Congenital syphilis outbreak is a shame for the Country, says the President of the Brazilian Society of STDs

Experts say the shortage of benzathine penicillin is among the reasons for the increase in case numbers

The increase in syphilis cases in Brazil worries especially due to the high number of mother-child transmissions, known as congenital. Some factors have been quoted to explain this scenario, as issues releasing diagnosis and treatment or even due to the increase in diagnostic numbers in the past years. However, regardless of reasons, the outbreak of congenital cases of the disease is a shame for the Country, according to the president of the Brazilian Society of Sexually Transmitted Diseases (STDs), Doctor Mauro Romero. If there is a reason for Brazilian public health system to be ashamed, this reason is congenital syphilis. Because we have tests, a simple medication which is easy and cheap and it is possible to reach these infected people quickly and broadly, says the physician who is also a full professor at the STD department at the Fluminense Federal University (UFF), in Rio de Janeiro.

Between 2014 and 2015, the acquired syphilis cases in Brazil increased by 32.7%, as grew cases in pregnant women (20.9%) and the congenital cases (19%). This way, 2015 reported 6.5 syphilis cases for every thousand live births, 170% greater than in 2010. The most concerning situation is in Rio de Janeiro State, where 12.4 cases per thousand live births are reported.

Despite the increase of cases among pregnant women and fetuses, there was also an increase in syphilis test coverage during prenatal, according to the SDT, Aids and Viral Hepatitis Department from the Health Ministry (DDAHV). This happens since this test was included in the Rede Cegonhas procedure protocol, in October 2012. Besides this, there is a certain resistance by health professionals applying penicillin in basic attention fearing allergic reactions, despite the cancellation of the decree, allowing its application without emergency apparatus, clarifies the director of the organs STD/Aids department, Adele Benzaken.

As a reaction to this situation, the Health Ministry launched several strategies to contain the disease, with help from associations and entity councils. Among them, increasing tests; managers and health professionals mobilization to offer syphilis exams and treatment during prenatal care; increase of diagnostic (by rapid tests) and treating both the pregnant women and their partners with penicillin. However, besides these actions, Dr. Mauro believes there must have direct actions over structural issues, as lack of qualification for diagnostic. I am able to identify problems as delayed tests and treatments as well as poor medical formation, not enough to efficiently act on STDs. Specific medical sub-areas must be created for sexually transmitted diseases, he says while adding that if these cases cannot be reduced from one year to the other, then we are incompetent to deal with the problem.

Research: prevention is not a priority

Field authorities defend the release of all information about syphilis and other STDs to the society, especially when a research by the Health Ministry shows that precaution is not a priority, even when people know they must prevent themselves.

A study from 2013 involving 12 thousand men and women, aging from 15 to 64 years old, showed that 94% of the interviewed people knew the importance of using condoms, but only 23.5% of them admitted to have used protection in all sexual relations in the past 12 months. The survey – known as Research of Knowledge, Attitudes and Practices in the Brazilian Population (PCAP) – was published in 2016. To Dr. Mauro, the concern about diseases as syphilis was never great in Brazil, reason why the number of cases has always been high. We cannot blame the lack of penicillin (main antibiotic used treating the disease), since it only happened one or two years ago.

Some experts say the shortage of Benzathine penicillin, affecting the whole world since 2014, is among the reasons why the number of cases has risen. According to the Health Board, the Brazilian government, has purchased under emergency criteria, 2.7 million flasks of the antibiotic, and has given pre ion priority for pregnant women and their partners. Still according to the Board, Brazil has increased by over 4 times the number of tests distributed to States and Municipalities, from 1.1 million in 2001 to 6.1 million tests in 2015. Besides this, still according to the Health Ministry, until past August, over 3 million tests had been shipped across the Country.

To the president of the Brazilian Society of STDs, the debate about these diseases must be strengthened, especially in schools. Schools do not want to talk about this, arguing this will encourage sexual activity. As long as we think this way, we will hardly reach the young. We must disclose information, whether on TV, at school or at home, says the physician. A good example of the lack of information, according to him, is the vaccine against the HPV, a sexually transmitted disease that causes genial lesions and cancer. The immunization campaign aiming girls from nine to 13 years old, from 2014 to 2015, were considered successful and reached 92.3% of the targeted population. However, until last March, only 69.5% of the targeted population had taken the first dose of the vaccine. As for the second dose, the result was even worse: 43.73%.

Where is the debate? Where are the demands? The vaccines are already at the health centers and will expire. We must debate more. The societies must be more active, more united, to be firm when requesting better health and education, said the UFF professor. Asked about this years low adherence to the HPV campaign, the Health Ministry informed the initiative was affected by the disclosure of erroneous information about the vaccines possible side effects, which were then discarded. However, despite the difficulties, professor Mauro said to be optimistic. I am safe I have never seen a moment so propitious to advance towards a reduction of syphilis cases, especially congenital syphilis. This time we can see a good engagement among the sectors, the Health Ministry, medical societies, class organs, etc. If we could engage the Education Board, the State and City secretaries, direct contact health professionals, as well as the large media, who knows if we could strike a great mobilization with a national day for syphilis tests on all pregnant women in the Country. Who knows, if we could then reach these womens sexual partners, he suggests.…