199478 Congenital syphilis: A public health problem in Ciudad Juarez, Chihuahua, Mexico

Wednesday, November 11, 2009: 11:38 AM

Martha Sánchez Escalante, MD, MPH , Jurisdicción Sanitaria II de Ciudad Juárez, Chihuahua, Servicios de Salud del Estado de Chihuahua, México, Ciudad Juárez, Chihuahua, Mexico
Jorge Duque Rodriguez, MD , Consejo Estatal de SIDA, Servicios de Salud del Estado de Chihuahua, México, Ciudad de Chihuahua, Mexico
Guadalupe Muñoz Saucedo , Misericordia y Vida para el Enfermo con SIDA, A.C., Ciudad Juárez, Mexico
Stephen W. Pan, MSPH , Office of Border Health HSR 9/10, Texas Department of State Health Services, El Paso, TX
Susan S. Reese, MPH , Zoonosis Control Branch HSR 9/10, Texas Department of State Health Services, El Paso, TX
Luis G. Castellanos, MD, PhD , Office for the U.S. - Mexico Border, Panamerican Health Organization, El Paso, TX

Elimination of congenital syphilis with community participation, diagnosis and treatment of HIV and other sexually transmitted infections (STI) with integrated actions.


STI represent a major risk factor for HIV transmission; syphilis and congenital syphilis are responsible for premature death and abortion. In Mexico, STI are a significant cause of morbidity even though underreporting is estimated to be over 80%. Chihuahua State (U.S. – Mexico Border) is at the top of national reporting of congenital syphilis.


Between September and December of 2008, six public health units and a women's hospital implemented an integrated strategy of health education, free and voluntary access to diagnosis and treatment, to all pregnant women requesting medical care. Also, commercial sex workers from Ciudad Juarez were contacted and provided with the same services as requested. A questionnaire was administered to sex workers.


935 women were attended, 15 (1.6%) resulted positive for syphilis; six time higher than the Mexican mean value for pregnant women with syphilis (0.3). 10 of 15 babies born to syphilitic mothers were diagnosed with congenital syphilis, twice the average number of cases reported yearly in Juarez since 2002.

Of 299 sex workers contacted, 50% reported babies dying before 12 months; 35% had either abortion or stillborn history; 108 (36%) were randomly blood drowned and 18% were positive for syphilis.

Conclusions and recommendations:

Active surveillance and enhanced services to detect syphilis is critical to interrupt transmission and eliminate congenital syphilis.

Ensuring health services for commercial sex workers is mandatory to achieve equity.

Learning Objectives:
Describe and analyze the impact of enhanced medical services for prevention, diagnosis and treatment of pregnant women with syphilis through an integrated intervention.

Keywords: Maternal and Child Health, Sex Workers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working in public health and community-based medical services since 1986. I hold an M.D. from the University of San Carlos de Guatemala (1980-86), an M.P.H. from the University of Puerto Rico (1990-91) and a Ph.D. from the University of South Carolina (1991-1994); aditionally, I was in the EIS program from CDC (1994-96). Since 1997, I became a PAHO international staff to work in surveillance, management, prevention and control of transmissible and non-transmissible diseases in Latin América. I have been posted in Honduras, Brazil, México and currently in the U.S. Although most of my training is in applied epidemiology for infectious diseases, I have also devoted a significant amount of my professional time (over the past 10 years), to fight chronic diseases and its major risk factors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.