Impact of implementation of rapid treponemal testing in prenatal care on incidence and severity of congenital syphilis

Abstract

Objective: to compare the incidence of congenital syphilis (CS) before and after the introduction of the rapid treponemal test and to determine whether there were changes in the clinical characteristics and severity of this disease. Methods: a cross-sectional study was conducted in the community of Viamão, Brazil. Reported cases of CS identified by maternal screening with a nontreponemal test (group I) and those identified by screening with a rapid treponemal test (group II) were compared. Data were obtained from the Notifiable Diseases Information System (SINAN). Results: 302 cases of CS were detected in the sample, with an incidence of 7.7 ‰ live births (80 / 10,369) in group I and 23.2 ‰ (222 / 9,538) in group II (p=0.000). After the introduction of the rapid treponemal test, there was a slightly higher proportion of pregnant women (1 (2.0 %) x 14 (8.8 %); p = 0.12) and their sexual partners (6 (11.8 %) x 38 (24.0 %); p = 0.12) who received adequate treatment during prenatal care, there were fewer newborns with clinical manifestations (11 (16.7%) x 12 (6. 2%); p = 0.02) and proven or highly probable CS (16 (24.2%) x 29 (14.8%); p = 0.10). The incidence per group of proven or highly probable CS was 1.5 and 3.0 ‰ live births, and possible CS was 4.7 and 16.6 ‰ (p = 0,10), respectively. Conclusion: screening with the rapid treponemal test was associated with a slight improvement in maternal management and fewer clinically affected neonates, although the incidence of CS increased significantly. This raises doubts about the quality of prenatal care for gestational syphilis.