Successes and Challenges in the Elimination of Congenital Syphilis in Brazil: Evidence of Progress and Persistent Challenges.

Abstract

Background: Brazil has implemented multiple policies targeting congenital syphilis (CS); however, evaluations of their effectiveness remain limited. This study aimed to analyze temporal trends in annual rates of gestational syphilis (GS) and CS from 2011 to 2022 across Brazil and its regions. It was hypothesized that effective prenatal care would enable early GS detection and that appropriate treatment of pregnant patients and their partners would reduce CS detection rate.

Methods: This temporal study used GS and CS notification data from all Brazilian municipalities. National and regional annual rates were analyzed using the joinpoint regression model. Annual percent change (APC), average APC (AAPC), 95% confidence intervals, and p values were calculated.

Results: A total of 586,855 new GS cases and 272,491 CS cases were reported during the study period. GS rates increased throughout Brazil and all regions, accompanied by a decline in APC values. For CS, rates achieved overall stabilization in Brazil as well as the North, Midwest, and South regions, whereas the Southeast and Northeast regions experienced continuous growth with a reduced APC from 2015 and 2017, respectively.

Conclusion: Although CS trends stabilized or increased at reduced APC values over time, rates remain high. Additional efforts are required to eliminate the disease, including earlier initiation of prenatal care and improved prevention, diagnosis, and treatment of syphilis in pregnant patients and their partners.