Introduction In the last decade, syphilis has increased incidence in Brazil, necessitating the integration of health care services, surveillance and actions in the community. The objective of this study was to describe the strategy of using the office on the street to deal with congenital syphilis among pregnant users of crack.

Method A case study, in which the actions implemented and the results achieved will be described. Since 2013, Ribeirão Preto has developed a harm reduction project with vulnerable populations focused on pregnant users of crack living in the street, who are carrying syphilis. In 2016, the project was accredited as Consultation Office in the Street Type II, composed of 5 social action agents and a psychologist, supported by professionals from the STI/AIDS Program. Interventions are carried out daily in scenes of drug use and prostitution. The care of the pregnant woman begins with her identification, sensitisation and conduction to the Health Unit,where she is made reception, collection of the exams, vaccination and medical attention. This pregnant woman and her partner are accompanied by the team and conducted to the care, including for the application of Penicillin.There is integration between the maternity hospitals and the Program. In addition to the weekly planning of the actions and discussion of the cases, Conversation are held together with the Health Unit teams to discuss the service to drug users.

Results Between 2013 and 2016, 30 women were followed up (3 with 2 pregnancies), all crack users, 19 with up to 30 years of age; 30.5% with more than 5 pregnancies. Nobody was diagnosed with HIV; 76.7% were with syphilis, all treated after the intervention. Even with follow-up, some of the newborns were born with syphilis; in 43.3% of the women were placed contraceptive implant.

Conclusion The challenge is constant- pregnant women heavily dependent on the drug, multiplicity of partners, unprepared health workers. There is a need for continuity of the strategy and work with other institutions to form a network of protection for this population.