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Abstract
BackgroundUntreated male partners are a critical source of maternal re-infection. Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal re-infection. This study aimed to analyze the current situation and related factors of contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners.MethodData of syphilis-seropositive pregnant women and their male partners attending clinic for syphilis-screening were obtained from the Shenzhen Program for Prevention of Congenital Syphilis. Contact tracing rate of syphilis-seropositive pregnant women and syphilis prevalence among male partners were counted, and related factors were also analyzed using a random-effects logistic regression model.ResultOf the 1299 syphilis-seropositive pregnant women, 74.1% (963/1299) had their male partners receiving syphilis-screening and 19.1% (184/963) of male partners were syphilis-infected. For pregnant women, being divorced (adjusted odds ratio [AOR] =0.39; 95%CI: 0.17–0.87), seeking for emergency services at their first antenatal clinics visits (AOR = 0.58; 95%CI: 0.44–0.77), reporting willingness to notify partner(AOR = 7.65; 95%CI: 4.69–12.49), multi-partners (AOR = 1.38; 95%CI:1.03–1.86) and having a history of drug abuse (AOR = 0.37; 95%CI: 0.14–1.00)were independently associated with successful contact tracing. For male partners, of minority ethnicity (AOR = 4.15; 95%CI: 1.66–10.34), age at first sex>20(AOR = 0.57; 95%CI: 0.37–0.87), reporting multi-partners (AOR = 1.60; 95%CI: 1.04–2.46), having a history of drug abuse (AOR = 4.07; 95%CI: 1.31–12.64) were independently associated with syphilis-infection. In addition, pregnant women with TRUST titer ≥1:8 (AOR = 2.81; 95%CI: 1.87–4.21), having a history of adverse pregnancy outcomes (AOR = 1.70; 95%CI: 1.14–2.53), reporting multi-partners (AOR = 0.43; 95%CI: 0.29–0.64) and reporting the current partner as the source of syphilis (AOR = 5.05; 95%CI: 2.82–9.03) were independently associated with partners’ syphilis-infection.ConclusionContact tracing is feasible and effective in identifying syphilis-infected partners among syphilis-seropositive pregnant women. Contact tracing is associated with many factors such as women’s marital status, services at their first antenatal clinics visit and willingness of partner notification. Partners’ ethnicity, age at first sex, multi-partners and history of drug abuse as well as women’s levels of TRUST titer were associated with partners’ syphilis-infection.
Highlights
IntroductionContact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal reinfection
Untreated male partners are a critical source of maternal re-infection
Most pregnant women presented to the clinics for routine antenatal care at their first Antenatal Clinics (ANCs) visits (n = 936, 72.1%), and the rest presented for emergency services, including in labor (n = 165, 12.7%), spontaneous abortion (n = 43, 3.3%), stillbirth (n = 25, 1.9%), ectopic pregnancies (n = 120, 9.2%), and artificial abortions or inductions of labor (n = 10, 0.8%). 10 (0.8%) women having existing symptoms of early syphilis in the physical examination at their first ANC visits, 419(32.3%) women having a history of syphilis and having been treated before pregnancy, and 870 (67.0%) women lacking existing symptoms of syphilis in the physical examination and without anti-syphilis treatment before pregnancy were diagnosed as early syphilis, syphilis after adequate treatment, and latent syphilis, respectively
Summary
Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal reinfection. Despite advances in syphilis prevention of mother-tochild transmission (PMTCT) [1, 2], pregnant women face a high risk of syphilis re-infection from infected male partners and adverse pregnancy outcomes (APOs) related to mother-to-child transmission [3,4,5]. It was estimated that globally there were 355,000 APOs caused by mother-to-child transmission of syphilis in 2016, of which 6% were due to treatment failures or re-infection during pregnancy [2]. Untreated male partners are a critical source of maternal reinfection, and pregnant women with syphilis-infected partners are more likely to have APOs [3, 5]. Contact tracing was included as an integral part of PMTCT program to identify partner infection, interrupt transmission, prevent re-infection, and reduce fetus mortality caused by syphilis and HIV infection [3, 4, 7]
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