Abstract
BackgroundDespite the availability of screening guidelines and effective treatment for maternal syphilis (MS), its prevalence remains high and is re-emerging in many parts of the world. This might be because of varying screening tests and algorithms for the laboratory diagnosis and treatment of syphilis. In addition, HIV co-infection may compromise the elimination of MS. The present study is a clinical audit of the prevalence of MS in KwaZulu-Natal, South Africa, using the ‘Traditional Algorithm’ screening.MethodsThis was a retrospective audit in which data on syphilis testing were obtained over a 1-year period (2016) at a large regional hospital in South Africa. The standard screening test at the study site was the non-treponemal antigen, rapid plasma reagin (RPR). Data on the prevalence of MS and comorbidity with HIV infection were analysed.ResultsThere were 10 680 deliveries in the study period of which 118 were RPR reactive, giving an MS prevalence of 1.1%. MS occurred predominantly in the age groups < 18 and > 35 years (p = 0.001). The prevalence of HIV infection was 41.2% (n = 4451). Seventy-two (61.0%) had both HIV and MS infection, whilst 46 (39.0%) had discordant results (p = 0.001).ConclusionWe report an increase in the prevalence of MS compared to previous South African National Antenatal Syphilis Surveillance studies. This may be because of the prozone effect caused by HIV infection on the sensitivity of the RPR. We propose a change in MS screening, using a Rapid DUO (Dual HIV and syphilis point of care test) and Reverse Algorithm for screening that could improve the sensitivity, detection and management of both diseases.
Highlights
Despite the availability of screening guidelines and effective treatment for maternal syphilis (MS), its prevalence remains high and is re-emerging in many parts of the world
In 2015, the South Africa National Surveillance Reports (NASHSPS) found that the prevalence of MS had increased to 2.0% after a slight drop from 1.9% to 1.6% in 2011.13,14 It is noteworthy that the prevalence of MS between the two NASHSPS reports for 2008–2011 and 2015, found mixed trends in different provinces;[13,14] in particular, KwaZulu-Natal (KZN) and the Free State had increased MS prevalence rates from 0.4% to 2.3% and from 1.9% to 4.6% respectively, whilst Gauteng, the Northern Cape and Western Cape had registered declines in the 2015 report.[13,14]
There were no cases of symptomatic congenital syphilis (CS) recorded and all ‘exposed neonates’ (n = 118) had a full course of penicillin treatment, according to the hospital clinical protocol
Summary
Despite the availability of screening guidelines and effective treatment for maternal syphilis (MS), its prevalence remains high and is re-emerging in many parts of the world. This might be because of varying screening tests and algorithms for the laboratory diagnosis and treatment of syphilis. The present study is a clinical audit of the prevalence of MS in KwaZuluNatal, South Africa, using the ‘Traditional Algorithm’ screening. Africa has the highest incidence of syphilis with 63% of cases being reported annually in pregnant women.[1,2] The incidence of maternal syphilis (MS) and congenital syphilis (CS) is reported to have decreased to 38% and 39% in 2008 and 2012 respectively.[3,4,5] there is a recent concern about the re-emergence of syphilis, following reports of the increasing incidence of MS and CS rates in the United States, Eastern Europe and Russia.[6,7,8] Regarding Southern Africa, in Swaziland and Mozambique, during the period 2009–2010, antenatal clinic attendees had MS prevalence rates of 5.7% and 8.3% respectively, whilst South Africa, Namibia, Lesotho and Botswana had MS prevalence rates of 1.3% – 2.2%.9,10,11,12 In 2015, the South Africa National Surveillance Reports (NASHSPS) found that the prevalence of MS had increased to 2.0% after a slight drop from 1.9% to 1.6% in 2011.13,14 It is noteworthy that the prevalence of MS between the two NASHSPS reports for 2008–2011 and 2015, found mixed trends in different provinces;[13,14] in particular, KwaZulu-Natal (KZN) and the Free State had increased MS prevalence rates from 0.4% to 2.3% and from 1.9% to 4.6% respectively, whilst Gauteng, the Northern Cape and Western Cape had registered declines in the 2015 report.[13,14]
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