Syphilis: still a major cause of infant mortality

Abstract

www.thelancet.com/infection Vol 12 April 2012 269 1 Mabey D, Peeling RW. Syphilis, still a major cause of infant mortality. Lancet Infect Dis 2011; 11: 654–55. 2 Hawkes S, Matin N, Broutet N, Low N. Eff ectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 2011; 11: 684–91. 3 Walker DG, Walker GJ. Forgotten but not gone: the continuing scourge of congenital syphilis. Lancet Infect Dis 2002; 2: 432–36. 4 Walker GJA. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database Syst Rev 2001; 3: CD001143. 5 Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives saved tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health 2011; 11 (suppl 3): S9. 6 Walker DG, Walker GJA. Prevention of congenital syphilis—time for action. Bull World Health Organ 2004; 82: 401. 7 Walker GJA, Walker DG. Congenital syphilis: a continuing but neglected problem. Semin Fetal Neonatal Med 2007; 12: 198–206. makers might have chosen to give little attention to the scourge of congenital syphilis in part because of two Cochrane systematic reviews, which they incorrectly claimed showed “no good evidence that the treatment of syphilis in pregnant women improved pregnancy outcome”. However, the systematic review, authored by one of us, concluded that “...there is no doubt that penicillin is eff ective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis”. The second review mentioned by Mabey and Peeling states that “detection and appropriate, timely penicillin treatment is a highly eff ective intervention to reduce adverse syphilis-related pregnancy outcomes”. To misinterpret the fi ndings of systematic reviews and place responsibility on them for the failure to adequately control congenital syphilis diverts attention away from organisations such as WHO, which should be working with governments and other partners to increase eff orts to tackle congenital syphilis. Unfortunately, babies in countries as diverse as Australia, Belarus, China, and Haiti continue to be born with congenital syphilis. This situation should be unacceptable. That antenatal screening and treatment can work is well known, and yet there has been limited success over the past decade in controlling, let alone eliminating, congenital syphilis. As we have argued previously on several occasions, the time has come to be more ambitious, resourceful, and innovative in preventing this tragedy. Business as usual is not an option.