Evidence map›Paper›PMID 36081843›Full record

ArticleAJOG global reports2022

Ineffective penicillin treatment and absence of partner treatment may drive the congenital syphilis epidemic in Brazil.

Emma J Swayze, Mary Catherine Cambou, Marineide Melo, Eddy R Segura, Julia Raney, Breno Riegel Santos, Rita Lira, Raquel Borges Pinto, Ivana Rosangela Dos Santos Varella, Karin Nielsen-Saines

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in AJOG global reports, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.

  1. Pooled it
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  8. Temporal trends of the incidence rate of syphilis during pregnancy and congenital syphilis in São Paulo, Brazil, 2011-2023.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2025
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 3 countries.

Emma J SwayzeWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Mary Catherine CambouWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Marineide MeloWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Eddy R SeguraWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Julia RaneyWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Breno Riegel SantosWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Rita LiraWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Raquel Borges PintoWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Ivana Rosangela Dos Santos VarellaWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
Karin Nielsen-SainesWestern Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI (Ms Swayze); Department of Medicine at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Segura); Department of Pediatrics at UCLA, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Nielsen-Saines); Department of Infectious Diseases, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Drs Melo, Santos, Lira); Department of Epidemiology, Hospital Nossa Senhora da Conceição, Rua Francisco Trein, Porto Alegre, Rio Grande do Sul, Brazil (Dr Varella); Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (Dr Segura); Department of Pediatrics, Stanford University, Department of Pediatrics, Palo Alto, CA (Dr Raney); Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Dr Pinto).
University of California, Los Angeles · USPeruvian University of Applied Sciences · PEWestern Michigan University · US

Funding

UCLA AIDS Prevention and Treatment Clinical Trials UnitUM1AI069424 · NIAID · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Judith S. Currier, RAPHAEL J LANDOVITZ · 2012 to 2026
$51.8M
UCLA AIDS Prevention and Treatment Clinical Trials UnitU01AI069424 · NIAID · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI CURRIER, JUDITH S. · 2007 to 2011
$13.9M
Postdoctoral Training in Global AIDS Prevention ResearchT32MH080634 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JESSE LAWTON CLARK, Pamina Mae Gorbach · 2007 to 2026
$6.4M
South American Program in HIV Prevention Research (SAPHIR)R25MH087222 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JESSE LAWTON CLARK, Karin Nielsen · 2011 to 2026
$3.9M
NIAID NIH HHS U01 AI069424NIAID NIH HHS UM1 AI069424NIMH NIH HHS R25 MH087222NIMH NIH HHS T32 MH080634
6 · The paper itself

Abstract

backgroundReducing congenital syphilis has been the focus of Brazilian health programs for decades, yet the cases continue to increase. Although health interventions have targeted HIV screening and treatment, syphilis management continues to be challenging. Syphilis during pregnancy may enhance the HIV maternal seroconversion risk. The potential factors fueling the syphilis epidemic were evaluated in south Brazil, an area of high HIV or syphilis endemicity.

objectiveWe hypothesized that ineffective treatment because of a lack of partner treatment, late presentation to care, and reinfection of previously treated mothers were potential drivers of syphilis mother-to-child transmission. STUDY

designData on women diagnosed with syphilis during pregnancy between January 1, 2008 and December 31, 2018 were obtained from a large urban hospital in Porto Alegre, Brazil. The patients were stratified into effective vs ineffective treatment groups according to the World Health Organization guidelines. Crude and adjusted risk ratios for the prediction of congenital syphilis and adverse fetal or neonatal outcomes were computed using Poisson regression.

resultsNearly 56,000 pregnant women delivered over the 11-year period; 1541 (2.8%) had confirmed syphilis during pregnancy, with 934 (61%) receiving ineffective syphilis treatment because of late presentation and diagnosis, delayed treatment initiation, and loss to follow-up with no treatment recorded. Ineffective treatment was associated with maternal education, prenatal care, timing of syphilis diagnosis, venereal diseases research laboratory titers, and maternal HIV coinfection. On multivariate regression analysis, ineffective treatment (adjusted risk ratio, 4.52; 95% confidence interval, 2.35-8.69), absence of prenatal care (adjusted risk ratio, 9.31; 95% confidence interval, 3.77-23.0), syphilis diagnosis at delivery (adjusted risk ratio, 3.08; 95% confidence interval, 2.07-4.58), and maternal nontreponemal titers ≥1:64 (1.09-1.93) were associated with an increased risk of fetal loss. Ineffective treatment (adjusted risk ratio, 1.71; 95% confidence interval, 1.59-1.84), year of diagnosis 2014 to 2016 (adjusted risk ratio, 1.07; 95% confidence interval, 1.02-1.13), absence of prenatal care (adjusted risk ratio, 1.44; 95% confidence interval, 1.17-1.76), and maternal nontreponemal titers >1:4 were associated with an increased risk of congenital syphilis. Although partner treatment reduced the congenital syphilis risk (adjusted risk ratio, 0.60; 95% confidence interval, 0.55-0.66), only 31.8% of partners received treatment. Maternal HIV coinfection was not associated with an increased risk of fetal loss, low birthweight, preterm birth, congenital syphilis, or symptomatic neonatal infection.

conclusionPublic health initiatives promoting effective syphilis treatment in pregnancy, increased access to high-quality prenatal care, and partner treatment should be considered to reduce congenital syphilis.

Indexed as

BrazilHIVineffective treatmentmother-to-child transmissionpartner treatmentpregnancyprenatal carepublic healthsyphilis

Identifiers

PMID36081843
PMCPMC9451022
OpenAlexW4210292028

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.