Abstract
Congenital syphilis constitutes a major preventable public health problem, that has been targeted for elimination by the World Health Organisation. Adverse pregnancy outcomes occur in upto 80% of untreated maternal syphilis. National impact targets for elimination include 95% syphilis testing and treatment coverage for pregnant women. Screening and treatment of maternal syphilis should ideally happen at the first ante-natal clinic visit. This may be facilitated by the use of rapid point-of-care tests (POCTs), especially for healthcare centres with limited laboratory access. There are several commercial syphilis POCTs, some of which also screen for HIV infection. These have different technical specifications, and their performance characteristics vary when capillary fingerprick whole blood is used for testing in a clinic setting. Syphilis POCT implementation in ante-natal care is affordable and rational in resource-constrained settings; however, managers and policy makers should be aware of the various programmatic issues that need to be addressed in the preimplementation phase and monitored over time.
Highlights
Congenital syphilis is a preventable infection, and one that still constitutes a major public health burden
The utility of Determine Syphilis point-ofcare tests (POCTs) was evaluated in Peruvian commercial sex worker venues in comparison with serum nontreponemal and treponemal assays such as rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA), respectively.[8]
Evaluation of POCTs in the field is essential for assessing their implementation in ‘real-world’ situations, where staffing and resource constraints may contribute to suboptimal performance
Summary
Congenital syphilis is a preventable infection, and one that still constitutes a major public health burden. The World Health Organization (WHO) estimated that in 2012 nearly one million pregnant women were infected with syphilis globally, resulting in 350 000 adverse pregnancy outcomes.[1] A recent meta-analysis has revealed that these adverse pregnancy outcomes, including stillbirths, preterm deliveries, low birthweight neonates and infants with features of congenital syphilis, may be expected in up to 80% of untreated maternal syphilis.[2] In 2007, the WHO stated that elimination of mother-to-child transmission (EMTCT) of syphilis is one of the most cost-effective public health interventions, and provided guidance for country-level action.[3] The 2014 WHO global guidance document on the criteria for EMTCT of syphilis and HIV set a minimum national impact target of ≤ 50 cases of congenital syphilis per 100 000 livebirths, as well as process targets of ≥ 95% syphilis testing and treatment coverage for pregnant women.[4] In pursuit of these goals, the use of rapid point-ofcare tests (POCTs) for syphilis has been considered to enable provision of screening and treatment for pregnant women at the first antenatal clinic visit Such screening tests would have to meet specific performance criteria, as stipulated by the WHO. Southern African Journal of Infectious Diseases is co-published by NISC (Pty) Ltd, Medpharm Publications, and Informa UK Limited (trading as the Taylor & Francis Group)
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