Syphilis and congenital syphilis are preventable diseases if the infected patient or pregnant woman is promptly diagnosed and properly treated, as well as sexual partner (s), being their occurrence an indicative of failure in the prenatal and health care. Serological screening at prenatal is an effective measure and penicillin treatment is efficient and also cheap. However the production and availability of the drug in the last five years has become scarce in Brazil due to a lack of production and economic issues. Such shortages, associated with a poor process of work in these primary care units, resulted in a scenario with the resurgence of this disease. According to data available at the Secretária Municipal de Saúde de Betim (Betim Municipal Health Secretary), in 2015, 88 cases of syphilis were reported; in 2016, 171 new cases meaning an increase of almost 100%. A trend observed on a global scale. The numbers of infected pregnant women and congenital syphilis also increased at an alarming rate. Thus, educational measures and appropriate prenatal screening became a priority issue in the health services agenda.

This work aims to elaborate an intervention plan, with measures for prevention, diagnosis and appropriate treatment of pregnant women diagnosed with syphilis in the city of Betim and at the primary health care unit Campos Elíseos. The methodology was carried out in three stages:

1. - Situational diagnosis - with a review of all medical reports from pregnant women between jan 2013 to jan 2018, searching for: moment where syphilis rapid test happened, moment of notification, time until the start of treatment, total of partners notified and treated, , total of congenital syphilis and intercourses related to the infection.
2. - Review of the literature on the subject - the search was carried out in the Biblioteca Virtual de Saúde (BVS), in the databases of the Latin American and Caribean literature on Health Science (LILACS) and in on the Scientific Eletronic Library Online (Scielo) as well as in the modules of the Curso de Especialização de Estratégia de Saúde da Família da Universidade Federal de Minas Gerais, publications of Ministerio da Saude (MS) and books related to subject.
3. - Elaboration and implementation of the action plan- it is expected with the adjustment of the work process, to reduce syphilis in the general population, especially in pregnant women and also reduce cases congenital syphilis.

What will audience learn from your presentation?

The main goal of these project was to reduce the cases of syphilis during pregnancy and the cases of congenital syphilis using only the technology and resources already available at the primary health system in the city of Betim. To do so, it was important to understand where the assistance was failing and create a new approach to the work process. With a review of all medical records of pregnant women between Jan 2013 to Jan 2018, it was possible to highlight five major problems.

1. - Syphilis rapid tests were happening only in the fourth appointment of prenatal assistance.
2. - In a case where a test had a positive result, the median interval until the first dose of penicillin was 28 days. 3 - In only 25% of the the partner was also treated

4 - Only 45 % percent of the cases were notificated to the local epidemiological surveillance service. 5 - Inadequate choice of antibiotics and poor follow up.

The new work process proposed was: Do the rapid test in the first appointment of prenatal. Begin treatment of all positive results in the same day the test was done and do the follow up according to local guidelines. Reinforce the importance of the notification and how it should be done. Reinforce the importance of inviting all partners to be  tested and treated if necessary. Educate doctors, nurses and other health professionals about the subject with current and consistent scientific data. This process was carried out in the year of 2018; in a 10 month evaluation, it was tested for syphilis 78 pregnants, treated and notificated 21 cases, no children were born with congenital syphilis. The results of these intervention were shown to the local health authorities and to all doctors and nurses of all other 17 health  care units as a possible, viable and affordable solution.