Syphilis In Pregnancy Research Articles

A Narrative Review of Congenital Syphilis in the United States: Innovative Perspectives on a Complex Public Health and Medical Disease.

Over the past two decades, congenital syphilis cases have risen 11-fold in the United States. While disparities across geography, race, and ethnicity exist, lack of timely screening or treatment is identified in 88% of cases nationally. Congenital syphilis is a public health and medical problem rooted in systematic and societal structural determinants of health and healthcare limitations. Early syphilis in pregnancy leads to congenital syphilis if untreated in 50 - 70% of cases, with risk for fetal demise, and among survivors, congenital anomalies, organ damage, and central nervous system disease. Prevention of congenital syphilis lies in early detection and treatment in pregnant persons. In this narrative review, we describe the evolving epidemiology of syphilis and congenital syphilis, highlighting unique aspects among women. We explore the role of novel screening and treatment strategies, public health policy, and medical considerations in terms of congenital syphilis prevention. Readers of this review will understand CS as a complex public health and medical disease that can be prevented through innovative and coordinated strategies in public health policy, expanded screening and research opportunities.

Syphilis in pregnant women and congenital syphilis from 2012 to 2021 in Switzerland: a multicentre, retrospective study.

Congenital syphilis is a rare complication of syphilis in pregnant women. Vertical transmission may occur at any time during pregnancy. The incidence of congenital syphilis has been increasing worldwide. Congenital syphilis has been a notifiable disease for many years in Switzerland but reporting does not include maternal features associated with syphilis in pregnancy or infant's subsequent development. We described syphilis cases among pregnant women screened over a 10-year period in Switzerland and subsequent cases of congenital syphilis, in order to identify maternal risk profiles and to optimise prevention. Second, we compared the characteristics of pregnant women screened early (1st trimester) vs late in pregnancy (2nd or 3rd trimester). Finally, we assessed the risk factors for premature birth among these women with syphilis. A multicentre retrospective study conducted in Swiss hospitals from 2012 to 2021, including pregnant women who screened positive for syphilis (Treponema pallidumhaemagglutination assay [TPHA] /T. pallidumparticle agglutination assay [TPPA ] ≥1:80) and newborns exposed toT. pallidumin utero and/or congenitally infected and with a positive syphilis serology at birth. Data were collected from medical records. A total of 147 syphilis-positive pregnant women and 102 infants were included. A history of treated syphilis was known for 44% (65/147) of the mothers corresponding to a serological scar and the remaining 56% (82/147) were newly identified syphilis cases. Syphilis screening was done during the first trimester in 54%, second trimester in 29% and third trimester in 13% of cases. Two babies were diagnosed with congenital syphilis (1.96%). Several potential factors that could contribute to women's risk of syphilis during pregnancy were identified such as a foreign origin (93% of mothers), lack of healthcare insurance (25%), no employment status (37%), drug use (5%), co-infection with other sexually transmitted infections (24%) and a late first antenatal consultation (42%). The number of pregnant women without insurance was higher in women diagnosed in the second or third trimester than in those diagnosed in the first trimester (odds ratio 0.41; 95% CI 0.19-0.89; p = 0.024). Syphilis diagnosed in the second or third trimester was associated with a late first antenatal consultation (odds ratio 77.82; 95% CI 9.81-617.21; p <0.001). A high rate of intrauterine growth retardation and of preterm birth was observed in newborns (18% versus 6% in Switzerland in 2022). Congenital syphilis remains rare in Switzerland. However, we found potential maternal factors associated with a positive syphilis serology during pregnancy, which can help to improve future prevention measures. The study protocol was registered on ClinicalTrials.gov (ID NCT05975502).

A model of prevention of mother-to-child transmission and health management team for improving adverse outcomes of pregnancy syphilis in Ningxia, China

Regional variations exist in the implementation of Syphilis Mother-to-Child Transmission Prevention (PMTCT). Thus, it is crucial to assess the effectiveness of this model in the Ningxia region and explore the supplementary role of Health Management Teams (HMT). This study established the PMTCT + HMT model and examined its impact on adverse outcomes in pregnant women with syphilis infection. The majority of participants were urban residents, married, had a minimum high school education, and held public positions; 36.7% and 26.7% were from minority ethnic groups. The PMTCT + HMT model enhanced participants’ knowledge, rates of voluntary counseling, and testing. The incidence of adverse pregnancy outcomes (miscarriages, preterm births, stillbirths) significantly decreased, and adverse neonatal outcomes (low birth weight, neonatal mortality, congenital syphilis) were notably reduced. Simultaneously, we identified factors associated with adverse outcomes, including non-residency, unmarried status, lower educational attainment, minority ethnicity, primary syphilis, and positive titers. Thus, HMT may be an effective intervention to enhance the effect of PMTCT for syphilis. The unique population structure in Ningxia is closely linked to adverse outcomes, highlighting the significance of providing equitable treatment for vulnerable populations.

British Association of Sexual Health and HIV (BASHH) UK guidelines for the management of syphilis in pregnancy and children 2024.

This new guideline details the specific management of syphilis in pregnancy and in children. It is to be used in clinical practice alongside the BASHH UK guidelines for the management of syphilis 2024.

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service

Congenital syphilis, syphilis in pregnancy and prenatal care in Brazil: An ecological study.

The aim of this research was to evaluate the incidence of congenital syphilis and the ratio between congenital syphilis and syphilis in pregnant women in Brazil according to socioeconomic indicators (inadequate water supply and sanitation; illiteracy at 15 years of age or older; household income per capita; proportion of poor people; Gini index; human development index; and average health expenditure per inhabitant by the health system) and prenatal quality-of-care indicators. We conducted an ecological study using a sample composed of 257 municipalities, each with ≥ 100,000 inhabitants. Data was collected from four public databases: the Brazilian Institute of Geography and Statistics, comprising socioeconomical data from the 2010 census; and the data of 2019 available in the databases of the Department of Informatics of the Brazilian Health System, Information and Management of Primary Care, and the Electronic Citizen Information System. Descriptive analysis of dependent and independent variables and bivariate analysis by Negative Binomial regression were carried out. The mean incidence of congenital syphilis was 38% higher in municipalities with a Human Development Index up to 0.785 (ratio of means [RM] = 1.38; p = 0.049) and 57% higher among populations where less than 50% of primary healthcare services provided a rapid test for syphilis (RM = 1.57; p < 0.001). The ratio between congenital syphilis and syphilis in pregnant women was 29% higher in municipalities with a low household income per capita (RM = 1.29; p < 0.001) and 28% higher in locations where less than 50% of the primary healthcare services provided a rapid test for syphilis (RM = 1.28; p < 0.001). There was no statistical significance of the quality of prenatal care compared to the outcomes. This result underscores the challenges in detecting syphilis infections among pregnant women during prenatal care, consequently increasing the risk of vertical transmission of the disease to the fetus. Traits of inequality in the occurrence of congenital syphilis also draw attention to strategies to reduce health inequities and improve prenatal care.

Congenital Syphilis: A Re-Emerging but Preventable Infection.

Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.

Benzathine penicillin G stockouts and other barriers to documented syphilis treatment in pregnancy in Zambia.

The prevalence of syphilis in Zambia remains high and is a critical public health concern. The Zambian Ministry of Health recommends universal screening and same-day treatment for syphilis in pregnancy, yet the syphilis screening rate is low, and treatment is poorly documented. The goal of this study was to document syphilis treatment rates and associated factors among pregnant women in care in Zambia. This retrospective cohort study included pregnant women diagnosed with syphilis according to rapid plasma reagin (RPR) screening during routine antenatal care (ANC) in Lusaka, Zambia in 2018-2019. The main outcome of interest was lack of documented BPG treatment during pregnancy. Additional information about pregnancy and neonatal outcomes, partner referral for therapy, and facility level stockout data were included. Patient characteristics were compared by treatment status using Pearson Chi-Square Test and logistic regression models were created to estimate the association between individual level-factors, facility type, and lack of BPG treatment. A Cochran-Mantel-Haenszel test was used to evaluate facility-level data with significance set at p<0.05. Among 1,231 pregnant women who screened positive for syphilis at clinic, 643 (52%) lacked documented antibiotic treatment at the facility. BPG was the only antibiotic used to treat syphilis in the cohort and 8% of sex partners had evidence of referral for therapy. Preterm delivery rates were higher in women without documented BPG (43% vs 32%; p = 0.003). In adjusted models, only calendar year and hospital facility type were associated with lack of treatment. At the facility level, annual syphilis screening rates ranged from 37-65% and most (7/10) clinics reported at least one stockout of BPG. Treatment rates for syphilis in pregnancy in Zambia were low and BPG medication stockouts at the facility level were common. A consistent supply of BPG at all ANC facilities is needed to facilitate timely treatment and improve birth outcomes.

Syphilis in Pregnancy: Fetal and Neonatal Complications.

Syphilis in Pregnancy: Fetal and Neonatal Complications.

Syphilis in pregnancy and adverse birth outcomes: Anationwide longitudinal study in Brazil.

The present study aimed to evaluate the association between syphilis in pregnancy and low birth weight, small for gestational age, and preterm birth. This longitudinal study used Brazilian National Information System for livebirths (SINASC) linked to the gestational syphilis cases from Notifiable Diseases Information System (SINAN) from 2011 to 2017. Descriptive statistics and logistic regression were used to compare the birth outcomes of pregnant women with and without syphilis. The study protocol was approved by the Research Ethics Committee of the Institute of Collective Health of the Federal University of Bahia (CAAE: registration no. 18022319.4.0000.5030). A total of 17 930 817 live births were included in the study. Of these, 155 214 (8.7/1000) were exposed to syphilis during pregnancy. Maternal syphilis increased the odds of low birth weight (aOR 1.88, 95% CI: 1.85-1.91), small for gestational age (aOR 1.53, 95% CI: 1.51-1.56), and preterm birth (aOR 1.35, 95% CI: 1.33-1.37). Higher odds were observed for pregnant women with VDRL titer ≥64 and untreated maternal syphilis when compared to mothers without syphilis. Analysis stratified by prenatal care showed higher odds for all adverse birth outcomes for mothers attending ≤6 prenatal appointments. Our findings showed a strong association between gestational syphilis and adverse birth outcomes with increased odds observed among women with higher VDRL titers, lack of treatment, and fewer prenatal appointments. These results highlight the need for adequate screening and treatment for gestational syphilis during pregnancy to mitigate the risk of adverse birth outcomes.

Epidemiology of Syphilis in Pregnancy and Congenital Syphilis in Brazil and the Risk or Associated Factors: Protocol for a Systematic Review.

Syphilis in pregnancy and congenital syphilis are growing public health issues worldwide. Several factors can influence their occurrence in the population. Therefore, understanding the epidemiology of this condition and the factors that influence its occurrence is fundamental for decision-making by clinicians and health managers. However, so far, no systematic review has summarized and analyzed data on the incidence, prevalence, and predictors of these diseases in Brazilian cities, considering different sociocultural, demographic, economic, sanitary, and spatial-temporal characteristics presented across locations. We propose a systematic review protocol to gather and analyze data on the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil, taking into account different local or regional contexts. Searches will be conducted in CINAHL, MEDLINE, LILACS, Embase, and Web of Science databases. We will include observational studies (ie, cross-sectional, longitudinal, or case-control studies), analyzing the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil from primary data. The diagnosed syphilis will be assessed based on direct pathogen detection tests or through immunological, treponemal or nontreponemal tests, following Brazilian protocols for diagnosing syphilis. The studies are currently undergoing screening in the databases, and after this step, 2 reviewers will perform all identified documents. The Newcastle-Ottawa Scale and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system will be used to assess methodological quality and quality of evidence of studies, respectively. The Kappa coefficient will assess the agreement between researchers in each study stage. Cochran Q test will assess the heterogeneity among studies. Then, a random-effects meta-analysis will be performed. Results will be discussed based on subgroup analysis, which is as follows: (1) type of syphilis (in pregnancy or congenital), (2) type of study (case-control and cross-sectional studies for analysis of associated factors and longitudinal studies for risk factors), and (3) contextual factors (ie, region of country, socioeconomic and demographic characteristics, and year of study). This systematic review is expected to be completed by December 2023, and our results will be disseminated through publication in peer-reviewed journals and scientific events. This systematic review aims to assist health care managers and professionals in their decision-making to control these diseases in Brazil, considering location heterogeneity. Furthermore, countries with health systems and demographic and socioeconomic contexts similar to those of Brazil may benefit from this information. DERR1-10.2196/50702.

652 Opportunities to reduce inadequate treatment of syphilis in pregnancy associated with substance use disorder

652 Opportunities to reduce inadequate treatment of syphilis in pregnancy associated with substance use disorder

380 Cost-effectiveness of a reverse screening algorithm for syphilis in pregnancy

380 Cost-effectiveness of a reverse screening algorithm for syphilis in pregnancy

Clinical aspects of co-infection by HIV and syphilis in pregnancy and exposure in newborn intended at Pediatric Hospital of Santa Catarina

Introduction: Sexually transmitted infections frequently affect pregnant women and, consequently, newborns. HIV and syphilis are vertically transmitted to children and co-infection requires special attention due to its clinical implications. Objective: To describe clinical aspects of HIV/syphilis coinfection during pregnancy and the exposure of newborns to infections treated at a pediatric reference hospital in Santa Catarina between 2015 and 2020. Methods: Observational, descriptive study, secondary to a line of research “Epidemiological description of children exposed to HIV” from January 2015 to December 2020 in a tertiary pediatric hospital in Santa Catarina. Results: 678 medical records were analyzed with ICD Z.206 (contact with and exposure to HIV), in which 71 (10.5%) newborns were exposed to HIV and Syphilis co-infection. Of these, 37 (52.1%) were male, 14 (19.7%) confirmed a diagnosis of HIV and 30 (42.2%) of congenital syphilis. Of the co-infected pregnant women, 38 (53.5%) were diagnosed with HIV prior to pregnancy, 53 (74.6%) used ART and 40 (52.1%) used harmful substances. Furthermore, 34 (46.4%) pregnant women had a minimum number of 6 prenatal consultations, 35 (49.3%) had vaginal births and 29 (40.8%) had undetectable HIV RNA quantification at the time of delivery. HIV prophylaxis for newborns occurred in 66 (92.9%) of cases. Conclusion: It is concluded that the studied population was mostly made up of pregnant women who were diagnosed with HIV infection prior to pregnancy. Of these, the majority were using ART, but the minority carried out the minimum number of consultations recommended by the Ministry of Health. Regarding newborns, the majority received HIV prophylaxis.

Associations between maternal syphilis infection during pregnancy and low birth weight and preterm birth: a prospective cohort study.

In recent years, syphilis is still the most common sexually transmitted disease worldwide. Pregnant women infected with syphilis can transmit it to the fetus in utero through mother-to-child transmission, which can directly lead to adverse pregnancy outcomes. The aim of this study was to investigate the associations between maternal syphilis infection and low birth weight and preterm birth in offspring. Multinomial logistic regression model was used to analyze the associations between maternal syphilis infection and low birth weight and preterm birth, and to explore its stability through subgroup analysis. A total of 34,074 subjects were included in the study. After adjusting for potential confounders, maternal syphilis infection during pregnancy was associated with a 2.60-fold (95% CI 1.83-3.69) increased risk of low birth weight and a 1.91-fold (95% CI 1.35-2.69) increased risk of preterm birth. Subgroup analysis showed that the association was stable. We found that maternal syphilis infection during pregnancy was significantly associated with an increased risk of low birth weight and preterm birth. The implementation of reasonable syphilis screening and standardized treatment and follow-up of pregnant syphilis may have important practical significance in reducing the low birth weight and preterm birth rate in offspring.

Secondary Syphilis with Giant Condyloma Acuminatum in Pregnant Women: A Report from a Limited Resource Area

Introduction: This report shows a case of secondary syphilis in pregnancy with Giant Condyloma Acuminatum (GCA) co-infection DD/condyloma lata which was resolved with alternative treatment of syphilis. Case illustration: A 21-year-old, primigravid woman came to obstetrics outpatient clinic in rural SoE Hospital, East Nusa Tenggara, with a complaint of mass enlargement around vulva (minor and major labia) since 2 months before. Based on Last Menstrual Period (LMP), she was in 34 + 6 weeks of gestation. There were coin lesions in the palms. On genital examination, there was protruded mass sized around 15 x 10 cm, erythematous, and it easily bled on the center part which was suspected to be GCA. Treponema Pallidum rapid (TP-rapid) test using AIM© syphilis rapid test revealed positive results. The patient was diagnosed with secondary syphilis in pregnancy mixed with GCA with dd/condyloma lata and administered Ceftriaxone 1 g intramuscularly once daily for 14 days. She delivered at 41-42 weeks of gestation and a baby girl with 1,980 grams of body weight according to symmetric Intrauterine Growth Restriction (IUGR) was born. No clinical signs of congenital syphilis found. Discussion: Vertical transmission which occurs in each stage of syphilis is related to the presence of spirochetes in the blood circulation. Infants born from syphilis pregnant women consist of 56% of jaundice, 14% of hearing impairment, 8% of renal disease, 8% of mental retardation, and 6% of IUGR or Small for Gestational Age (SGA). Conclusion: Secondary syphilis coinfection with GCA in pregnancy is a rare case report. Syphilis is a significant public health problem globally, especially in Indonesia.

Congenital Syphilis—What Nurse Practitioners Need to Know

Congenital syphilis (CS) is associated with significant negative health consequences. Rates of CS have skyrocketed in the United States and Canada since the early 2000s. Despite effective treatment with penicillin, CS rates are impacted by socioenvironmental factors that further complicate the treatment of this transmissible infection. The emergence of point-of-care syphilis testing offers novel screening and prevention modalities for rapid detection and treatment. Nurse practitioners can help prevent CS by promptly identifying and treating syphilis in pregnancy and reduce disease burden by being aware of its clinical presentation and management, including recent trends, current approaches, barriers, and facilitators to care.

Perspectives and challenges for mother-to-child transmission of HIV, hepatitis B, and syphilis in Brazil.

Eliminating mother-to-child transmission (MTCT) of HIV, hepatitis B, and syphilis is a challenge in Brazil. Many policies have been implemented since 1986, but important gaps remain. This study aimed to describe the trends of MTCT in Brazil and evaluate the gaps and perspectives in this scenario. This is a descriptive study conducted with secondary data publicly available in the information systems of the Brazilian Ministry of Health regarding data on HIV, syphilis, and hepatitis B in pregnant women and children from 2011 to 2021. HIV and hepatitis B have had constant rates over the years in pregnant women, with the detection rates around 2.5/1,000 live birth (LB) and 0.5/1.000LB, respectively. The same did not happen with syphilis, which has shown an increasing line in the last decade. In 2011, the detection rate of syphilis in pregnancy was 4.7/1,000LB, and in 2021 it reached 27.1/1,000LB. Regarding the trends in children, an important decrease was observed in HIV/AIDS (incidence rate from 0.18/1,000 in 2011 to 0.04/1,000 in 2021) and Hepatitis B (incidence rate from 0.9/1,000LB in 2011 to 0.5/1,000LB in 2021). For congenital syphilis, there is a continuous increase, being 3.3/1,000LB in 2011 and 9.9/1,000LB in 2021. Data from the HIV clinical monitoring showed that antiretroviral treatment coverage among pregnant women identified increased slightly between 2011 and 2021, in Brazil, from 92.3% to 94.3%. For syphilis, 82.5% of pregnant women were treated with benzathine penicillin, and 88.7% in 2011. The historical series of hepatitis B vaccination coverage in children has decreased over the years; it was 96% in 2013 and 76% in 2021. These data show many gaps and some perspectives in the MTCT program in Brazil. The country is close to reaching MTCT HIV elimination, but there are many challenges regarding HBV and syphilis. These data can be used to organize the strategies to improve the Brazilian response to MTCT elimination of HIV, hepatitis B, and syphilis.

Prevalence of Syphilis among Pregnant Women attending antenatal care clinic, Udaipur, Southern Rajasthan

Background Maternal syphilis is an important cause of adverse pregnancy outcome . Syphilis, caused by infection with Treponema pallidum, is a mucocutaneous sexually transmitted infection (STI) with high infectivity in the early stages. Untreated maternal syphilis is strongly associated with adverse birth outcomes including increased incidence of stillbirths, low birth weight and premature live births compared with uninfected women. The WHO recommends serological test for syphilis in pregnancy and treatment with injectable penicillin, including the partner, as a routine part of antenatal care. Ideally this screening should be done in the first trimester or at first antenatal visit and again early in the third trimester. Method A retrospective, quantitative study of hospital and laboratory records of all pregnant women booked at the RNT Medical college for antenatal care in a one-year period (1ST JULY 2021 to 30TH JUNE 2022) was carried out. Data were collected from department register maintained by authority. VDRL testing was done to screen the patient. Data were analysed. Result : During the study period, 10194 antenatal clinic patients had VDRL screening out of which 27 were positive. The overall prevalence rate in this study was 0.26% Conclusion Universal screening of all pregnant women at first antenatal visit with a non-treponemal test should be used for screening for syphilis in pregnancy. Also considering prevalence of gestational syphilis in Udaipur region , policy translation is required at state and national level to scale up prevention, screening, and management of syphilis.

Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada.

Data were collected on the incidence and characteristics of stillbirths attributed to congenital syphilis (CS). Data were extracted on stillbirths in Edmonton Zone January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (one of whom was treated early in pregnancy and presumably reinfected), and one had a stillbirth in the week following one dose of benzathine penicillin G. Stillbirths due to CS were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.