Seroprevalence Of Syphilis Research Articles

Prevalence monitoring in syphilis surveillance: results from a multicenter research program.

Syphilis seroprevalence data can be used as an independent measure of syphilis trends and to augment syphilis case report data for program planning. The prevalence of reactive syphilis serology in jails, delivery rooms, and drug treatment centers was examined from 1995 to 1999. Prevalence was evaluated by age and gender at each site and compared with county primary and secondary syphilis case rates. Annual prevalence of high titer-reactive serology in jails was compared with primary and secondary syphilis case rates. The goal was to examine trends in syphilis seroprevalence and to evaluate the relationship of trends in seroprevalence to reported cases. This was a cross-sectional survey. Prevalence of reactive serology and high titer-reactive serology was lowest among women in delivery rooms (2.9% and 0.4%, respectively) and highest among women in jails (11.1% and 4.1%, respectively), indicating substantial recently treated or active infection among women in jails. Trends in high titer-reactive serology were similar to primary and secondary syphilis case rates. The prevalence of high titer-reactive serology can provide valuable information about community syphilis morbidity for use in prevention and control programs.

An evaluation of on-site testing for syphilis.

One of the major obstacles to the eradication of perinatal transmission of syphilis is the delay in obtaining the results of syphilis serological tests. The availability of on-site syphilis testing lead to this study which attempted to evaluate on-site syphilis testing performed by nursing staff. The seroprevalence of syphilis by laboratory rapid plasma reagin (RPR) was 8.2% (n=42). Twenty-one of the 42 women were correctly identified by the on-site test. The overall sensitivity of on-site testing was 50% [95% confidence interval (CI)=34.4-65.6]; specificity of 90.9% (95% CI=87.8-93.2). The on-site test correctly identified as uninfected 429 of the 471 women reported as RPR negative by the laboratory, giving a specificity of 91.1% (95% CI=88.1-93.4). The results of the study show that on-site RPR test had a sensitivity of 75% in respect of the clinically important titres of > or = 1:8. The specificity of the on-site test was 91.1% and on-site testing only failed to detect syphilis in those patients with titres of 1:1 and 1:2. On-site testing is a practical and cost-effective option to prevent congenital syphilis, in settings of a high prevalence of syphilis and using skilled testers.

Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction.

Between 4-15% of pregnant women are believed to be infected with syphilis in sub-Saharan Africa. Active infection with syphilis in pregnant women results in foetal or infant death or disability for 50-80% of affected pregnancies, and is a major cause of adult morbidity as well. Antenatal syphilis screening is cheap and effective; however, it is often poorly implemented in countries with high syphilis risk. This study sought to estimate the missed opportunities for antenatal syphilis screening in sub-Saharan Africa. Survey data were collected from 22 ministries of health in sub-Saharan Africa, complemented by data from published sources and key informants. Informants described their country's policies and experience with antenatal syphilis screening and estimated their national syphilis screening rates. Seventy-three percent of women are reported by WHO to receive antenatal care in the study countries. Of women in antenatal care, 38% were estimated by survey respondents to be screened for syphilis. Costs and the organization of services were the principal reported obstacles to screening. With syphilis seroprevalence estimated at 8.3%, approximately 1 640 000 pregnant women with syphilis are undetected annually, including 1 030 000 women who attend antenatal care. Syphilis testing and treatment is a cost-effective intervention that deserves much greater attention, particularly in sub-Saharan Africa and other countries where syphilis infection is high.

Prevalence of hepatitis B, hepatitis C, syphilis and HIV in Georgian blood donors.

Prevalence of human immunodeficiency (HIV), hepatitis B (HBV), hepatitis C (HCV) virus and syphilis in the population of blood donors in Georgia has been investigated. Out of 4970 donors 7.3% had anti-HCV (6.9% confirmed), HbsAg was positive in 4.1% (3.4% confirmed), Seroprevalence of Syphilis was 2.3%. Three individuals had HIV. Prevalence of HCV and HBV in Georgia is higher than national prevalence estimates of viral hepatitis in neighboring countries.

Seroprevalence of syphilis among women attending urban antenatal clinics in Burkina Faso, 1995–8

Objectives: To describe annual trends in syphilis seroprevalence and to identify risk factors of syphilis among pregnant women receiving antenatal care in Bobo-Dioulasso, Burkina Faso. Methods: Women were recruited between...

Seroprevalence of HIV, hepatitis B, and syphilis in an urban population and isolated villages in Gabon.

interval of 95%. The observed diVerences were considered as significant for an alpha error of 5%. The seroprevalence rates were adjusted by sex. Results The seroprevalence rates for HIV are...

Seroprevalence of syphilis, human immunodeficiency virus type-1, and hepatitis B virus infections among pregnant women in Turkey

Recent data indicates that incidence of syphilis is increasing in many areas of the world with a w x rate as high as 3.9]15.8% 1 . Since risk of perinatal transmission of HIV-1 has been estimated to range from 13% to 40%, all pregnant women are encouraged to be tested for HIV-1 infection to reduce risk of perinatal transmission and to protect health personnel. There is no substantial data related to prevalence of syphilis and HIV-1 infections in recent years in Turkey. HBsAg-positive pregnant women are also at significant risk of Ž . transmitting hepatitis B virus HBV to their inŽ . fants particularly if they are ‘e’ antigen HBeAg positive. The objective of this study was to find prevalence of syphilis and HIV-1 infections and HBV carriers among pregnant women who applied for antenatal care in a low-risk population. A total of 3050 pregnant women were screened for syphilis, HBsAg and HIV-1 antibody at their

Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field?

Untreated maternal syphilis during pregnancy will cause adverse pregnancy outcomes in more than 60% of the infected women. In Nairobi, Kenya, the prevalence of syphilis in pregnant women of 2.9% in 1989, showed a rise to 6.5% in 1993, parallel to an increase of HIV-1 prevalence rates. Since the early 1990s, decentralized STD/HIV prevention and control programmes, including a specific syphilis control programme, were developed in the public health facilities of Nairobi. Since 1992 the prevalence of syphilis in pregnant women has been monitored. This paper reports the findings of 81,311 pregnant women between 1994 and 1997. A total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7-7.7) in 1994, 7.3% (95% CI: 6.9-7.7) in 1995, 4.5% (95% CI: 4.3-4.8) in 1996 and 3.8% (95% CI: 3.6-4.0) in 1997. In conclusion, a marked decline in syphilis seroprevalence in pregnant women in Nairobi was observed since 1995-96 (P<0.0001, Chi-square test for trend) in contrast to upward trends reported between 1990 and 1994-95 in the same population.

Seroprevalence of HIV, HBV, and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan.

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention.

Seroprevalence of HIV, HCV and syphilis in Brazilian prisoners: preponderance of parenteral transmission.

Between November 1993 and April 1994, our physicians' team interviewed and took blood samples of 631 prisoners randomly drawn from the largest prison of South America, which counted about 4700 inmates at that time. The interview consisted of questions related to risk behaviour for HIV infection, and the subjects were asked to provide blood for serological tests for HIV, hepatitis C and syphilis. Our main purpose was to investigate the relationship between HCV and injecting drug use as related to HIV seropositivity. Participation in the study was voluntary and confidentiality was guaranteed. Overall prevalences found were as follows: HIV: 16% (95% confidence interval (CI): 13-19%); HCV: 34% (95% CI: 30-38%), and syphilis: 18% (95% CI: 15-21%). Acknowledged use of ever injecting drug was 22% and no other parenteral risk was reported. Our results, as compared with other studies in the same prison, suggest that HIV prevalence has been stable in recent years, and that the major risk factor for HIV infection in this population is parenteral exposure by injecting drug use.

Prevalence, burden, and control of syphilis in Haiti's rural artibonite region

Objectives: A study was conducted to determine the prevalence and health consequences of syphilis and to evaluate existing control measures in a Haitian rural district of 200,000 people served by 12 community dispensaries and Hospital Albert Schweitzer. Methods: Syphilis seroprevalence among consecutive women receiving antenatal services was assessed using rapid plasma reagin (RPR) screening and fluorescent treponemal antibody absorption (FTA-ABS) confirmatory testing. Hospital and dispensary records were used to review genital ulcer disease and syphilis cases seen during 1995. Results: Of 811 pregnant women attending prenatal clinics during a 3-month period in 1996, 46 (5.7%) were RPR reactive. Syphilis seroreactivity was confirmed in 45 (97.8%) of 46 samples by FTA-ABS. Of 649 women attending dispensaries in the valley 41 (6.3%) were syphilis seroreactive compared with 4 (2.5%) of 162 women attending dispensaries in the mountains (OR = 2.66; P = 0.056). In 1995, 620 cases of genital ulcer disease were seen at the community dispensaries. At the central hospital, 257 new diagnoses of syphilis were made in 1995, including 30 cases of primary and secondary syphilis, 168 cases of latent disease, 17 cases of recurrent infection, 9 cases of tertiary disease, and 33 cases of congenital syphilis. Conclusions: The 33 cases of congenital syphilis, a rate of 550 cases for 100,000 live births, clearly demonstrated a failure of local control measures. Decentralized prenatal screening for syphilis, same-day treatment of seroreactors, and strengthened partner treatment were initiated. Further studies to improve primary prevention of syphilis in rural populations have been started. Other strategies, including mass treatment of high-risk groups, should be investigated.

Sexually transmitted diseases and human immunodeficiency virus infections in women attending an antenatal clinic in Abidjan, Côte d'Ivoire.

A cross-sectional survey was conducted among women attending an antenatal clinic in Abidjan to determine the prevalence of sexually transmitted diseases (STDs) and HIV infection, and to identify factors associated with the presence of gonococcal and/or chlamydial cervical infection. Among 546 women, 3.7% had a gonococcal infection and 5.5% had a chlamydial infection. The seroprevalence of syphilis and HIV was 1.1% and 16.2% respectively. Gonococcal and/or chlamydial cervical infection was associated with young age, the presence of endocervical mucopus and with more than 10 polymorphonuclear leucocytes per high power field in a vaginal smear. None of these associated factors had a large enough predictive value to allow its use as a diagnostic criterion. Sexually transmitted diseases are common in pregnant women in Abidjan. The development of rapid, inexpensive diagnostic tests for STD is a priority to improve the care of women attending antenatal clinics in the developing world.

Infection with HIV, syphilis and hepatitis B in Ethiopia: a survey in blood donors.

Sera of all male donors appearing at the blood bank of a regional hospital in Northwest Ethiopia in 1994 (n = 1022) and 1995 (n = 1164), were screened for the presence of human immunodeficiency virus (HIV-1) and treponemal antibodies. Additionally, screening for hepatitis B surface antigen (HBsAg) was carried out on 549 consecutive sera. In 1995, the crude seroprevalence of HIV-1 infection and syphilis was 16.7% and 12.8%. Seroprevalence of HBsAg was 14.4%. HIV and syphilis seroprevalence was highest in soldiers (30.6% and 20.9%) and daily workers (18.8% and 13.5%), and lowest in farmers (8% and 6.7%). However, farmers had the highest rate of HBsAg (18.8%). HIV-positive donors had an increased risk for being positive for syphilis antibodies (OR = 3.69, 95% CI = 2.69-4.96), but not for HBsAg (OR = 0.79, 95% CI = 0.36-1.67). The data indicate that (i) the HIV epidemic has not yet reached a plateau phase in Ethiopia, and (ii) the transmission and epidemiology of HBsAg in Ethiopia is different from that of HIV and syphilis.

Syphilis seroprevalence among pregnant women and its role as a risk factor for stillbirth in Maputo, Mozambique.

To elucidate the role of current syphilis as a risk factor for foetal death. Sera were obtained from 57 women with third trimester foetal death (cases) and 58 women with foetus alive (controls) matched for age and parity. All sera reactive in qualitative Rapid Plasma Reagin (RPR) analyses were tested with serial twofold dilutions to determine endpoint flocculation titres and tested with the micro-haemagglutination assay for Treponema pallidum (MHA-TP). Placental biopsies were sectioned and stained by haematoxylin-eosin and Warthin-Starry for light microscopy. Central Hospital, in Maputo, Mozambique, from January 1990 to June 1991. The MHA-TP was reactive in 42% of cases and in 12% of controls (OR = 5.3; 95% CI: 1.9-15.4). The RPR card test was reactive at the dilution of 1.32 or greater in 28% of cases and in 7% of controls. All these results were confirmed by MHA-TP (OR = 5.3; 95% CI: 1.5-15.4). In 9/28 (32%) MHA-TP seroreactive women (7 cases and 2 controls) placental morphological changes indicated syphilitic infection. MHA-TP seroreactivity and high titre RPR were associated with stillbirth. Morphological changes presumptive of syphilis infection were found in 32% placentas histologically studied. Syphilis is a risk factor for foetal death in Maputo, Mozambique.

Prevalence of HIV and Treponema pallidum infections in pregnant women in Campinas and their association with socio-demographic factors.

The anonymous seroprevalence of HIV and syphilis was studied by collecting umbilical cord blood samples from 5,815 women who gave birth in Campinas' hospitals throughout a six-month period. ELISA and Western blot were used for HIV, and VDRL and TPHA for Treponema pallidum screening. While maintaining the anonymity of the women, information was recorded on the hospital of origin, divided into university (public) and private hospitals, as well as on the form of payment (social security, private insurance or direct payment), age, marital status, education, employment and place of residence. Seroprevalence was 0.42 percent for HIV and 1.16 percent for syphilis. There was a significant correlation between a positive reaction to the two infections (p = 0.02). After univariate and logistic regression analysis, only university hospitals were shown to be associated with seropositivity for HIV, whereas the same variable and an older age were associated with syphilis. All positive reactions were found either in public hospitals or among social security patients treated at private institutions. The conclusion was that HIV infection is becoming almost as prevalent as syphilis among this population, and affects primarily the lower socio-economic strata. This suggests that routine, voluntary HIV serology should be considered and discussed with patients during prenatal or delivery care whenever a population shows a seroprevalence close to or greater than 1 percent.

Seroprevalence of syphilis amongst pregnant women attending antenatal clinics in a rural hospital in north west Ethiopia.

To determine the seroprevalence of syphilis in pregnant women attending antenatal care clinics in a rural hospital in Ethiopia and describe their characteristics so that timely and effective care can be offered. Pregnant women attending antenatal care clinics at a rural hospital. A cross sectional study was conducted at a rural hospital in north west Ethiopia in September 1994. Data were collected on socio demographic characteristics and past history of sexually transmitted diseases of antenatal care attenders from the records of the hospital. Sera from these pregnant women were examined for syphilis using the VDRL test. VDRL positivity was cross tabulated with socio demographic variables and past history of sexually transmitted diseases. Two hundred and seventy pregnant women were included in the study. Median age of the respondents was 25.2 years. A substantial majority were orthodox Christians (97.4%) and married (92.6%). Town dwellers constituted 58.2% of the antenatal care attenders. Only 4.7% of the women started attending antenatal care clinics during the first trimester. Thirty seven women (13.7%) were found to be VDRL positive. Past history of sexually transmitted diseases was significantly associated with VDRL positivity (p < 0.05). High VDRL positivity rate is observed in this study. Certain risk factors may be responsible for current and past episodes of sexually transmitted diseases. There is a need for improvement of antenatal care activities at different levels of health care. Appropriate strategies should be devised for prevention and control of sexually transmitted diseases in women of reproductive age groups and the general population.

Urban rape survivors: Characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections

To determine the prevalence of recent rape, the characteristics or recent rape survivors, and the seroprevalence of human immunodeficiency virus (HIV), syphilis, and genital herpes (HSV-2) among recent rape survivors. We surveyed women 18-29 years old who were recruited from places unassociated with medical or drug treatment or the criminal justice system in three urban communities where illicit drug use is common. We compared characteristics and HIV, syphilis, and HSV-2 seroprevalence of women who reported recent rape with those of women who denied recent rape. One hundred fifty-one of 1104 (13.7%) women reported having been raped in the year before our interview. Rape survivors were more likely than women who denied recent rape to smoke crack cocaine (86.8 versus 56.7%; odds ratio [OR] 5.0, 95% confidence interval [CI] 3.2-7.8), to be homeless (17.2 versus 6.1%; OR 3.2, CI 2.0-5.2), to report a recent sexually transmitted disease (38.7 versus 18.7%; OR 2.7, CI 1.9-3.9), and to be infected with syphilis (42.4 versus 28.4%; OR 1.9, CI 1.3-2.6) and HSV-2 (71.9 versus 57.5%; OR 1.9, CI 1.3-2.8). Survivors were more likely to acknowledge any HIV risk behavior (including sex work) (85.4 versus 49.5%; OR 5.9, CI 3.9-9.0) and to be HIV-infected (23.3 versus 13.4%; OR 1.9, CI 1.3-2.9). Rape was not independently associated with HIV (OR 0.8, 95% CI 0.4-1.3), syphilis (OR 0.9, 95% CI 0.6-1.3), or HSV-2 (OR 1.3, 95% CI 0.9-2.0) infections after adjustment for confounding factors. One in seven women reported being raped recently. Rape was most common among sex workers, crack smokers, and the homeless. Most survivors reported HIV risk behaviors, and many were HIV-infected. Programs to prevent repeated rape, voluntary HIV counseling and testing, and other medical and social services may benefit survivors in these and similar communities.

Prevention indicators for evaluating the progress of national AIDS programmes

Major interventions to reduce HIV transmission involve increasing knowledge about preventing HIV transmission for sustained behavioral changes; and enhancing the control of sexually transmitted diseases (STD), which increase the probability of HIV transmission. Activities have also been developed to prevent the transmission of HIV by blood, donor selection, and more rational use of transfusions. Behavioral changes among injecting drug users have also been promoted. Recommendations are made for the evaluation of AIDS programs, focusing on prevention of sexual transmission of HIV, and outlining the approach developed by the Global Program on AIDS (GPA; Geneva, Switzerland) for use by national programs. Based on the feasibility, accuracy, reliability and validity of the quantitative assessment of programs, 10 indicators of progress and outcomes of prevention activities have been developed by GPA. These include indicators of population knowledge regarding preventive practices, reported sexual behavior and use of condoms in the general population, STD service evaluation, and indicators of program impact. The latter are measured through the reported STD incidence in the general male population, and syphilis and HIV prevalence in women. The four methods are proposed for measuring the 10 core prevention indicators (PI). Five PIs are measured during a population survey: reported knowledge of preventive practices (PI-1), condom availability at peripheral level (PI-3), reported frequency of nonregular sexual partners (PI-4), reported condom use during nonregular sexual encounters (PI-5), and reported STD incidence among men (PI-9). Condom availability at central level (PI-2) is assessed through key-informant interviews with major distributors. Structured health facility surveys allow assessment of the appropriateness of STD case management (PI-6 and PI-7). A serosurvey among antenatal clinic attenders aged 15-24 years allows the measurement of HIV and syphilis seroprevalence in that population (PI-8 and PI-10). GPA recommends that such surveys be repeated after a period of 1 to several years.

HIV and syphilis seroprevalence among clients with sexually transmitted diseases attending a walk-in clinic at Cook County Hospital.

To determine the HIV and syphilis seroprevalence in a patients with suspected sexually transmitted diseases at an urban walk-in clinic. Between January and November 1991, 515 patients with suspected sexually transmitted diseases were simultaneously tested for syphilis and HIV antibodies. The cohort studied was young (85% were < 40 years), 81% were black, 11% Hispanic, and 71% reported heterosexual contact as the primary HIV risk factor. HIV seroprevalence was 8% (41/515), (95% confidence interval [95% CI], 5.66%, 10.34%). Syphilis seroprevalence rate was 21.4% (110/515), (95% CI 17.86%, 24.94%). Syphilis seroprevalence in those who were HIV positive was 31.7% (13/41), (95% CI 17.46%, 45.94%) as compared to 5.9% (28/574), (95% CI 3.78%, 8.02%) in those who were HIV negative. The HIV seroprevalence among patients with sexually transmitted diseases who are screened for syphilis was disturbingly high. Patients who were seropositive for HIV had a significantly higher rate of syphilis than those who were HIV negative.

Syphilis and HIV infection among displaced pregnant women in rural Mozambique.

A cross-sectional study was conducted among displaced pregnant women in Mozambique to determine the prevalence and correlates of HIV infection and syphilis. Between September 1992 and February 1993, 1728 consecutive antenatal attendees of 14 rural clinics in Zambézia were interviewed, examined, and tested for HIV and syphilis antibodies. The seroprevalence of syphilis and HIV were 12.2% and 2.9%, respectively. Reported sexual abuse was frequent (8.4%) but sex for money was uncommon. A positive MHA-TP result was significantly associated with unmarried status, history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genital warts. Significant correlates of HIV seropositivity included anal intercourse, history of past STD, and syphilis. In summary, displaced pregnant women had a high prevalence of syphilis but a relatively low HIV seroprevalence suggesting recent introduction of HIV infection in this area or slow spread of the epidemic. A syphilis screening and treatment programme is warranted to prevent perinatal transmission and to reduce the incidence of chancres as a cofactor for HIV transmission.