Abstract
The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary.
Highlights
Syphilis is a severe bacterial disease that in pregnancy may manifest as stillbirth, early fetal death, low birth weight, preterm delivery, neonatal death, or infection or disease in the newborn
Most adverse outcomes occurred among women who attended antenatal care (ANC) but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage
Both archaeological and literary evidence suggest that mother-tochild transmission (MTCT) of syphilis, commonly referred to as ‘‘congenital syphilis,’’ is an ancient scourge [1,2]
Summary
Syphilis is a severe bacterial disease that in pregnancy may manifest as stillbirth, early fetal death, low birth weight, preterm delivery, neonatal death, or infection or disease in the newborn. Despite the tools being available for over 60 y, MTCT of syphilis persists as a public health problem It is unknown exactly what proportion of pregnant women globally receives adequate testing and treatment for syphilis. The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for $90% of pregnant women to be tested for syphilis and $90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Because coverage of testing and treatment of syphilis remains low in many countries, mother-to-child transmission of syphilis—‘‘congenital syphilis’’—is still a global public health problem. The researchers generate global and regional estimates of the burden of syphilis in pregnancy and associated adverse outcomes for 2008 using a health services delivery model
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