How to interpret syphilis testing.

Syphilis.

Commentary

Blissful Ignorance When Managing Pregnant Women With Syphilis and Nonreactive Nontreponemal Tests?

BackgroundSerologic tests for syphilis remain the mainstay of diagnosis. However, diagnosis of congenital syphilis is complicated by the passive transfer of maternal antibodies to the infant. Non treponemal test (NTT)...

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Syphilis is a sexually transmitted bacterial disease relevant to pregnancy because it has the potential to cause congenital syphilis if it occurs at any time during pregnancy. An upsurge in cases of syphilis in women and hence congenital syphilis has been reported worldwide recently. 40% of cases can result in spontaneous miscarriages, stillbirth, non-immune hydrops, fetal growth restriction and perinatal death, as well as serious sequelae in liveborn infected children. Pregnancy complications can be avoided by early detection and treatment in the antenatal period. All antenatal women should be screened for syphilis at the first antenatal visit. There is no gold standard for diagnostic test of syphilis. A combination of serological tests consisting of treponemal and a non treponemal test are used for diagnosis. Screening with non-treponemal tests such as rapid plasma reagin or venereal disease research laboratory test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption assay is the usual cost effective approach. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin depending upon the stage of the maternal infection. All neonates born to mothers who have reactive nontreponemal and treponemal test results should be evaluated.

Introduction: Syphilis is a sexually transmitted disease caused by Treponema pallidum, and results in considerable morbidity and mortality. Congenital syphilis can lead to miscarriage, prematurity, bone deformities, hearing loss and other important clinical changes. Objective: To analyze prenatal quality and clinical conditions of newborns exposed to syphilis in a public maternity hospital in Rio Branco-Acre. Method: This is a cross-sectional study that included 92 mothers diagnosed with syphilis during pregnancy, attended from July to December 2017. Two pregnant women had fetal death, and the final sample consisted of 90 newborns exposed to syphilis. An interview with the postpartum woman was used, analysis of the pregnant woman's card and search for information from the pregnant woman's records and newborns. It was considered confirmed case of syphilis in pregnant woman: a) All pregnant women who presented non-treponemal reagent test with any titration and reagent treponemal test performed during prenatal care; b) Pregnant woman with reagent treponemal test and nonreactive or unreacted nontreponemal test, without previous treatment record. To characterize congenital syphilis we considered: a) newborn whose mother was not diagnosed with syphilis during pregnancy and who presented a nontreponemal test reactive with any titration at the time of delivery; b) child whose mother was not diagnosed with syphilis during pregnancy and had a non-treponemal test reagent at the time of delivery; c) newborns whose mother presented a reactive treponemal test and a nonreactive non-treponemal test at the moment of delivery, without previous treatment record. Results: Most newborns were born in normal delivery (65.5%), 17.8% had acute fetal distress and 11.2% required resuscitation maneuvers. Prematurity occurred in 10% of births and 12.2% of them were small for gestational age. Complete prenatal care was performed by 29.5% of the mothers, following the recommendations of the Ministry of Health of seven visits to the Health Unit and or Health Professional. From the 90 pregnant women, 79 had a reactive treponemal test when admitted to the maternity ward. 29.3% of them performed the treatment properly. In the analysis about the treatment of the sexual partner, it was reported that 58% did not adhere to syphilis treatment. Conclusion: The prenatal quality of pregnant women with syphilis was lower than that recommended by the Brazilian Ministry of Health, although there are few cases of syphilis as the primary outcome in newborns with childbirth with mothers diagnosed with syphilis. Prenatal, newborn, syphilis in pregnancy, congenital syphilis.

The objective of this study was to describe the temporal distribution and the epidemiological characteristics of congenital syphilis (CS), in the city of Niteroi, from 2007 to 2016. Descriptive and temporal series study with secondary data from SINAN (reporting system of notification- congenital syphilis) and SINASC (Information system on live births) of the Municipality of Niteroi / RJ. The study population consisted of all cases of CS reported in SINAN, residents of the city of Niteroi. The incidence of congenital syphilis was calculated and performed a probabilistic relationship with SINASC to recover information ignored in the CS database. The time series of the incidence of congenital syphilis according to the social and prenatal variables was estimated by the Joinpoint regression program. A total of 754 CS cases were reported from 2007 to 2016. Most of the women received prenatal care and more than half completed seven or more consultations, but about 39% were diagnosed only during hospitalization for childbirth or curettage. The treatment regimen was inadequate or not performed (68,6%; 19,1%) in most women and only 12,2% of the partners were treated. There were high rates of congenital syphilis (23,2/ 1.000 lb in 2016), with increasing tendency over the study period (APC= 16%). There was a constant and significant increase in the incidence, especially in adolescent mothers (25,2%), with low education level (57,1%), with brown color (16,8%) and who received prenatal care (17,3%). The use of the category ignored in the analysis allowed the identification of higher rates of congenital syphilis in this category in the variables schooling and race / color of skin. The temporal series evidenced a significant increase trend for color ignored from 2012 to 2016. Training of health professionals is necessary for the adequate management of syphilis in pregnant and for the correct completion of the CS's notification form. In addition, government actions are needed to reduce social inequalities

From 2012 to 2014, rates of congenital syphilis increased in Louisiana and Florida. We evaluated the effectiveness of early (first or second) and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. Reported syphilis cases among pregnant women in Louisiana and Florida during January 1, 2013, to December 31, 2014, were reviewed for documented screening for syphilis in the first 2 trimesters and third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether the pregnancy led to a reported congenital syphilis case. Seven hundred ten pregnant women with syphilis in Louisiana and Florida were linked to 155 congenital syphilis cases. Three hundred seventy (52%) pregnant women with syphilis were staged as early syphilis (n = 270) or high-titer late or unknown duration-latent syphilis (n = 100), and 109 (70% of the total) were linked to congenital syphilis cases. Screening in the first 2 trimesters identified 513 pregnant women who tested positive for syphilis, and 470 (92%) potential congenital syphilis were averted. One hundred nine pregnant women tested positive for syphilis in the third trimester, and 85 (78%) had babies without congenital syphilis. During their pregnancy, 85 (12%) women tested negative at least once, and 55 (65%) had babies with congenital syphilis. Thirty-nine women had no reported syphilis screening 30 days or longer before delivery. Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women.

IntroductionBetween 2012 and 2014, rates of congenital syphilis increased in Louisiana (LA) (from 52.7 to 73.4 cases per 1 00 000 live births) and Florida (FL) (from 17.4 to 22.1...

Congenital syphilis occurs when syphilis is transmitted from a pregnant woman to her fetus; congenital syphilis can be prevented through screening and treatment during pregnancy. Transmission to the fetus can occur at any stage of maternal infection, but is more likely during primary and secondary syphilis, with rates of transmission up to 100% at these stages (1). Untreated syphilis during pregnancy can cause spontaneous abortion, stillbirth, and early infant death. During 2013-2017, national rates of congenital syphilis increased from 9.2 to 23.3 cases per 100,000 live births (2), coinciding with increasing rates of primary and secondary syphilis among women of reproductive age (3). In New York City (NYC), cases of primary and secondary syphilis among women aged 15-44 years increased 147% during 2015-2016. To evaluate measures to prevent congenital syphilis, the NYC Department of Health and Mental Hygiene (DOHMH) reviewed data for congenital syphilis cases reported during 2010-2016 and identified patient-, provider-, and systems-level factors that contributed to these cases. During this period, 578 syphilis cases among pregnant women aged 15-44 years were reported to DOHMH; a congenital syphilis case was averted or otherwise failed to occur in 510 (88.2%) of these pregnancies, and in 68, a case of congenital syphilis occurred (eight cases per 100,000 live births).* Among the 68 pregnant women associated with these congenital syphilis cases, 21 (30.9%) did not receive timely (≥45 days before delivery) prenatal care. Among the 47 pregnant women who did access timely prenatal care, four (8.5%) did not receive an initial syphilis test until <45 days before delivery, and 22 (46.8%) acquired syphilis after an initial nonreactive syphilis test. These findings support recommendations that health care providers screen all pregnant women for syphilis at the first prenatal care visit and then rescreen women at risk in the early third trimester.

Why Can't We Eradicate Congenital Syphilis?

Commentary

Congenital Syphilis, Réunion Island, 2010

ResumenIntroducción. Tradicionalmente, la sífilis se ha detectado con pruebas no treponémicas y se ha confirmado con pruebas treponémicas, un algoritmo diagnóstico implementado a nivel mundial.Objetivo. Evaluar el desempeño de las pruebas treponémicas y no treponémicas para detectar en forma efectiva la sífilis entre los donantes de sangre. Materiales y métodos. Se realizó un estudio transversal con 384 muestras, inicialmente reactivas para sífilis según los resultados de pruebas no treponémicas. Posteriormente, se reevaluaron todas las muestras mediante VDRL, ELISA, CLIA y FTA-ABS, esta última como prueba confirmatoria. Se calculó el coeficiente kappa para determinar la concordancia entre las pruebas no treponémicas y se estimaron los índices de desempeño. Resultados. Se determinó la concordancia entre las pruebas no treponémicas y las treponémicas. Entre la VDRL y ELISA, fue del 78,8 %, mientras que, entre la VDRL y el CLIA, fue del 76 % (p < 0,005). La concordancia entre el ELISA y el CLIA fue del 83 %. Al comparar los resultados obtenidos en las pruebas treponémicas y las no treponémicas con la FTA-ABS, la concordancia osciló entre el 44,2 y el 61,9 %. Los índices de desempeño evidenciaron que las pruebas no treponémicas y las treponémicas tienen valores de sensibilidad entre el 89,70 y el 99,39 %. El valor predictivo positivo fue más elevado en las pruebas treponémicas (CLIA = 95,27 %) y la tasa más alta de falsos positivos fue del 94,52 % en la prueba VDRL.Conclusiones. Las muestras analizadas fueron reactivas desde el inicio, lo que podría interferir en los parámetros de medición. Sin embargo, aportaron información valiosa para evaluar los algoritmos implementados.