the need to address specific gaps in order to improve the quality of care during pregnancy, delivery, and the neonatal period.

Acquired oral syphilis: A multicenter study of 339 patients from South America

“…Second, the figures of positive cases of syphilis can be underestimated, as the number of nonshows at services to obtain the results of the requested tests is high (Schuch et al, 2019). Although European countries have used partner notification as one of a series of measures to control STI since the early 1900s (Lowndes et al, 2004), in South America, compulsory notification has only been applied to acquired syphilis very recently, with government regulations set in place in Peru in 2009, in Brazil in 2010, and in Uruguay in 2013 (Cabrera et al, 2019; Marques Dos Santos et al, 2020). Yet, mandatory syphilis notifications in other countries of this continent are still deficient (Zoni et al, 2013).…”

“…set in place in Peru in 2009, in Brazil in 2010, and in Uruguay in 2013 (Cabrera et al, 2019;Marques Dos Santos et al, 2020). Yet, mandatory syphilis notifications in other countries of this continent are still deficient (Zoni et al, 2013).…”

Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study

“…In addition, most mothers of children diagnosed with CS had low education levels and attended less than five prenatal care visits 32. In a province of Northern Italy, the syphilis prevalence was higher among immigrant women with most of them receiving a late diagnosis 33. From 2008 to 2015, in the Northeast Brazilian region, the syphilis prevalence trended up among those pregnant women with low schooling levels, aged 15–19 years old and having black/brown skin colour 34.…”