Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Congenital Syphilis Prevention Challenges, Pacific Coast of Colombia, 2018-2022

High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018-2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having >1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.

Congenital Syphilis-An Illustrative Review

Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from an infected mother to her fetus during pregnancy or by contact with a maternal lesion at the time of delivery. The incidence of congenital syphilis is rapidly increasing all over world with 700,000 to 1.5 million cases reported annually between 2016 and 2023. Despite the widespread availability of Penicillin, 2677 cases were reported in 2021 in the US. Clinical manifestations at birth can vary widely ranging from asymptomatic infection to stillbirth or neonatal death. Low birth weight, rash, hepatosplenomegaly, osteolytic bone lesions, pseudoparalysis, central nervous system infection, and long-term disabilities have been reported in newborns with congenital syphilis. Prevention of congenital syphilis is multifaceted and involves routine antenatal screening, timely treatment of perinatal syphilis with penicillin, partner tracing and treatment, and health education programs emphasizing safe sex practices and strategies to curb illicit drug use. Neonatal management includes risk stratification based on maternal syphilis history, evaluation (nontreponemal testing, complete blood counts, cerebrospinal fluid, and long-bone analysis), treatment with penicillin, and followup treponemal testing. Public health measures that enhance early detection during pregnancy and treatment with penicillin, especially in high-risk mothers, are urgently needed to prevent future cases of congenital syphilis.

The impact of antibiotic treatment for syphilis, chlamydia, and gonorrhoea during pregnancy on birth outcomes: A systematic review and meta-analysis

Background

Sexually transmissible infections are important causes of loss of health and lives in women and infants worldwide. This paper presents the methods and results of a systematic review that focuses on the impact of antibiotic treatment for syphilis, chlamydia, and gonorrhoea during pregnancy on birth outcomes for the Lives Saved Tool (LiST).

Methods

We searched PubMed, Embase, Cochrane Libraries, Global Health and Global Index Medicus for articles available until May 23rd, 2022. The search criteria focused on the impact of treatment for the three sexually transmitted infection among pregnant women. Nearly all the articles found were non-randomized studies.

Results

Treatment for pregnant women with active syphilis reduced the risk of preterm birth by 52% (95% CI = 42%-61%; 11 043 participants, 15 studies; low quality); stillbirth by 79% (95% CI = 65%-88%; 14 667 participants, eight studies; low quality); and low birth weight by 50% (95% CI = 41%-58%; 9778 participants, seven studies; moderate quality). Treatment for pregnant women with chlamydia infection reduced the risk of preterm birth by 42% (95% CI = 7%-64%; 5468 participants, seven studies; low quality) and might reduce the risk of low birth weight by 40% (95% CI = 0%-64%; 4684 participants, four studies; low quality). No studies provided data on treatment of gonorrhoea therefore no meta-analysis was conducted.

Conclusions

Because few studies adjusted for potential confounding factors, the overall quality of evidence was considered low. However, given the consistent and large effects, we recommend updating the estimated effect of timely detection and treatment for syphilis on preterm birth and stillbirth in the LiST model. More research is required to ascertain the effect of antibiotic treatment for chlamydia and gonorrhoea infection in pregnancy.

Quality of life, depressive symptoms, anxiety, and sexual function in mothers of neonates with congenital syphilis in the Northeast Brazil: A cohort study

Background

Congenital syphilis is an important public health problem in low- and middle-income countries. Poor neonatal health outcomes associated with the disease may lead to maternal psychological distress and feelings of helplessness. This study aimed to evaluate the quality of life, anxiety levels, depressive symptoms, and sexual function in mothers of neonates with congenital syphilis in the Northeast of Brazil.

Methods

This cohort study compared patient-centered outcomes between mothers of neonates with congenital syphilis and mothers of healthy neonates during the first three months of the postpartum period. The study was conducted in Sergipe state, Northeast Brazil, a region with one of the highest rates of congenital syphilis (14·1 cases per 1000 live births). Quality of life, depressive symptoms, anxiety levels, and sexual function were evaluated by using the World Health Organization Quality of Live - shortened version (WHOQoL-BREF) instrument, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Female Sexual Function Index, respectively. Unadjusted differences between groups were anayzed by using the Mann-Whitney test. Glass's delta with 95% confidence interval (CI) was used to measure the effect size.

Findings

Sixty-three women were included in each group. During the in-hospital stay, mothers of neonates with congenital syphilis had lower scores for overall quality of life (p < 0·001; large effect size: -0·559 [95% CI -0·683 to -0·405]) and higher levels of anxiety (p < 0·001; large effect size: 0·558 [95% CI 0·403 to 0·681]) and depressive symptoms (p < 0·001; large effect size: 0·561 [95% CI 0·407 to 0·684]) than mothers of healthy neonates. Three months after childbirth, we found persistent depressive symptoms (p = 0·021; small effect size: 0·239 [95% CI 0·041 to 0·419]) and low overall sexual function (p = 0·041; small effect size: -0·211 [95% CI -0·394 to -0·012]) among mothers of neonates with congenital syphilis compared to the control group.

Interpretation

Mothers of neonates with congenital syphilis present poorer quality of life, mental health, and sexual function compared to mothers of healthy neonates.

Funding

Brazilian Federal Agency for Coordination of Improvement of Higher Education Personnel (CAPES).

Outcomes of infectious syphilis in pregnant patients and maternal factors associated with congenital syphilis diagnosis, Alberta, 2017-2020

BACKGROUND

Congenital syphilis (CS) is a significant public health challenge, requiring early diagnosis and treatment to improve infant outcomes. The aim of this study is to describe public health outcomes of infectious syphilis cases among pregnant patients and factors associated with a CS diagnosis for their infant.

METHODS

We conducted a retrospective review of demographic and clinical characteristics of infectious syphilis cases diagnosed during pregnancy and resulting infant outcomes in Alberta from 2017 to 2020 from the provincial communicable disease database. Adequate maternal treatment was defined as receiving at least one dose of Benzathine penicillin G-LA 2.4 million units IM at least 28 days before delivery. Univariate and multivariate analysis was performed to determine factors associated with CS diagnosis using SPSS version 25.

RESULTS

A total of 374 cases of infectious syphilis were diagnosed in pregnancy, with two patients being diagnosed twice in a single pregnancy. The majority (79.1%; n=296) of women had a live birth, followed by therapeutic abortion (9.4%; n=35), stillbirth (7.5%; n=28) and spontaneous abortion (4.0%; n=15). Infant records (n=265) were available for review (n=117 CS cases and 148 non-cases). Correlates associated with CS were screening time in third trimester (adjusted odds ratio [AOR] 8.4, 95% confidence interval [CI], 2.9-24.6) and fewer than 28 days before delivery (AOR 8.1, 1.4-47.8 [vs. first and second trimester] and inadequate treatment (AOR 86.1, CI, 15.9-466.5). Among the CS cases, 23.1% (n=27) were stillborn compared with one (0.7%) stillbirth in the non-CS infants (p<0.001).

CONCLUSION

The early identification and treatment of syphilis in pregnancy is crucial to preventing poor infant outcomes.

Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China

BACKGROUND

There are a lack of studies about factors influencing congenital syphilis (CS) in economically underdeveloped areas, such as Jiangxi Province, China.

METHODS

A retrospective study was conducted based on the information system of prevention of mother-to-child transmission of syphilis management in Jiangxi Province, China. Pregnant women with syphilis infection who delivered ≥28 gestational weeks and registered in this system from 1 January 2013 to 2030 June 2018 were enrolled. Maternal characteristics and treatment regimens associated with CS were evaluated using multivariable regression analysis.

RESULTS

1196 syphilis infected mothers and their 1207 infants were included in the analyses, and 116 infants were diagnosed with CS, providing an overall incidence of 9.61% (116/1207). Multivariable logistic regression analysis showed that increasing maternal age was barely associated with the risk of CS (adjusted odds ratio (aOR) = 0.97, 95% CI, 0.93-1.00, p = .047). Women with a high nontreponemal serum test titer (≥1:8) had a 126% increased risk of delivering an infant with CS than those with a low titer (<1:8) (aOR = 2.26, 95% CI, 1.51-3.39, p < .001). The risk for CS decreased significantly in infants born to mothers receiving adequate treatment than those receiving no treatment (aOR = 0.36, 95% CI, 0.21-0.61, p < .001).

CONCLUSIONS

Adequate treatment is critical for the prevention of CS. Further strategies focusing on early diagnosis and adequate treatment among syphilis infected pregnant women, particularly among those with younger age and high nontreponemal titer, should be strengthened to prevent CS.

Factors associated with prematurity in reported cases of congenital syphilis

OBJECTIVE:

To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil.

METHODS:

Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers’ and babies’ medical records and from prenatal cards. For the bivariate analysis, Pearson’s chi-squared and Fisher’s exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval.

RESULTS:

We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33–4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74–7.13; p< 0.001) were associated with higher chances of prematurity.

CONCLUSION:

The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

BACKGROUND

Studies investigating the associations of maternal syphilis treatment with birth outcomes mainly concentrated in economically developed areas. Limited data are available in economically underdeveloped areas, such as Jiangxi Province. The study aims to investigate the impact of maternal treatment on birth outcomes in Jiangxi Province, China.

METHODS

Data were obtained from the China's Information System of Prevention of Mother-to-Child Transmission in Jiangxi Province. All syphilis infected pregnant women who delivered ≥28 gestational weeks and were registered in this system between 1 January 2013 and 31 December 2019 were enrolled. Pregnancy outcomes were evaluated by group-specific analyses according to their treatment status, adequacy and initiation time.

RESULTS

4210 syphilis infected pregnant women were included in the analyses. Infants born to untreated mothers (n = 1364) were at significantly higher risk for stillbirth (adjusted odds ratio (aOR) = 1.74, 95% CI, 1.01-3.00, P = 0.045), preterm birth (aOR = 1.27, 95% CI, 1.02-1.59, P = 0.034) and low birth weight (LBW) (aOR = 1.44; 95% CI, 1.11-1.86, P = 0.006) than those born to treated mothers (n = 2846) after adjustment for confounding factors. A significantly higher risk of stillbirth (aOR = 3.68; 95% CI, 1.62-8.34, P = 0.002), preterm birth (aOR = 2.26; 95% CI, 1.71-3.00, P < 0.001), LBW (aOR = 2.23; 95% CI, 1.59-3.14, P < 0.001) and congenital syphilis (CS) (aOR = 3.63; 95% CI, 1.80-7.31, P < 0.001) was found in infants exposed to mothers treated inadequately (n = 1299) than those treated adequately (n = 1547). No pregnant women who initiated the treatment in the first trimester (n = 682) delivered a neonatal CS case. Compared with mothers who initiated treatment in the first trimester (n = 682), those initiated in the third trimester (n = 1234) suffered an increased risk of stillbirth (aOR = 4.48; 95% CI, 1.31-15.30, P = 0.017), preterm birth (aOR = 2.34; 95% CI, 1.61-3.40, P < 0.001) and LBW (aOR = 3.25; 95% CI, 1.97-5.37, P < 0.001).

CONCLUSIONS

Maternal treatment, especially early and adequate treatment, plays a crucial role in mitigating adverse pregnancy outcomes among syphilis infected women.

Differences in maternal characteristics and pregnancy outcomes between syphilitic women with and without partner coinfection

BACKGROUND

Partner infection is a significant factor in preventing mother-to-child syphilis transmission. We compared pregnancy outcomes between syphilis discordant and syphilis concordant couples.

METHODS

We conducted a retrospective study among 3076 syphilis-positive women who received syphilis screening together with their partners during pregnancy. Multivariate analysis was used to explore risks for abnormal outcomes in objects correcting for the major covariate factors. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to compare pregnancy outcomes between syphilis concordant and syphilis discordant couples.

RESULTS

Overall, 657 of the 3076 women were diagnosed with gestational syphilis and had a syphilis-positive partner, giving a partner concordance prevalence of 21.36%. Women in concordant couples were more likely to have higher parity, more children, late antenatal care and syphilis screening, a lower proportion of latent syphilis, and elevated serologic titers than women in discordant couples (P < 0.01 for all). Totally, 10.08% of women had adverse pregnancy outcomes. Multivariate analysis showed partners' syphilis infection (OR_adj = 1.44, 95% CI: 1.10-1.89), untreated pregnancy syphilis (OR_adj = 1.67, 95% CI: 1.15-2.43), and higher maternal serum titers (> 1:8) (OR_adj = 1.53, 95% CI: 1.17-2.00) increased the risks of adverse pregnancy outcomes. Concordance was associated with increased risk for stillbirth (OR_adj = 2.86, 95%CI:1.36-6.00), preterm birth (PTB) (OR_adj = 1.38,95%CI:1.02-1.87) and low birth weight (LBW) (OR_adj = 1.55, 95%CI:1.13-2.11) compared with discordance. Even among treated women, concordance was associated with increased risk for stillbirth (OR_adj = 3.26, 95%CI:1.45-7.31) and LBW (OR_adj = 1.52, 95%CI:1.08-2.14). Among women with one treatment course, the risks for PTB(OR_adj = 1.81, 95%CI:1.14-2.88) and LBW(OR_adj = 2.08, 95%CI:1.28-3.38)were also higher among concordant couples than discordant couples. Nevertheless, there were no significant differences between concordant and discordant couples in risks of stillbirth (OR_adj = 2.64, 95% CI: 0.98-7.05),PTB (OR_adj = 1.15, 95% CI: 0.76-1.74), and LBW(OR_adj = 1.21, 95% CI: 0.78-2.02) among women with two treatment courses.

CONCLUSION

Male partner coinfection increased the risks for stillbirth, PTB and LBW, particularly when gestational syphilis treatment was suboptimal. However, this risk could be reduced by adequate treatment.

Sociodemographic characteristics and clinical description of congenital syphilis patients and their mothers in Japan: a qualitative study, 2016

Background In Japan, congenital syphilis (CS) notifications have increased recently. However, little is known about the CS cases or the clinical and sociodemographic characteristics of the patients' mothers.

METHODS

Twelve cases of CS were reported through national surveillance in the period March-December 2016, and the mothers of seven patients were included in this study. The patients' mothers and physicians completed a self-administered questionnaire, providing sociodemographic and clinical information of the patients and their mothers. In addition, we explored the awareness and knowledge of, attitudes towards and practices regarding CS occurrence through semistructured interviews with the mothers.

RESULTS

Of the seven CS patients, three were asymptomatic, with a range of non-specific clinical manifestations in the rest. The mothers tended to be of young age, unmarried and to have a history of commercial sex work, other sexually transmissible infections (STIs) and no or irregular prenatal care visits during pregnancy. Of the four mothers who had had regular prenatal care visits, two had tested negative for syphilis at the first trimester antenatal screening. Themes emerged that indicated challenges in preventing CS, including a lack of guidance or guidelines for physicians to consider testing for syphilis after the first trimester, lack of physicians' awareness or experience of syphilis or CS and a lack of awareness or knowledge in pregnant women regarding STIs.

CONCLUSIONS

Key characteristics of recent CS patients and their mothers in Japan were revealed, identifying previously reported factors as well as new challenges. A holistic approach, designed to address challenges at the level of the healthcare system, healthcare provider and the pregnant woman and her partner will be important in preventing CS.

Mother-to-child transmission prevention of human immunodeficiency virus, syphilis and hepatitis B virus

BACKGROUND

China is the first country to initiate a nationwide program for prevention of mother-to-child transmission of human immunodeficiency virus, syphilis and hepatitis B virus by an integrated approach. However, the progress of this program remains unreported at national or local level for China. Therefore, we performed a hospital-based longitudinal study to assess the integrated prevention effect in Hunan, South-central China.

METHODS

This study was conducted at 123 counties in Hunan and covered all local hospitals providing midwifery and antenatal care services from 2010 to 2016. We used the Cochran-Armitage test to examine the temporal changes of the indicators related with prevention of mother-to-child transmission. Besides, we used Spearman rank correlation analysis to assess the association between mother-to-child transmission rates and the process indicators related with prevention of mother-to-child transmission.

RESULTS

After implementation of integrated prevention program, the indicators related with prevention of mother-to-child transmission are moving in the right direction. From 2010 to 2016, mother-to-child transmission rates significantly decreased from 19.4% to 9.6% for human immunodeficiency virus, and from 116.3 to 13.6 cases per 100,000 live births for syphilis. The proportion of children receiving hepatitis B immunoglobulin injection within 24h after birth increased from 95.2% to 98.9% among exposed neonates. Mother-to-child transmission rates were negatively associated with the process indicators related with prevention of mother-to-child transmission (all P<0.05).

CONCLUSIONS

Our prevention program of mother-to-child transmission for three diseases by an integrated approach proved to be viable and effective. Our model may be of interest to other countries.

Surveillance of Maternal Syphilis in China: Pregnancy Outcomes and Determinants of Congenital Syphilis

Background

We sought to describe the epidemiological characteristics of pregnant women with syphilis in Beijing, China, and to investigate the determinants of adverse pregnancy outcomes, including congenital syphilis.

Material/Methods

We used data from laboratory-confirmed syphilis-infected women who delivered between 2013 and 2015 and were registered in China’s Information Management System for Prevention of Mother-to-Child Transmission of Syphilis. Sociodemographic, clinical, and prevention predictors of adverse pregnancy outcomes (i.e., congenital syphilis, neonatal death, and neonatal asphyxia) were assessed using multivariable regression analyses.

Results

Among 807 eligible pregnant women with syphilis in Beijing, the maternal syphilis ratios increased from 1.1 (in 2013) to 1.4 (in 2015) per 1000 live births, while adverse pregnancy outcomes decreased, including congenital syphilis (1.3% to 0.4%), neonatal deaths (1.3% to 0%), and neonatal asphyxia (0.9% to 0%). Both prevention and treatment interventions increased, including antenatal testing (93.5% to 93.9%), any treatment (76.6% to 85.2%), adequate treatment (51.1% to 65.1%), and treatment initiated in the first trimester (30.7% to 42.8%). In the logistic regression analysis, higher maternal rapid plasma reagin antibody titers (aOR=1.1 95%CI=1.0–1.1) and third-trimester syphilis diagnosis (aOR=1.7 95%CI=1.1–2.6) were independent risk factors for adverse pregnancy outcomes. Protective factors included being married (aOR=0.4; 95%CI=0.2–0.6) and adequate prenatal treatment (aOR=0.3; 95%CI=0.1–0.7).

Conclusions

Integrated strategies for maternal syphilis control were associated with improved outcomes but must be strengthened. Future efforts should include education and outreach for antenatal care for at-risk women, syphilis screening at first antenatal care visit, immediate initiation of treatment, and syphilis screening extended to women presenting with miscarriage or stillbirth.

Screening for Syphilis Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement

IMPORTANCE

Untreated syphilis infection in pregnant women can be transmitted to the fetus (congenital syphilis) at any time during pregnancy or at birth. Congenital syphilis is associated with stillbirth, neonatal death, and significant morbidity in infants (eg, bone deformities and neurologic impairment). After a steady decline from 2008 to 2012, cases of congenital syphilis markedly increased from 2012 to 2106, from 8.4 to 15.7 cases per 100 000 live births (an increase of 87%). At the same time, national rates of syphilis increased among women of reproductive age.

OBJECTIVE

To update the US Preventive Services Task Force (USPSTF) 2009 recommendation on screening for syphilis infection in pregnant women.

EVIDENCE REVIEW

The USPSTF commissioned a reaffirmation evidence update to identify new and substantial evidence sufficient enough to change its prior recommendation. Given the established benefits and practice of screening for syphilis in pregnant women, the USPSTF targeted its evidence review on the direct benefits of screening on the prevention of congenital syphilis morbidity and mortality and the harms of screening for and treatment of syphilis infection in pregnant women.

FINDINGS

Using a reaffirmation process, the USPSTF found that accurate screening algorithms are available to identify syphilis infection. Effective treatment with antibiotics can prevent congenital syphilis and significantly decrease adverse pregnancy outcomes, with small associated harms, providing an overall substantial health benefit. Therefore, the USPSTF reaffirms its previous conclusion that there is convincing evidence that screening for syphilis infection in pregnant women provides substantial benefit.

CONCLUSIONS AND RECOMMENDATION

The USPSTF recommends early screening for syphilis infection in all pregnant women. (A recommendation).

Screening for Syphilis Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

The incidence of syphilis and congenital syphilis in the United States has increased after reaching historic lows in the early 2000s.

OBJECTIVE

To systematically review literature on the effectiveness and harms of screening for syphilis in pregnancy and the harms of penicillin treatment in pregnancy to inform the US Preventive Services Task Force.

DATA SOURCES

MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant English-language literature, published from January 1, 2008, to June 2, 2017. Ongoing surveillance was conducted through November 22, 2017.

STUDY SELECTION

Studies conducted in countries categorized as "high" or "very high" on the Human Development Index that explicitly addressed 1 of 3 a priori-defined key questions.

DATA EXTRACTION AND SYNTHESIS

Independent critical appraisal and data abstraction by 2 reviewers. Data from included studies were narratively synthesized without pooling data.

MAIN OUTCOMES AND MEASURES

Incidence of congenital syphilis; any harms of screening or penicillin treatment in pregnancy.

RESULTS

Seven studies in 8 publications were included. One observational study evaluated the implementation of syphilis screening in pregnancy in 2 441 237 women in China. From 2002 to 2012, screening for syphilis in all pregnant women increased from 89.8% to 97.2%, and the incidence of congenital syphilis decreased from 109.3 to 9.4 cases per 100 000 live births. Five studies (n = 21 795) evaluated the false-positive findings of treponemal tests and 1 study (n = 318) evaluated the false-negative findings of nontreponemal tests. These studies found that false-positives with treponemal-specific enzyme or chemiluminescent immunoassays were common (46.5%-88.2%), therefore warranting reflexive (automatic confirmatory) testing for all positive test findings. One study (n = 318) found no false-negatives with treponemal tests, and 1 study (n = 139) demonstrated the prozone phenomenon (false-negative response from high antibody titer) with rapid plasma reagin screening using undiluted samples (2.9%). No studies were identified for harms of penicillin in pregnancy.

CONCLUSIONS AND RELEVANCE

Screening for syphilis infection in pregnant women is associated with reduced incidence of congenital syphilis, and available evidence supports the need for reflexive testing for positive test results.

Risk of Congenital Syphilis (CS) Following Treatment of Maternal Syphilis: Results of a CS Control Program in China

Background

Early screening for syphilis among pregnant women and the effective treatment of maternal syphilis is fundamental to prevent congenital syphilis (CS).

Methods

We obtained data from the Shenzhen Program for Prevention of CS (SPPCS) and estimated incidence rates of CS among infants born to syphilis-seropositive women treated with different regimens or untreated for maternal syphilis.

Results

A total of 4746 matched cases of syphilis-seropositive mothers and their infants were included for analyses, and 162 infants were diagnosed with CS, providing an overall incidence of 3.41% (95% confidence interval [CI], 2.91%-3.98%). Among infants born to syphilis-seropositive women who had syphilis and were adequately treated before pregnancy, the incidence was 0.22% (95% CI, .05%-.66%). There were 159 cases of CS occurring in 3519 infants born to women who were syphilis-seropositive during their pregnancies, for an incidence of 4.52% (95% CI, 3.84%-5.28%). The incidence of CS was 1.82%-11.90% lower among infants born to the women treated with early benzathine penicillin G (BPG) compared with those treated with late BPG (adjusted odds ratio [aOR], 8.06 [95% CI, 2.93-22.21]; P < .001), other antibiotics (aOR, 7.71 [95% CI, .86-69.28]; P = .068), or those untreated (aOR, 68.28 [95% CI, 29.64-157.28]; P < .001). The incidence rates were 0.22% (95% CI, .06%-.80%) and 0.59% (95% CI, .35%-1.02%) in infants born to women treated with 2 courses and 1 course of BPG, respectively, corresponding to a risk difference of 0.37% (aOR, 1.74; 95% CI, .37-8.26).

Conclusions

Treatment of syphilis-seropositive pregnant women with 1 course of intramuscular BPG before 28 gestational weeks is critical for prevention of CS.

Advancing STI priorities in the SDG era: priorities for action

The Sustainable Development Goals present an opportunity to reimagine and then reconfigure the approach to controlling sexually transmitted infections (STIs). The predilection of STIs for women and for vulnerable populations means that services that ameliorate STIs, by their nature, enhance equity, a key focus of the goals. Given the considerable breadth and depth of the goals, it is important to locate points of convergence between the SDGs and STIs, further craft synergies with HIV and select a few population groups and settings to prioritise. There are many opportunities for STI aficionados in this era to advance the field and global control of these infections.

Effectiveness of treatment to improve pregnancy outcomes among women with syphilis in Zhejiang Province, China

OBJECTIVES

To determine the effectiveness of treatment in improving pregnancy outcomes among women with syphilis.

METHODS

This is a retrospective study based on the provincial prevention of mother-to-child transmission of syphilis database. All women with syphilis with singleton pregnancies were recruited. We evaluated their pregnancy outcomes by group-specific analyses according to their treatment time and adequacy.

RESULTS

The syphilis prevalence among pregnant women was 0.3% (4214/1 338 739) in Zhejiang Province, China, during 2013-2014, considering all live births and abortions. Women with singleton pregnancies (3767) were included in the study, including live births and stillbirths (≥28 weeks). The treatment coverage for all women with syphilis was 80.2% (3022/3767), and 68.2% (2062/3022) of the women were treated adequately. Of 745 infants born to untreated pregnant women with syphilis, 1.2% manifested pneumonia, 2.7% asphyxia, 1.6% birth defects, 3.8% congenital syphilis (CS), 14.2% were preterm, 10.1% had low birth weight (LBW) and 3.1% experienced perinatal death. The risks of asphyxia (OR=2.7), CS (OR=3.1), preterm birth (OR=1.5), LBW (OR=1.9) and perinatal death (OR=3.1) were much higher in infants born to mothers treated inadequately than from those treated adequately. Moreover, mothers with syphilis who initiated treatment in the third trimester suffered an increased risk for asphyxia (OR=3.0), CS (OR=6.0) and LBW (OR=1.7) compared with those who initiated treatment in the first trimester.

CONCLUSIONS

Early and adequate treatment could improve the adverse pregnancy outcomes among women with syphilis.