Sífilis na gestação em pessoas negras e pardas, Santos, SP, Brasil: uma revisão crítica narrativa

Abstract

Gestational and congenital syphilis remain significant public health problems in Brazil, partic-ularly among socially vulnerable populations. In the municipality of Santos, in the state of São Paulo, there has been a substantial increase in disease detection rates in recent years, with a pronounced impact on Black and Brown pregnant individuals, highlighting the relationship be-tween illness, social and racial inequalities, and limitations in access to healthcare services. This study aimed to critically analyze the scientific literature and epidemiological data related to syphilis among Black and Brown pregnant women in Santos, São Paulo, Brazil, articulating the social determinants of health, structural racism, and gender inequalities within the context of maternal and child health. This study consisted of a critical narrative literature review with a qualitative approach, grounded in the theoretical frameworks of Collective Health, intersection-ality, and racial studies. Scientific articles published between 2015 and 2025 were analyzed, identified through the SciELO, MEDLINE/PubMed, LILACS, and Virtual Health Library da-tabases, in addition to epidemiological bulletins, institutional documents, and other national and international academic publications addressing gestational syphilis, congenital syphilis, struc-tural racism, and social vulnerabilities. The data were organized into thematic categories that enabled a critical analysis of the social and racial inequalities influencing access to and quality of healthcare provided to Black and Brown pregnant women. The findings demonstrated that Black and Brown populations experience greater vulnerability to gestational syphilis due to the combined effects of low educational attainment, unfavorable socioeconomic conditions, de-layed access to prenatal care, difficulties in continuity of care, and the persistence of institu-tional racism within healthcare services. Epidemiological data from Santos revealed rates of acquired syphilis, gestational syphilis, and congenital syphilis above state and national aver-ages, as well as a substantial increase in reported cases between 2016 and 2023. Despite the existence of a structured healthcare network and local epidemiological surveillance strategies, important limitations remain in the effectiveness of prevention, diagnosis, and treatment, par-ticularly for the most vulnerable populations. Although the studies included in this review were not conducted specifically in the municipality of Santos, their findings provide important in-sights into and a critical examination of the local reality considering the municipality’s epide-miological indicators and its social and territorial characteristics. It is concluded that gestational and congenital syphilis constitute important markers of social and racial health inequalities, demonstrating how factors related to race, education, income, and living conditions influence illness, access to healthcare services, and maternal and neonatal outcomes. Addressing these conditions requires integrated strategies that include epidemiological surveillance, improve-ments in prenatal care, strengthening of Primary Health Care, and enhancement of healthcare practices by incorporating anti-racist perspectives into maternal and childcare. Furthermore, strengthening public policies aimed at racial equity and implementing intersectoral actions to reduce social inequalities and confront structural racism are essential, as these factors are key social determinants of health and fundamental to promoting health equity.