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Foles AI, Eiras Dias M, Figueiredo M, Marçal M. Congenital syphilis: the re-emergence of a forgotten disease. BMJ Case Rep 2024; 17:e257694. [PMID: 38233003 PMCID: PMC10806924 DOI: 10.1136/bcr-2023-257694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality.
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Affiliation(s)
- Ana Isabel Foles
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mariana Eiras Dias
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Melissa Figueiredo
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mónica Marçal
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
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2
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Wozniak PS, Cantey JB, Zeray F, Leos NK, Michelow IC, Sheffield JS, Wendel GD, Sánchez PJ. The Mortality of Congenital Syphilis. J Pediatr 2023; 263:113650. [PMID: 37536483 DOI: 10.1016/j.jpeds.2023.113650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/09/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To document the case-fatality rate (CFR) of congenital syphilis diagnosed by molecular tools and rabbit infectivity testing (RIT) of clinical specimens in addition to standard evaluation and to compare that with the CFR using the Centers for Disease Control and Prevention (CDC) surveillance case definition. STUDY DESIGN Prospective, single site, cohort study of all cases of syphilis among mothers and their infants from 1984 to 2002. The diagnosis of congenital syphilis was determined using IgM immunoblotting, polymerase chain reaction, and RIT of fetal or infant specimens in addition to clinical, laboratory, and radiographic criteria. Data were retrospectively reviewed to ascertain fetal and neonatal mortality. RESULTS During the 18-year study, there were 191 cases of congenital syphilis confirmed by abnormalities on clinical, laboratory, or radiographic evaluation and/or positive serum IgM immunoblot, blood polymerase chain reaction, or blood/cerebrospinal fluid RIT. Of the 191 cases, 59 died for a CFR of 31%. Of the 59 deaths, 53 (90%) were stillborn and 6 (10%) died in the neonatal period. The majority (74%, 39/53) of stillbirths occurred in the third trimester. The CDC surveillance case definition correctly identified all infants with congenital syphilis, but the CDC CFR was 10% which underestimated the CFR by more than 300%. CONCLUSIONS Our findings corroborate the high sensitivity of the CDC surveillance definition for congenital syphilis but highlight its poor estimation of its associated mortality. The CFR among infected progeny of pregnant women with syphilis was 31%, due mostly to demise in the third trimester and as such highlights the need for detection and appropriate treatment of syphilis during pregnancy.
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Affiliation(s)
- Phillip S Wozniak
- University of Missouri Kansas City, Kansas City, MO; Children's Mercy Hospital, Kansas City, MO; University of Texas Southwestern Medical Center, Dallas, TX; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Joseph B Cantey
- University of Texas Southwestern Medical Center, Dallas, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Fiker Zeray
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Nora K Leos
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian C Michelow
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT
| | - Jeanne S Sheffield
- University of Texas Southwestern Medical Center, Dallas, TX; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Pablo J Sánchez
- University of Texas Southwestern Medical Center, Dallas, TX; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
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3
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Lee K, You S, Li Y, Chesson H, Gift TL, Berruti AA, Hsu K, Yaesoubi R, Salomon JA, Rönn M. Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018. Clin Infect Dis 2023; 76:e810-e819. [PMID: 35684943 PMCID: PMC9907519 DOI: 10.1093/cid/ciac427] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to estimate the health impact of syphilis in the United States in terms of the number of quality-adjusted life years (QALYs) lost attributable to infections in 2018. METHODS We developed a Markov model that simulates the natural history and management of syphilis. The model was parameterized by sex and sexual orientation (women who have sex with men, men who have sex with women [MSW], and men who have sex with men [MSM]), and by age at primary infection. We developed a separate decision tree model to quantify health losses due to congenital syphilis. We estimated the average lifetime number of QALYs lost per infection, and the total expected lifetime number of QALYs lost due to syphilis acquired in 2018. RESULTS We estimated the average number of discounted lifetime QALYs lost per infection as 0.09 (95% uncertainty interval [UI] .03-.19). The total expected number of QALYs lost due to syphilis acquired in 2018 was 13 349 (5071-31 360). Although per-case loss was the lowest among MSM (0.06), MSM accounted for 47.7% of the overall burden. For each case of congenital syphilis, we estimated 1.79 (1.43-2.16) and 0.06 (.01-.14) QALYs lost in the child and the mother, respectively. We projected 2332 (1871-28 250) and 79 (17-177) QALYs lost for children and mothers, respectively, due to congenital syphilis in 2018. CONCLUSIONS Syphilis causes substantial health losses in adults and children. Quantifying these health losses in terms of QALYs can inform cost-effectiveness analyses and can facilitate comparisons of the burden of syphilis to that of other diseases.
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Affiliation(s)
- Kyueun Lee
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shiying You
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Yunfei Li
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Harrell Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrés A Berruti
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Hsu
- Sexually Transmitted Disease Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joshua A Salomon
- Center for Health Policy/Center for Primary Care & Outcomes Research, Stanford University, Stanford, California, USA
| | - Minttu Rönn
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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4
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Williams JEP, Graf RJ, Miller CA, Michelow IC, Sánchez PJ. Maternal and Congenital Syphilis: A Call for Improved Diagnostics and Education. Pediatrics 2022; 150:188941. [PMID: 36000327 DOI: 10.1542/peds.2022-057927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jessica E P Williams
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
| | - Rachel J Graf
- The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Ian C Michelow
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,Divisions of Neonatology and Pediatric Infectious Diseases, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
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Matthias J, Spencer EC, Bowen VB, Peterman TA. Exploring changes in maternal and congenital syphilis epidemiology to identify factors contributing to increases in congenital syphilis in Florida: a two time-period observational study (2013-2014 vs 2018-2019). BMJ Open 2022; 12:e065348. [PMID: 36008067 PMCID: PMC9422834 DOI: 10.1136/bmjopen-2022-065348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES As, cases of congenital syphilis (CS) and infectious syphilis among women more than doubled in Florida and across the nation during 2013-2019, we sought to understand what may be contributing to these increases in Florida. DESIGN A two time-period observational study. SETTING Pregnant women with reported syphilis infections and their pregnancy outcomes (2013-2014 and 2018-2019) in Florida. PARTICIPANTS 1213 pregnant women with reported syphilis infections living in Florida and 341 infants meeting the CS case definition. OUTCOME MEASURES We assessed what proportion of the increase in CS was from increases in maternal syphilis infections. We examined maternal demographics, infection characteristics and timing of diagnoses that could explain the increase in CS. Finally, we reviewed if changes in presentation or severity of CS cases occurred. RESULTS During 2013-2014, 83 (21%) of 404 pregnant women with syphilis delivered babies with CS. During 2018-2019, 258 (32%) of 809 pregnant women with syphilis delivered babies with CS. Comparing CS prevention rates, it was determined that 65% of the increase in CS was due to the increases in maternal syphilis infections. The proportion of maternal cases staged as primary or secondary increased over time (7%-13%) (p<0.01) and reports of drug use became slightly more common (6%-10%) (p=0.02). During 2018-2019, women delivering CS infants were more likely to be reinfected during the same pregnancy (27 (10%) vs 5 (6%) p=0.23) and more had negative third trimester screening tests (43 (17%) vs 7 (8% p=0.07)). The percentage of infants with CS who had ≥1 sign or symptom increased from 35% to 40%, and the combined total of stillbirths and infant deaths increased from 5 to 26. CONCLUSIONS Recently, more pregnant women are being infected with syphilis and a higher per cent are not being treated to prevent CS. The reasons for this finding are unclear.
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Affiliation(s)
- James Matthias
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA
| | - Emma C Spencer
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA
| | - Virginia B Bowen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas A Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tavares CSS, Gomes dos Santos Oliveira SJ, de Gois-Santos VT, Vaez AC, de Menezes MO, Santos Jr HP, Santos VS, Martins-Filho PR. Quality of life, depressive symptoms, anxiety, and sexual function in mothers of neonates with congenital syphilis in the Northeast Brazil: A cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100127. [PMID: 36777650 PMCID: PMC9903911 DOI: 10.1016/j.lana.2021.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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).
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Affiliation(s)
- Carolina Santos Souza Tavares
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
| | - Sheila Jaqueline Gomes dos Santos Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
| | - Vanessa Tavares de Gois-Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
| | - Andreia Centenaro Vaez
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
- Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
| | | | - Hudson P Santos Jr
- Biobehavioral Laboratory, University of North Carolina, Chapel Hill, USA
| | - Victor Santana Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
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7
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Wan Z, Tao Y, Zhang H, Hu Y, Shu K. Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China. Int J STD AIDS 2021; 33:156-163. [PMID: 34704494 DOI: 10.1177/09564624211052184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Zhihua Wan
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Yuling Tao
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Huan Zhang
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Yang Hu
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Kuanyong Shu
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
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8
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Martin EG, Ansari B, Hart-Malloy R, Smith DK, Delaney KP, Gift TL, Berruti AA, Trigg M, Rosenberg ES. Racial and ethnic disparities in HIV diagnoses among heterosexually active persons in the United States nationally and by state, 2018. PLoS One 2021; 16:e0257583. [PMID: 34543322 PMCID: PMC8451999 DOI: 10.1371/journal.pone.0257583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite declining HIV infection rates, persistent racial and ethnic disparities remain. Appropriate calculations of diagnosis rates by HIV transmission category, race and ethnicity, and geography are needed to monitor progress towards reducing systematic disparities in health outcomes. We estimated the number of heterosexually active adults (HAAs) by sex and state to calculate appropriate HIV diagnosis rates and disparity measures within subnational regions. METHODS The analysis included all HIV diagnoses attributed to heterosexual transmission in 2018 in the United States, in 50 states and the District of Columbia. Logistic regression models estimated the probability of past-year heterosexual activity among adults in three national health surveys, by sex, age group, race and ethnicity, education category, and marital status. Model-based probabilities were applied to estimated counts of HAAs by state, which were synthesized through meta-analysis. HIV diagnoses were overlaid to calculate racial- and ethnic-specific rates, rate differences (RDs), and rate ratios (RRs) among HAAs by sex and state. RESULTS Nationally, HAA women have a two-fold higher HIV diagnosis rate than HAA men (rate per 100,000 HAAs, women: 6.57; men: 3.09). Compared to White non-Hispanic HAAs, Black HAAs have a 20-fold higher HIV diagnosis rate (RR, men: 21.28, women: 19.55; RD, men: 15.40, women: 31.78) and Hispanic HAAs have a 4-fold higher HIV diagnosis rate (RR, men: 4.68, RD, women: 4.15; RD, men: 2.79, RD, women: 5.39). Disparities were ubiquitous across regions, with >75% of states in each region having Black-to-White RR ≥10. CONCLUSION The racial and ethnic disparities across regions suggests a system-wide failure particularly with respect to preventing HIV among Black and Hispanic women. Pervasive disparities emphasize the role for coordinated federal responses such as the current Ending the HIV Epidemic (EHE) initiative.
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Affiliation(s)
- Erika G. Martin
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, Albany, New York, United States of America
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, New York, United States of America
| | - Bahareh Ansari
- Department of Information Science, College of Emergency Preparedness, Homeland Security and Cybersecurity, University at Albany, Albany, New York, United States of America
| | - Rachel Hart-Malloy
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, New York, United States of America
- New York State Department of Health, Office of Sexual Health and Epidemiology, AIDS Institute, Albany, New York, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, United States of America
| | - Dawn K. Smith
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin P. Delaney
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas L. Gift
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrés A. Berruti
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Monica Trigg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Eli S. Rosenberg
- Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, Albany, New York, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, United States of America
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9
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Mukosha M, Kaonga P, Kapembwa KM, Musonda P, Vwalika B, Lubeya MK, Jacobs C. Modelling mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia: a retrospective review of hospital-based records. Pan Afr Med J 2021; 39:69. [PMID: 34422192 PMCID: PMC8363965 DOI: 10.11604/pamj.2021.39.69.27138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction globally, almost half of all deaths in children under five years of age occur among neonates. We investigated the predictors of mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia. Methods we reviewed admission records linked to birth, mortality, and hospital discharge from 1st January 2018 to 30th September 2019. Information was retrieved with a follow-up period of 28 days post-delivery to discharge/mortality. We used the Weibull hazards regression to establish the best predictor model for mortality among the neonates. Results a total of 3237 case records of women with a median age of 27 years (IQR, 22-33) were included in the study, of which 971 (30%) delivered term infants and 2267 (70%) preterm infants. The overall median survival time of the infants was 98 hours (IQR, 34-360). Preterm birth was not associated with increased hazards of mortality compared to term birth (p=0.078). Being in the Kangaroo Mother Care compared to Neonatal Intensive Care Unit (NICU), and a unit increase in birth weight were independently associated with reduced hazards of mortality. On the other hand, having hypoxic-ischemic encephalopathy, experiencing difficulty in feeding and vaginal delivery compared to caesarean section independently increased the hazards of mortality. Conclusion having hypoxic-ischemic encephalopathy, vaginal delivery, and experiencing difficulty in feeding increases the risk of mortality among neonates. Interventions to reduce neonatal mortality should be directed on these factors in this setting.
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Affiliation(s)
- Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka, Zambia.,School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia.,Young Emerging Scientists Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
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10
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Abstract
Syphilis in neonates and infants remains a significant public health problem because it is a major cause of fetal and neonatal morbidity and mortality globally. Despite decades of experience with syphilis in adults and infants, maternal and congenital syphilis are increasing substantially in the United States. The vertical transmission, clinical manifestations, diagnosis, evaluation, treatment, and follow-up are reviewed to guide the health care professional in understanding the optimal management of this preventable disease.
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11
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Jensen KK, Oh KY, Patel N, Narasimhan ER, Ku AS, Sohaey R. Fetal Hepatomegaly: Causes and Associations. Radiographics 2021; 40:589-604. [PMID: 32125959 DOI: 10.1148/rg.2020190114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fetal hepatomegaly is associated with significant fetal morbidity and mortality. However, hepatomegaly might be overlooked when numerous other fetal anomalies are present, or it might not be noticed when it is an isolated entity. As the largest solid organ in the abdomen, the liver can be seen well with US or MRI, and the normal imaging characteristics are well described. The length of the fetal liver, which can be used to identify hepatomegaly, can be determined by measuring the liver from the diaphragm to the tip of the right lobe in the sagittal plane. Fetal hepatomegaly is seen with infection, transient abnormal myelopoiesis, liver storage and deposition diseases, some syndromes, large liver tumors, biliary atresia, and anemia. Some of these diagnoses are treatable during the fetal period. Attention to the associated findings and specific hepatic and nonhepatic imaging characteristics can help facilitate more accurate diagnoses and appropriate patient counseling.©RSNA, 2020.
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Affiliation(s)
- Kyle K Jensen
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239
| | - Karen Y Oh
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239
| | - Neel Patel
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239
| | - Evan R Narasimhan
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239
| | - Alexei S Ku
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239
| | - Roya Sohaey
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239
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Galvis AE, Arrieta A. Congenital Syphilis: A U.S. Perspective. CHILDREN-BASEL 2020; 7:children7110203. [PMID: 33137962 PMCID: PMC7692780 DOI: 10.3390/children7110203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022]
Abstract
Congenital syphilis still represents a worldwide public health problem. If left untreated, it can lead to fetal demise and high neonatal morbidity and mortality. Unfortunately, in the last decade, there has been a resurgence of cases in the U.S. This review discusses the ongoing problem of this preventable congenital infection, vertical transmission and clinical manifestations while providing a guidance for the evaluation and management of infants born to mothers with reactive serologic tests for syphilis.
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Affiliation(s)
- Alvaro E. Galvis
- Department of Infectious Diseases, Children’s Hospital of Orange County, Orange, CA 92868, USA;
- School of Medicine, University of California, Irvine, CA 92697, USA
| | - Antonio Arrieta
- Department of Infectious Diseases, Children’s Hospital of Orange County, Orange, CA 92868, USA;
- School of Medicine, University of California, Irvine, CA 92697, USA
- Correspondence:
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Incidence Trends, Risk Factors, Mortality and Healthcare Utilization in Congenital Syphilis-related Hospitalizations in the United States: A Nationwide Population Analysis. Pediatr Infect Dis J 2019; 38:1126-1130. [PMID: 31469777 DOI: 10.1097/inf.0000000000002445] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital syphilis (CS) is a devastating yet preventable disease affecting the fetus. Recent increase in cases of CS in the United States has been reported by Centers for Disease Control and Prevention. There is a lack of data on hospitalization trends and healthcare utilization related to CS. We sought to describe CS hospitalization trends, morbidity and mortality during 2009 through 2016 and related healthcare expenditure. METHODS National inpatient level data collected from Kid's Inpatient Database and National Inpatient Sample databases from 2009 to 2016 were analyzed. CS hospitalizations were identified using International Classification of Diseases codes in age less than 1 year. Related demographics, risk factors and outcomes were calculated. Infant mortality related to CS were calculated per number of hospitalizations. RESULTS From 2009 to 2016, there were a total of 5912 CS-related hospitalizations. The overall trends in hospitalizations related to CS was up trending since 2009. African American ethnicity, public insurance/uninsured, low socioeconomic status, geographic location (South and West hospital regions), prematurity and low birth weight were significantly associated with CS and remained as independent risk factors. The mean length of stay (12.38 ± 0.10 d vs. 3.42 ± 0.1 d) and mean hospitalization charges were significantly higher in CS (P < 0.001) as compared with other hospitalized infants without CS. The total inflation-adjusted hospitalization charges have more than doubled over the years ($120,665,203 in 2016 vs. $54,290,310 in 2009). The rate of in-hospital deaths in CS hospitalization was 0.54% (32 deaths among 5912 hospitalizations). CONCLUSIONS The incidence of CS hospitalization has been increasing since 2009. CS contributes to a significant healthcare utilization burden; its prevention can save a large amount of healthcare-related expenditure.
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Schmidt R, Carson PJ, Jansen RJ. Resurgence of Syphilis in the United States: An Assessment of Contributing Factors. Infect Dis (Lond) 2019; 12:1178633719883282. [PMID: 31666795 PMCID: PMC6798162 DOI: 10.1177/1178633719883282] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
In the last decade, there has been a marked resurgence of syphilis in the United States despite the availability of effective treatments and previously reliable prevention strategies. The majority of cases are among the population of men who have sex with men (MSM); however, there has also been a recent increase among premenopausal women, coinciding with a concerning rise of congenital cases. The resurgence of syphilis can be largely attributed to changing social and behavioral factors, especially among young MSM. The biological association of syphilis with human immunodeficiency virus (HIV) transmission and acquisition is particularly alarming because of the increased individual and healthcare burden. In addition, some individual actions and public health efforts that are meant to reduce the risk of acquiring HIV may actually lead to risk compensation that facilitates the transmission of syphilis. Untreated syphilis is associated with detrimental health outcomes; therefore, both effective prevention strategies and treatment of this systemic disease have important short-term and long-term public health implications. This article offers a review of social and behavioral factors contributing to the current resurgence and recommendations for reducing syphilis incidence through medical and public health prevention strategies.
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Affiliation(s)
- Rebecca Schmidt
- Department of Public Health, North
Dakota State University, Fargo, ND, USA
| | - Paul James Carson
- Department of Public Health, North
Dakota State University, Fargo, ND, USA
- Center for Immunization Research and
Education, North Dakota State University, Fargo, ND, USA
| | - Rick J Jansen
- Department of Public Health, North
Dakota State University, Fargo, ND, USA
- Center for Immunization Research and
Education, North Dakota State University, Fargo, ND, USA
- Biostatistics Core Facility, North
Dakota State University, Fargo, ND, USA
- Genomics and Bioinformatics Program,
North Dakota State University, Fargo, ND, USA
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15
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Jacobs K, Vu DM, Mony V, Sofos E, Buzi N. Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma. Pediatrics 2019; 144:peds.2019-1564. [PMID: 31537633 DOI: 10.1542/peds.2019-1564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 11/24/2022] Open
Abstract
Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.
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Affiliation(s)
| | - David M Vu
- Lucile Packard Children's Hospital, Palo Alto, California.,Santa Clara Valley Medical Center, San Jose, California; and.,School of Medicine, Stanford University, Stanford, California
| | - Vidya Mony
- Santa Clara Valley Medical Center, San Jose, California; and
| | - Elvera Sofos
- Santa Clara Valley Medical Center, San Jose, California; and
| | - Nadav Buzi
- Santa Clara Valley Medical Center, San Jose, California; and
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16
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Congenital Syphilis Prevention: Strategies, Evidence, and Future Directions. Sex Transm Dis 2019; 45:S29-S37. [PMID: 29624562 DOI: 10.1097/olq.0000000000000846] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Congenital syphilis (CS)-the preventable transmission of Treponema pallidum from infected mother to fetus-remains a significant problem worldwide. METHODS From July through November 2017, 239 articles relevant to CS prevention were identified via keyword searches in PubMed and Google Scholar, ancestry searches, and expert recommendation. Articles were then assessed for (1) measurement of a specified CS or adverse pregnancy outcomes (APOs) and (2) geographic setting in high/upper middle income countries according to United Nations criteria. In total, 119 articles met inclusion criteria. These were then vetted for 1 of 3 arms of CS prevention, after which additional ancestral searches were conducted within each arm to arrive at the final collection of articles per CS prevention strategy-maternal prenatal treatment (n = 33), prenatal screening (n = 24), and public health interventions that support screening and treatment (n = 15). RESULTS Of the 7 studies that evaluated treatment with benzathine penicillin G (BPG) use within the context of a modern health care system, all showed BPG to be highly effective in CS prevention; 3 additional studies demonstrated BPG effectiveness in preventing APOs. Ten studies revealed early disease detection through prenatal screening significantly reduces CS and APOs when paired with BPG. There was limited literature evaluating public health interventions, such as partner notification, surveillance, and prenatal screening laws. CONCLUSIONS Congenital syphilis is a preventable disease, effectively avoided with appropriate prenatal screening and BPG therapy. Increasing syphilis rates among all adults, accompanied by gaps in the provision of prenatal care to women at high risk of infection, are major contributors to CS persistence.
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Hersh AR, Megli CJ, Caughey AB. Repeat Screening for Syphilis in the Third Trimester of Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2019; 132:699-707. [PMID: 30095767 DOI: 10.1097/aog.0000000000002795] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of screening all women during the first and third trimesters compared with screening just once during pregnancy. METHODS We used a theoretical cohort of 3.9 million women in the United States to model syphilis screening approaches in pregnancy, particularly comparing one-time screening with repeat third-trimester screening. Outcomes of syphilis infection included in the model were congenital syphilis, intrauterine fetal demise, neonatal death, and total quality-adjusted life-years (QALYs). Probabilities, utilities, and costs were obtained from the literature, and a cost-effectiveness threshold was set at $100,000 per QALY. A societal perspective was assumed. RESULTS Our model demonstrated that repeat screening in the third trimester for syphilis in pregnancy will result in fewer maternal and neonatal adverse outcomes and higher QALYs when compared with screening once in the first trimester. Specifically, we demonstrated that repeat screening results in 41 fewer neonates with evidence of congenital syphilis, 73 fewer cases of intrauterine fetal demise, 27 fewer neonatal and infant deaths, in addition to a cost savings of $52 million and 4,000 additional QALYs. CONCLUSION Using our baseline assumptions, our data support that in pregnancy, repeat screening for syphilis is superior to single screening during the first trimester and is both cost-effective and results in improvement in maternal and neonatal outcomes. When screening policies are being created for pregnant women, the cost-effectiveness of repeat screening for syphilis should be considered.
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Affiliation(s)
- Alyssa R Hersh
- Oregon Health & Science University, Portland, Oregon; and the University of Pittsburgh, Pittsburgh, Pennsylvania
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Torres Soblechero L, Santiago Garcia B, Navarro Garcia M. Massive hepatomegaly and skin rash as manifestations of congenital infection. Enferm Infecc Microbiol Clin 2019; 38:188-190. [PMID: 31416632 DOI: 10.1016/j.eimc.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Begoña Santiago Garcia
- Sección de Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Marisa Navarro Garcia
- Sección de Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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19
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[School-based prevention programmes for adolescents: HIV, sexually transmitted infections, and pregnancy]. Urologe A 2019; 57:723-726. [PMID: 29744555 DOI: 10.1007/s00120-018-0659-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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20
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Araújo MAL, Andrade RFV, Barros VLD, Bertoncini PMRP. Factors associated with unfavorable outcomes caused by Syphilis infection in pregnancy. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objective: to analyze factors associated with unfavorable outcomes caused by syphilis infection in pregnancy. Methods: descriptive study carried out from May to August 2014, in public maternity hospitals. A questionnaire was administered to all women with a reactive Venereal Disease Research Laboratory (VDRL) test result and the data were supplemented with information from medical records and prenatal files. The bivariate analysis was performed using Pearson's chi-square or Fisher's exact test. For the multivariate analysis, was used through the logistic regression model. Results: a total of 137 puerperal women participated in the study, of which 14.3% had an unfavorable outcome, namely: stillbirth (2.9%), preterm birth (8.8%) and low birth weight (2.9%). In the multivariate analysis the odds ratio for the prevalence of an unfavorable outcome was three-fold higher in women who did not undergo a second VDRL test (OR=3,54; IC95% 1,04-15,33) and two-fold higher in women with a VDRL titer >1:8 (OR=2,15; IC95% 1,11-11,2). Conclusions: The unfavorable outcomes occurred in women who did not undergo the second VDRL test and those whose VDRL titer was >1:8 performed in the maternity hospital.
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Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016. Sex Transm Dis 2019; 45:447-451. [PMID: 29465662 DOI: 10.1097/olq.0000000000000783] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital syphilis occurs when a pregnant woman with syphilis is not diagnosed or treated and the infection is passed in utero, causing severe infant morbidity and mortality. Congenital syphilis is easily prevented if women receive timely and adequate prenatal care. Cases of congenital syphilis are considered indicators of problems in the safety net. However, maternal social and behavioral factors can impede women's care, even when providers follow guidelines. METHODS We reviewed case interviews and maternal records for 23 congenital syphilis cases reported to the Centers for Disease Control and Prevention from Indiana between 2014 and 2016. We used qualitative methods to analyze narrative notes from maternal interviews to learn more about factors that potentially contributed to congenital syphilis cases. RESULTS All providers followed Centers for Disease Control and Prevention and state recommendations for screening and treatment for pregnant women with syphilis. Twenty-one of 23 women had health insurance. The number of prenatal care visits women had was suboptimal; more than one third of women had no prenatal care. Nearly one third of women's only risk factor was sex with a primary male sex partner. The majority of women suffered social vulnerabilities, including homelessness, substance abuse, and incarceration. CONCLUSIONS Despite provider adherence to guidelines and health insurance availability, some pregnant women with syphilis are unlikely to receive timely diagnosis and treatment. Pregnant women at high risk for syphilis may need additional social and material support to prevent a congenital syphilis case. Additional efforts are needed to reach the male partners of vulnerable females with syphilis.
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Pathways to Congenital Syphilis Prevention: A Rapid Qualitative Assessment of Barriers, and the Public Health Response, in Caddo Parish, Louisiana. Sex Transm Dis 2019; 45:442-446. [PMID: 29465658 DOI: 10.1097/olq.0000000000000787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital syphilis (CS) disproportionately affects racial and ethnic minority women, especially in the US South. Although CS is relatively easy and inexpensive to prevent through screening and treatment of pregnant women, CS cases have continued to rise and are concentrated in relatively few US counties and states. In 2010, Louisiana had the highest case rate in the country for primary, secondary, and CS, with the highest number of CS cases in northwest Louisiana, where Shreveport is located. METHODS We conducted qualitative interviews with community members (women and frontline providers) living in Caddo Parish to obtain their views about factors that negatively impact CS prevention. RESULTS Participants described impediments in the pathways for prevention of CS. Lack of sexual and reproductive health education, discontinuities and fragmentation in health care insurance coverage, a dearth of referral points for prenatal care, and difficulty finding prenatal care providers who accept Medicaid can delay timely and adequate care for pregnant women. Participants reported that low reimbursement for necessary injections and difficulty obtaining required medication challenged efforts to screen and treat pregnant women according to guidelines. CONCLUSIONS Although CS is easily prevented, health system and policy obstacles in pathways to CS prevention and care may need remediation at state and local levels.
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Growth in syphilis-exposed and -unexposed uninfected children from birth to 18 months of age in China: a longitudinal study. Sci Rep 2019; 9:4416. [PMID: 30867463 PMCID: PMC6416265 DOI: 10.1038/s41598-019-40134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/30/2019] [Indexed: 11/09/2022] Open
Abstract
Early infant growth and development has attracted worldwide attention. Although numerous studies have demonstrated that maternal syphilis increases the risk of adverse pregnancy outcomes and congenital syphilis, the subsequent growth pattern and morbidity of syphilis-exposed uninfected infants are less understood. We conducted a longitudinal study to compare the growth pattern and disease distribution of syphilis-exposed and syphilis-unexposed uninfected children, and World Health Organization (WHO) reference standards from birth to 18 months of age. We obtained data from a prospective cohort study in three representative regions of Zhejiang Province in China. A total of 333 syphilis-uninfected children born to women with syphilis were recruited at birth and matched with 333 syphilis-uninfected children born to women without syphilis during pregnancy. Children were followed-up by medical staff every 3 months until 18 months of age. The mixed-effects model was used to compare changes in growth patterns and influencing factors between the two groups. Mean weight, length, and head circumference of children, as well as disease prevalence, were similar between the groups. Multilevel analysis indicated that, after controlling confounders, growth velocities were comparable in both weight and length measures from birth to 18 months old between the two groups; however, low birth weight had a negative impact on weight gain in both groups. There was no significant negative association between syphilis exposure and early growth and health in children, under 18 months in a setting with universal coverage of therapeutic interventions for maternal syphilis. These findings may contribute to improving prevention efforts for mother-to-child transmission of syphilis, such as early screening for syphilis in pregnant women, universal coverage of treatment, and interventions for exposed children. Children with low birth weight should be given priority as this is a risk factor for weight gain.
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Bremer V, Dudareva-Vizule S, Buder S, An der Heiden M, Jansen K. [Sexually transmitted infections in Germany : The current epidemiological situation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 60:948-957. [PMID: 28741188 DOI: 10.1007/s00103-017-2590-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexually transmitted infections (STIs) can impair sexual health. Surveillance and study data were used to provide an overview over STIs in Germany. We estimated 3900 new HIV diagnoses in 2015. Of newly diagnosed infections, 57% were attributed to men who have sex with men (MSM). It was further estimated that there were 3200 new HIV infections and 84,700 people living with HIV in 2015. A total of 6834 syphilis infections were recorded in 2015, which corresponds to an increase of 149% since 2009. The incidence in men was 16-times higher than in women. Of syphilis infections, 85% could be attributed to MSM. Antimicrobial resistance of gonococci against the broad-spectrum antibiotic cefixime decreased between 2014 and 2016 after a change of therapy guidelines and remained stable on a low level regarding the antibiotic ceftriaxone. After an increase of resistance against the antibiotic azithromycin to 11.3% in 2015, we observed a decreasing trend in 2016. Between 2013 and 2015, 2,355,336 chlamydia tests were reported through the chlamydia sentinel network. Of these, 92.5% of samples were from women. Uptake for screening for women <25 years was 11.3% in 2015, with 5.0% positive chlamydia tests. In a cross-sectional study among women aged 20-25 years, a prevalence of human papilloma virus (HPV) of 38.1% was observed. A total of 30.5% of 15-year-old women were vaccinated against HPV in 2014. Data suggest that STIs represent a high burden of disease. Knowledge of STI prevention should be improved by targeted education campaigns. Extending existing offers for counselling and testing through cooperation between different health sectors would improve early diagnosis and treatment of STIs.
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Affiliation(s)
- Viviane Bremer
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Sandra Dudareva-Vizule
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.,Charité Universitätsmedizin, Berlin, Deutschland
| | - Susanne Buder
- Konsiliarlabor für Gonokokken, Vivantes-Klinikum Neukölln, Berlin, Deutschland
| | - Matthias An der Heiden
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Klaus Jansen
- Abt. für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
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25
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Abstract
Syphilis, caused by Treponema pallidum, is transmitted both sexually and transplacentally. Untreated syphilis is a progressive disease that may result in death or disability in children and adults. Syphilis diagnosis requires 2-stage serologic testing for nontreponemal and treponemal antibodies. Congenital syphilis diagnosis requires careful review of maternal testing and treatment, comparison of maternal and neonatal nontreponemal antibody titers, and clinical evaluation of the neonate. In this review, we present the current epidemiology of syphilis, and the clinical manifestations, diagnosis, and management of syphilis as they relate to pediatric practice, specifically, congenital syphilis and acquired syphilis in adolescents and pregnant women.
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Affiliation(s)
- Sarah Heston
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Faculty Office Building, 49 North Dunlap Street, Room 293, Memphis, TN 38105, USA
| | - Sandra Arnold
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Faculty Office Building, 49 North Dunlap Street, Room 293, Memphis, TN 38105, USA.
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Elarrat Canto SV, Leite Araújo MA, Espinosa Miranda A, Paulo Cardoso AR, Freitas de Almeida RL. Fetal and infant mortality of congenital syphilis reported to the Health Information System. PLoS One 2019; 14:e0209906. [PMID: 30608958 PMCID: PMC6319744 DOI: 10.1371/journal.pone.0209906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Congenital syphilis (CS) is a major cause of mortality in several countries, especially in Latin America and the Caribbean. This study aimed to analyze fetal and infant mortality of CS reported to the Health Information System in a State in Northeastern Brazil. Methods and results This was a cross-sectional study that analyzed the deaths of CS from 2010 to 2014 through the linkage of the Mortality Information System (SIM) and the Notifiable Diseases Information System (Sinan). The Statistical Package for the Social Sciences (SPSS) version 23.0 was used to calculate the rates of Fetal, Perinatal, Neonatal (early and late), and Postneonatal Mortality. Simple linear regression was performed. Fisher's exact test or Pearson's chi-square test were used for comparison of proportions and Student's t-test was used for comparison of means. Of the 414 cases reported to the SIM as deaths possibly caused by CS, 44 (10.6%) presented CS as the underlying cause. From 2010 to 2014 the Infant Mortality Rate of CS was 16.3 per 100,000 live births (y = 0.65x + 14.33, R2 = 0.2338, p = 0.003). There was an 89.4% underreporting of deaths. Perinatal deaths and fetal deaths of CS accounted for 87.7% and 73.9% of total deaths, respectively. Conclusions The results of the study revealed a significant Fetal and Infant Mortality rate of CS and demonstrated the importance of using the linkage method in studies that involve the analysis of secondary data obtained from mortality and disease reporting systems. The underreporting of CS as a cause of fetal and infant mortality leads to unawareness of the reality of deaths from this disease, hindering the development of public policies aimed at its prevention.
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Affiliation(s)
| | - Maria Alix Leite Araújo
- Collective Health Post Graduation Program, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Angélica Espinosa Miranda
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Ana Rita Paulo Cardoso
- Department of Health Surveillance, Ceará State Secretary of Health, Fortaleza, Ceará, Brazil
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Abstract
BACKGROUND The recent occurrence of congenital syphilis in Columbus, OH, raised concern for an increase in syphilis among women and infants. The objectives were to examine the rates of syphilis among men, women and infants in Ohio from 2003 to 2016 and compare these rates to the rest of the United States. METHODS This retrospective study evaluated cases of syphilis among men, women and infants from 2003 to 2016 using data from the Ohio Department of Health and the Centers for Disease Control and Prevention. RESULTS In Ohio from 2003 to 2016, the number of all syphilis cases among women significantly increased from 153 (2.6/100,000) to 294 (5.2/100,000), respectively (b = 0.26; P = 0.001; 95% confidence interval [CI]: 0.137-0.382). From 2003 to 2016, congenital syphilis in Ohio also increased significantly from 3 (2/100,000) to 13 cases (9.3/100,000), respectively (b = 1.05; P ≤ 0.001; 95% CI: 0.687-1.408). The increase in congenital syphilis mirrored the increase in all cases of syphilis in women but not with the rates of primary and secondary syphilis. Among men, cases of primary and secondary syphilis increased significantly in Ohio and the rest of the United States, from 156 (2.8/100,000) and 5956 (4.2/100,000) in 2003 to 622 (10.5/100,000) and 24,724 (15.6/100,000) in 2016, respectively (Ohio: b = 0.55; P < 0.001; 95% CI: 0.426-0.679; United States: b = 0.77; P < 0.001; 95% CI: 0.629-0.916). CONCLUSIONS The association of congenital syphilis with all syphilis cases in women highlights the importance of reporting all cases and not just primary and secondary syphilis. The increase in congenital syphilis reinforces the recommendation for repeat maternal screening during pregnancy.
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Congenital Syphilis: A Discussion of Epidemiology, Diagnosis, Management, and Nurses' Role in Early Identification and Treatment. Adv Neonatal Care 2018; 18:438-445. [PMID: 30020089 DOI: 10.1097/anc.0000000000000534] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae or fetal, neonatal, or infant death. PURPOSE To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications of CS upon the infant; as well as the importance of the nurse's role in the prompt identification of CS and the timely interventions needed to minimize sequelae. METHODS A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published within the past 10 years were included. FINDINGS Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as compliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately 14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity. IMPLICATIONS FOR PRACTICE Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neonatal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/eliminate the devastating long-term consequences of CS upon this vulnerable population. IMPLICATIONS FOR RESEARCH The paucity of research, which focuses on CS, is most likely due to ethical concerns related to infants as research participants and provides an opportunity for future research. Future research could focus on factors that focus on maternal-fetal/maternal-child transmission of CS.
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Abstract
BACKGROUND The success of an intervention to prevent syphilis will depend on the context and the goal of the intervention. To help programs choose interventions, we reviewed major changes in context and types of interventions that may be effective. METHODS We reviewed the literature on the changing context of syphilis in the United States and interventions to prevent syphilis, focusing on articles that included evidence of effectiveness. RESULTS Populations acquiring syphilis are constantly changing. Currently, incidence is very high among men who have sex with men (MSM). Among adults, late disease caused by syphilis has become rare. Congenital syphilis incidence has been low but is increasing, and morbidity and mortality remain high when babies are infected. Congenital syphilis now causes more deaths than syphilis among adults.Routine screening of MSM can identify and treat infections before they progress to disease (secondary prevention). Screening rates are highest when done as part of routine standing orders. Partner notification effectiveness has decreased, partly because many partners are anonymous. Most congenital syphilis can be prevented by screening pregnant women; it has been eliminated in areas where intense primary prevention efforts eliminated syphilis among women. CONCLUSIONS So far, no program has stopped the increasing rates of infection among MSM, but secondary prevention efforts have prevented most disability. Congenital syphilis is increasing, and can be decreased by screening pregnant women and stopped by intensive efforts to prevent infection among women.
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Affiliation(s)
- Thomas A Peterman
- From the Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
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Abstract
Congenital syphilis remains a major public health problem worldwide, and its incidence is increasing in the United States. This review highlights the ongoing problem of this preventable infection, and discusses vertical transmission and clinical manifestations while providing a practical algorithm for the evaluation and management of infants born to mothers with reactive serologic tests for syphilis. Every case of congenital syphilis must be seen as a failure of our public health system to provide optimal prenatal care to pregnant women, as congenital syphilis can be prevented by early and repeated prenatal serologic screening of mothers and penicillin treatment of infected women, their sexual partners, and their newborn infants.
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Affiliation(s)
- Joshua M Cooper
- Department of Pediatrics, Division of Neonatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157
| | - Pablo J Sánchez
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Center for Perinatal Research, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, RB3, WB5245, Columbus, OH 43205-2664.
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Cooper JM, Michelow IC, Wozniak PS, Sánchez PJ. In time: the persistence of congenital syphilis in Brazil - More progress needed! ACTA ACUST UNITED AC 2017; 34:251-3. [PMID: 27521453 PMCID: PMC5178108 DOI: 10.1016/j.rppede.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Joshua M Cooper
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, EUA
| | - Ian C Michelow
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, EUA
| | - Phillip S Wozniak
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, EUA
| | - Pablo J Sánchez
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, EUA.
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Rodrigues DC, Domingues RMSM. Management of syphilis in pregnancy: Knowledge and practices of health care providers and barriers to the control of disease in Teresina, Brazil. Int J Health Plann Manage 2017; 33:329-344. [PMID: 28983958 DOI: 10.1002/hpm.2463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
AIMS The aim of the study is to verify the knowledge and practices of health professionals working in prenatal care (PNC) related with syphilis during pregnancy and to identify the main barriers to the implementation of protocols for the control of this disease. METHODS A cross-sectional study in Teresina, Brazil, from January to May 2015, was conducted with 366 physicians and nurses working in PNC, corresponding to 70% of eligible professionals. We evaluated 20 knowledge and practice criteria related to the diagnosis and treatment of syphilis during pregnancy with a 95% compliance standard. We performed descriptive analysis of the data and used χ2 statistical test to verify differences according to professional category. RESULTS Only 2 criteria, "knowledge about mother to child transmission according to gestational age" and "counselling on infection," reached 95% compliance. Knowledge of the epidemiological profile of congenital syphilis and the goal of elimination of congenital syphilis and knowledge about serological tests had scores below 50%, while practices related with posttest counselling, cure control, and treatment of partners reached 60%. We identified organisational barriers related to the late initiation of PNC, to the delayed return of syphilis test results, to the application of benzathine penicillin in primary care units and to the treatment of partners. CONCLUSIONS Strategies for early initiation of PNC, implementation of rapid tests for syphilis, ensuring treatment of pregnant women with penicillin, adequate partner treatment, and continued education of health professionals on clinical management and counselling in sexually transmitted diseases are necessary to eliminate congenital syphilis.
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Nijkamp J, Sebire N, Bouman K, Korteweg F, Erwich J, Gordijn S. Perinatal death investigations: What is current practice? Semin Fetal Neonatal Med 2017; 22:167-175. [PMID: 28325580 PMCID: PMC7118457 DOI: 10.1016/j.siny.2017.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded). In the next step, placental examination is suggested in all cases, together with molecular cytogenetic evaluation and fetal autopsy. Investigation for fetal-maternal hemorrhage by Kleihauer is also recommended as standard. In cases where parents do not consent to autopsy, alternative approaches such as minimally invasive postmortem examination, postmortem magnetic resonance imaging, and fetal photographs are good alternatives. After all investigations have been performed it is important to combine findings from the clinical review and investigations together, to identify the most probable cause of death and counsel the parents regarding their loss.
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Affiliation(s)
- J.W. Nijkamp
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Corresponding author. Department of Obstetrics and Gynecology, University Medical Centre Groningen, CB 21, P.O. box 30001, 9700 RB Groningen, The Netherlands.
| | - N.J. Sebire
- Department of Pediatric Pathology, Clinical Molecular Genetics, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, UK
| | - K. Bouman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F.J. Korteweg
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | - J.J.H.M. Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S.J. Gordijn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Em tempo: a persistência da sífilis congênita no Brasil – Mais avanços são necessários! REVISTA PAULISTA DE PEDIATRIA 2016. [DOI: 10.1016/j.rpped.2016.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhang XH, Xu J, Chen DQ, Guo LF, Qiu LQ. Effectiveness of treatment to improve pregnancy outcomes among women with syphilis in Zhejiang Province, China. Sex Transm Infect 2016; 92:537-541. [PMID: 27091728 DOI: 10.1136/sextrans-2015-052363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/09/2016] [Accepted: 03/05/2016] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Xiao-Hui Zhang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Jian Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Dan-Qing Chen
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Li-Fang Guo
- Women Hospital of Hang Zhou, Hangzhou, People's Republic of China
| | - Li-Qian Qiu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
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