Time trends and spatial patterns corresponding to maternal-child syphilis in the Brazilian North region
an ecological study
Keywords:
Syphilis, Syphilis, Congenital, Amazon Ecosystem, Infectious Disease Transmission, Vertical, Socioeconomic FactorsAbstract
Objective: To analyze time trends and spatial patterns corresponding to gestational and congenital syphilis in the Brazilian North region between 2014 and 2023.
Method: A time-based ecological study conducted with secondary data from the National Live Births System and from the national panel of syphilis indicators. The gestational and congenital syphilis rates were analyzed by means of log-linear regression and “joinpoint” models to estimate the Annual Percent Change. The associations were estimated via fixed-effects count and population-based offset methods, in turn, spatial dependence was estimated through spatial autoregressive regressions.
Results: Gestational Syphilis presented continuous growth in the historical series. Congenital Syphilis showed heterogeneity across the states, with an 80.5% annual increase in Amazonas until 2017, followed by a reverse trend after 2018; in turn, the increasing trend remained in Pará during the entire period.
Conclusion: Social and territorial inequalities remain as core determinants of persistent mother-to-child syphilis transmission in the Brazilian Amazon.
References
1. World Health Organization. Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus [Internet]. Geneva: WHO; 2021 [cited 2025 Sep 20]. Available from: https://www.who.int/publications/i/item/9789240039360
2. Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiané SG, et al. Correction: Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLoS One [Internet]. 2019 [cited 2026 Feb 24];14(2):e0211720. Available from: https://doi.org/10.1371/journal.pone.0219613
3. Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children [Internet]. 2023 [cited 2026 Feb 24];10(8):1310. Available from: https://doi.org/10.3390/children10081310
4. Ministério da Saúde (BR). Diretrizes Nacionais do Programa Brasil Saudável: unir para cuidar [Internet]. Brasília: Ministério da Saúde; 2025 [cited 2025 Oct 18]. Available from: https://www.gov.br/saude/pt-br/composicao/svsa/ciedds/publicacoes/diretrizes-nacionais-do-programa-brasil-saudavel-unir-para-cuidar.pdf/view
5. Dantas JC, Marinho CSR, Pinheiro YT, Ferreira MAF, da Silva RAR. Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: an ecological study. Front Pediatr [Internet]. 2023 [cited 2025 Oct 24];11:1109271. Available from: https://doi.org/10.3389/fped.2023.1109271
6. Seabra I, Ferreira GRON, Sorensen W, Oliveira C, Parente AT, Gir E, et al. Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study. BMJ Open [Internet]. 2022 [cited 2025 Oct 24];12(4):e058270. Available from: https://doi.org/10.1136/bmjopen-2021-058270
7. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico de Sífilis - 2023 [Internet]. Brasília: Ministério da Saúde; 2023 [cited 2025 Sep 20]. 53 p. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2023/boletim-epidemiologico-de-sifilis-numero-especial-out.2023
8. Echegaray F, Hernandez CJ, Sundar KG, Yang LZ, Cambou MC, Segura ER, et al. Repercussions of the COVID-19 pandemic on maternal and congenital syphilis in South Brazil: a time series analysis 2010-2022. BMC Infect Dis [Internet]. 2025 [cited 2025 Oct 24];25:528. Available from: https://doi.org/10.1186/s12879-025-10901-x
9. Reis EMC, Mendes SS, Calheiros CAP, da Silva SA, Silveira CA, Freitas PS. Prenatal care provided by nurses to pregnant women with syphilis: potential and challenges for preventing congenital syphilis. Rev. Eletr. Enferm. [Internet]. 2024 [cited 2025 Oct 24];26:77062. Available from: https://doi.org/10.5216/ree.v26.77062
10. da Silva TPR, Schreck RSC, de Oliveira DCB, Mascarenhas LV, Luvisaro BMO, Camargo BTS, et al. Spatial and trend analysis of gestational syphilis cases in Brazil from 2011 to 2020: an ecological study. BMC Public Health [Internet]. 2024 [cited 2026 Fev 24];24:1859. Available from: https://link.springer.com/article/10.1186/s12889-024-19286-z
11. Ministério da Saúde (BR). Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. Indicadores Sífilis [Internet]. Brasília: Ministério da Saúde; [cited 2025 Oct 18]. Available from: https://indicadoressifilis.aids.gov.br/
12. Paixao E, Ferreira AJF, Pescarini JM, Wong KLM, Goes E, Fiaccone R, et al. Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil. Lancet Glob Health [Internet]. 2023 [cited 2025 Oct 18];11(11):e1734-42. Available from: https://doi.org/10.1016/S2214-109X(23)00405-9
13. Ministério da Saúde (BR). Sistema de Informações sobre Nascidos Vivos [Internet]. Brasília: Ministério da Saúde; [©2025] [cited 2025 Oct 18]. Available from: https://www.gov.br/saude/pt-br/composicao/svsa/sistemas-de-informacao/sinasc
14 . Andrade LA, de Souza CDF, da Paz WS, de Gois Souza DG, Góes JAP, Camargo ELS, et al. Spacetime modeling of mortality by infectious and parasitic diseases in Brazil: a 20-year ecological and population-based study. Ther Adv Infect Dis [Internet]. 2025 [cited 2025 Oct 18];12:1-18. Available from: https://doi.org/10.1177/20499361251313830
15. de Oliveira GG, Palmieri IGS, de Lima LV, Pavinati G, dos Santos VMA, Luz KCSI, et al. Detection of gestational and congenital syphilis in Paraná state, Brazil, 2007–2021: a time series analysis. Epidemiol Serv Saude [Internet]. 2024 [cited 2025 Oct 18];33:e2024188. Available from: https://doi.org/10.1590/S2237-96222024V33E2024188.en
16. Silva ÂAO, Leony LM, de Souza WV, Freitas NEM, Daltro RT, Santos EF, et al. Spatiotemporal distribution analysis of syphilis in Brazil: cases of congenital and syphilis in pregnant women from 2001-2017. PLoS One [Internet]. 2022 [cited 2025 Oct 18];17(10):e0275731. Available from: https://doi.org/10.1371/journal.pone.0275731
17. Costa IB, Pimenta IDSF, Aiquoc KM, Oliveira ÂGRC. Congenital syphilis, syphilis in pregnancy and prenatal care in Brazil: an ecological study. PLoS One [Internet]. 2024 [cited 2025 Oct 18];19(6):e0306120. Available from: https://doi.org/10.1371/journal.pone.0306120
18. Wang Y, Wu M, Gong X, Zhao L, Zhao J, Zhu C, et al. Risk factors for congenital syphilis transmitted from mother to infant - Suzhou, China, 2011-2014. MMWR Morb Mortal Wkly Rep [Internet]. 2019 Mar 15 [cited 2025 Oct 18];68(10):247-50. Available from: https://doi.org/10.15585/mmwr.mm6810a4
19. Soares LG, Zarpellon B, Soares LG, Baratieri T, Lentsck MH, Mazza VA. Gestational and congenital syphilis: maternal, neonatal characteristics and outcome of cases. Rev Bras Saude Mater Infant [Internet]. 2017 [cited 2025 Oct 18];17(4):781-9. Available from: https://doi.org/10.1590/1806-93042017000400010
20. Pícoli RP, Cazola LHO. Missed opportunities in preventing mother-to-child transmission of syphilis in the indigenous population in central Brazil. Rev Bras Saude Mater Infant [Internet]. 2022 [cited 2025 Oct 18];22(4):823-31. Available from: https://doi.org/10.1590/1806-9304202200040006
21. Kidd S, Bowen VB, Torrone EA, Bolan G. Use of national syphilis surveillance data to develop a congenital syphilis prevention cascade and estimate the number of potential congenital syphilis cases averted. Sex Transm Dis [Internet]. 2018 [cited 2025 Oct 18];45(9 Suppl 1):S23-8. Available from: https://doi.org/10.1097/OLQ.0000000000000838
22. Ministério da Saúde (BR). Boletim Epidemiológico Sífilis 2024 [Internet]. Brasília: Ministério da Saúde; 2024 [cited 2025 Sep 20]. Available from: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2024/boletim_sifilis_2024_e.pdf
23. Soeiro CMO, Miranda AE, Saraceni V, dos Santos MC, Talhari S, Ferreira LCL. Syphilis in pregnancy and congenital syphilis in Amazonas State, Brazil: an evaluation using database linkage. Cad Saude Publica [Internet]. 2014 [cited 2025 Oct 24];30(4):715-23. Available from: https://doi.org/10.1590/0102-311X00156312
24. Bezerra MLMB, Fernandes FECV, Nunes JPO, Baltar SLSMA, Randau KP. Congenital syphilis as a measure of maternal and child healthcare, Brazil. Emerg Infect Dis [Internet]. 2019 Aug [cited 2025 Oct 18];25(8):1469-76. Available from: https://doi.org/10.3201/eid2508.180298
25. Rocha AFB, Araújo MAL, Taylor MM, Kara EO, Broutet NJN. Treatment administered to newborns with congenital syphilis during a penicillin shortage in 2015, Fortaleza, Brazil. BMC Pediatr [Internet]. 2021 [cited 2025 Oct 18];21:166. Available from: https://doi.org/10.1186/s12887-021-02619-x
26. Borges PKO, Martins CM, Stocco C, Zuber JFS, Borges WS, Muller EV, et al. Impact of COVID-19 on notifiable diseases: a time series study. Rev Esc Enferm USP [Internet]. 2024 [cited 2025 Oct 24];58:e20240098. Available from: https://doi.org/10.1590/1980-220X-REEUSP-2024-0098en
27. Araujo RS, de Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saude Publica [Internet]. 2020 [cited 2025 Oct 18];54:109. Available from: https://doi.org/10.11606/s1518-8787.2020054002196
28. dos Santos MM, de Lima KC, Bay MB. Impacto da pandemia de COVID-19 na utilização de testes rápidos de sífilis na rede de atenção básica em saúde. Braz J Infect Dis [Internet]. 2022 [cited 2025 Oct 18];26(Suppl 1):102187. Available from: https://doi.org/10.1016/j.bjid.2021.102187
29. Vital CL, Reis RB, Soares JFS, Miranda DLP, Reis MG. Spatial distribution of congenital syphilis in the state of Bahia, Brazil from 2009 to 2018. Front Epidemiol [Internet]. 2023 [cited 2025 Oct 18];3:1234580. Available from: https://doi.org/10.3389/fepid.2023.1234580
30. Medeiros JAR, Yamamura M, da Silva ZP, Domingues CSB, Waldman EA, Chiaravalloti-Neto F. Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil. Sci Rep [Internet]. 2022 [cited 2025 Oct 18];12:585. Available from: https://doi.org/10.1038/s41598-021-04530-y
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Maria Karoliny da Silva Torres, Laís Gabriela da Silva Neves, Andressa Tavares Parente, Cintia Yolette Urbano Pauxis Aben-Athar, Eliã Pinheiro Botelho, Glenda Roberta Oliveira Naiff Ferreira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Cogitare Enfermagem reserves the right to make normative, orthographic, and grammatical changes to the published article to maintain the cultured standard of the language, while respecting the authors' style.
The published study is the sole responsibility of the author(s), and Cogitare Enfermagem is exclusively responsible for evaluating the manuscript as a scientific publication vehicle. Revista Cogitare Enfermagem is not responsible for any violations of Law No. 9,610/1998, the Brazilian Copyright Law.
Cogitare Enfermagem allows the author to hold the copyright of articles accepted for publication, without restrictions.
The articles published are licensed under the Creative Commons license CC BY 4.0 Creative Commons - Attribution 4.0 International - CC BY 4.0 - The attribution adopted by Cogitare Enfermagem is permitted:
- Share - copy and redistribute the material in any media or format.
- Adapt - remix, transform and build upon the material for any purpose, even commercially.
- Attribution - You must give proper credit, provide a link to the license, and indicate if changes have been made. You may do this in any reasonable way, but not in a way that suggests that the licensor endorses it or approves of its use.
- No additional restrictions - You may not apply legal terms or technological measures that legally restrict others from doing something that the license allows.
