[Syphilis positivity in puerperal women: still a challenge in Brazil].
OBJECTIVE
To investigate the factors associated with positive syphilis serology results in puerperal women who were receiving care at 24 health centers accredited by Brazil's National Program on Sexually Transmitted Diseases and AIDS.


METHODS
This cross-sectional study included a probabilistic random sample of 3047 puerperal women. The eligibility criterion was being admitted for delivery or curettage in the selected centers. After an interview to collect demographic and clinical information, a blood sample was taken and then examined with the Venereal Disease Research Laboratory (VDRL) slide test. With positive VDRL results, the fluorescent treponemal antibody-absorption test (FTA-Abs) was used for confirmation. The event considered for analysis was positivity on the VDRL test, with confirmation by the FTA-Abs. For the statistical analysis, odds ratios and 95% confidence intervals were calculated. The model fit was assessed using the Hosmer-Lemeshow test.


RESULTS
The prevalence of syphilis among the women studied was 1.7%. Multivariate analysis showed that increased risk for positive VDRL and FTA-Abs results was associated with the following characteristics: family income below one minimum wage, age < 17 years at first sexual intercourse, age < or = 14 years at first pregnancy, history of syphilis or of other sexually transmitted diseases prior to the current pregnancy, treatment for syphilis during the current pregnancy, partner having been tested for syphilis, having a positive HIV test result or having no HIV test result on record, previous preterm delivery, and stillbirth as an outcome of pregnancy. Only 43% of the women had had six or more prenatal visits, and only 3% had had one VDRL test during the first trimester of pregnancy and another VDRL test during the third trimester, as is recommended by Brazil's national Ministry of Health.


CONCLUSIONS
This study shows that the problem of congenital syphilis is far from being solved in Brazil. It is necessary to provide adolescents with family planning services as well as guidance on sexual issues, to improve prenatal follow-up, and to research the history of sexually transmitted diseases in both the pregnant woman and her sexual partner.
Rodrigues
Celeste S
CS
Secretaria Municipal de Saúde de Belo Horizonte (MG), Brazil.
Guimarães
Mark D C
MD
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011644:Puerperal Disorders / Q000453:epidemiology*; D017584:Reproductive History; D012307:Risk Factors; D012494:Sampling Studies; D016036:Seroepidemiologic Studies; D012747:Sexual Partners; D012959:Socioeconomic Factors; D013587:Syphilis / Q000453:epidemiology*; D013588:Syphilis Serodiagnosis / Q000706:statistics & numerical data