# Gestational and congenital syphilis in the state of Rio de Janeiro, Brazil, 2021‒2023

## TL;DR

This study examines gestational and congenital syphilis in Rio de Janeiro, Brazil, finding higher rates among women with public healthcare and significant missed prevention opportunities.

## Contribution

The study provides new prevalence and incidence estimates for gestational and congenital syphilis in Rio de Janeiro, highlighting disparities in public versus private healthcare systems.

## Key findings

- The prevalence of gestational syphilis was 14.5%, with higher rates in women with public financing.
- The incidence of congenital syphilis was 53.1 per 1,000 live births, with a vertical transmission rate of 33.5%.
- Reported rates of gestational and congenital syphilis were double those in the national disease surveillance system.

## Abstract

Gestational (GS) and congenital syphilis (CS) are important public health problems in Brazil. This study aims to estimate the prevalence of GS, the incidence of CS and the rate of vertical transmission (VT) of syphilis, as well as to evaluate the management indicators of GS in the State of Rio de Janeiro (RJS), the Brazilian state with the highest detection rate of GS and incidence of CS in 2022. A hospital-based, cross-sectional study was carried out in public and private hospitals located in RJS, in the period 2021–2023, with interviews with 1,923 women, analysis of prenatal care (PNC) cards and hospital records. The GS management indicators, the prevalence of GS, the incidence of CS and the rate of VT were estimated with the respective 95 % confidence intervals (95 % CI), according to the source of financing for hospitalizations for childbirth or abortion care. PNC was reported by 93.7 % of women, 82.7 % had the first test for syphilis and 52.6 % the second. The prevalence of GS was estimated at 14.5 % (95 % CI 9.2 %- 22.2 %), with higher values in women with public financing (18.2 % public; 3.6 % private). Nearly one-third-of women with GS were diagnosed only during hospitalization for childbirth or abortion care and 13.4 % were appropriately treated during PNC. The incidence of CS was estimated at 53.1 per 1,000 live births (68.4 per 1,000 public; 9.7 per 1,000 LB private) with a VT rate of 33.5 %, with no difference according to the source of financing. The detection rate of GS and the incidence rate of CS were double those reported to the Brazilian Notifiable Diseases Information System. Several missed opportunities for the control of CS were identified. Women with public financing had a higher prevalence of GS and incidence of CS, and should be the priority target of control strategies.