Municipal Flowchart for Reducing Indicators of Syphilis in Pregnant Women and Congenital Syphilis

Syphilis is a preventable and curable sexually transmitted infection. The elimination of vertical transmission of syphilis, in particular, is a national priority, with intensified efforts to improve access and management of infection in pregnant women and their partners. Guaíba is a municipality in the metropolitan macro-region of Porto Alegre, which has some of the highest detection rates of gestational and congenital syphilis in the state of Rio Grande do Sul. In 2023, detection rates (cases per 1,000 live births) for syphilis in pregnant women and congenital syphilis were, respectively: Brazil – 34 and 9.9; RS – 41 and 14, highlighting the need for improvements in health actions. This study aims to describe the experience of reorganizing the municipal monitoring flow of syphilis, with the goal of reducing the number of syphilis cases in pregnant women and congenital syphilis in the municipality. At the beginning of 2023, a flowchart was designed and implemented by SAE/Guaíba and the Municipal Epidemiological Surveillance, which included the centralization of notifications from Primary Health Units (PHUs) at SAE/Guaíba for requalification, verification of prescriptions according to disease stage, data entry into the Salus platform, and organization into service spreadsheets with monthly and/or quarterly control, shared monthly with the PHUs. If problems were identified in notifications, treatment, or follow-up, SAE assisted the PHUs in active case tracing and/or data correction. With SAE’s support in monitoring syphilis cases in pregnant women, the proportion of correct prescriptions according to disease stage increased from 78.7% in 2022 to 93.1% in 2024, VDRL monitoring improved, and there was a reduction in the detection rate of syphilis in pregnant women, from 63/1,000 live births in 2022, peaking at 76/1,000 in 2023, and decreasing to 44/1,000 in 2024. The number of congenital syphilis cases also decreased from 36 in 2022 to 16 in 2023 and 9 in 2024. Organizing workflows that facilitate population access, supporting Primary Care professionals in monitoring reported cases, ensuring treatment, and conducting active case and partner tracing, as well as teamwork, allows for better care and contributes to reducing disease-related indicators.