Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study

Rose Mcgready,Isabella Watts,Miriam B Torchinsky,Borimas Hanboonkunupakarn,Mary Ellen G Tyrosvoutis,Aung Myo Htut,Chirapat Wangsing,Joy Kang,Lily Keereecharoen,François H Nosten,Nay Win Tun

doi:10.12688/f1000research.4190.2

Abstract

The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates. From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border. Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors. As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.

Highlights

The global health impact of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV)/AIDS and syphilis is well recognized1
Syphilis more than any other bacterial and curable sexually transmitted infection, has greater potential to cause adverse birth outcomes when the diagnosis is missed3. This was demonstrated in an area with a high rate of syphilis (7.7% amongst 19,878 women screened by RPR testing at antenatal clinic (ANC)) where, 51% of stillbirths, 24% of preterm live births, and 17% of all adverse pregnancy outcomes in unscreened women were attributable to maternal syphilis4,5
Age and gravidity were matched at all clinics, but women attending the migrant sites (WPA and MKT) had a significantly higher number of remarriages and a shorter duration of residence at their current address when compared with MLA

Summary

Introduction

The global health impact of sexually transmitted infections (STIs) including HIV/AIDS and syphilis is well recognized1 Both syphilis and HIV/AIDS pose major health risks in the developing world, impacting maternal and infant health due to vertical transmission via congenital infection and/or through breastfeeding. Both syphilis and HIV/AIDS pose major health risks in the developing world, impacting maternal and infant health due to vertical transmission via congenital infection and/or through breastfeeding2 This is estimated to cause over 500,000 adverse pregnancy outcomes per year, including stillbirth and congenital infection. Syphilis more than any other bacterial and curable sexually transmitted infection, has greater potential to cause adverse birth outcomes when the diagnosis is missed. For the mother, untreated syphilis and HIV can cause multiple medical problems including death, and the open sores of syphilis increase the risk of human immunodeficiency virus (HIV) infection

Methods

Results

Conclusion