Itinerários terapêuticos e dificuldades identificadas no diagnóstico e tratamento da sífilis gestacional durante o pré-natal

Abstract

Syphilis, which has existed for over 500 years, is considered a public health problem due to its high incidence. It is an infectious disease that affects thousands of people each year. Despite the ease of diagnosing and treating syphilis, it continues to be an epidemic presence in our society. Approximately 12 million cases of this disease are detected each year in adults, with around 1.85% of these cases occurring in pregnant women. Primary Health Care (PHC), as the gateway to the Unified Health System (SUS), has been playing a relevant and strategic role in both the prevention and early detection of syphilis in the mother-baby binomial. OBJECTIVE: To develop the therapeutic itineraries followed by pregnant and postpartum women who had babies reported with congenital syphilis and to analyze the main difficulties associated with treatments both during prenatal care in PHC and hospital care at the time of delivery. METHOD: This is an observational, descriptive, cross-sectional, prospective study with qualitative analysis, carried out between September 2023 and June 2024, with pregnant and postpartum women diagnosed with syphilis. Such data were collected through recorded interviews in open dialogue, in addition to the application of a semi-structured questionnaire containing socioepidemiological data and questions regarding the trajectory of these women from prenatal care to delivery. A database was constructed, composed of the oral narratives of the participants and subsequently analyzed descriptively. RESULT: Sociodemographic data identified in the profile of patients that 66.6% belonged to an age group between 20 and 29 years old, 100% had an income below 2 minimum wages; 75% self-identified as brown and 66.6% did not have any profession. Regarding gestational data, 50% of them received prenatal care according to the guidelines of the Ministry of Health. To analyze the patients' narratives, seven thematic categories were created: 1) Difficulties in accessing the service to start prenatal care, 2) Difficulties in treating the partner, 3) Perception about knowledge of the disease, 4) Professional conduct and treatment of syphilis, 5) Difficulties in performing tests, 6) Difficulties encountered in the UBS for administering penicillin and 7) Maternal feelings regarding the diagnosis of congenital syphilis. CONCLUSION: Failures were identified in the professional teams that performed prenatal care, resulting in the continuation of the chain of congenital syphilis contamination, generating emotional instability in patients and their families. Barriers were observed in the health network that made it difficult to provide qualified care to patients. The scenarios and stories demonstrate the need for greater investment in professional training, improvement in prenatal care, adequate management of public health supplies and increased investment in health education for teams and patients, seeking to minimize harm by improving the care provided to this population.