Current status of syphilis in pregnant women in Japan

Trends in Syphilis in Pregnant Women in Japan in 2016 and 2022

Since 2012, the rate of syphilis infection has increased dramatically in high-income countries including Japan. In this study, we examined the rate of syphilis infection among pregnant women and perinatal outcomes in the syphilis-infected pregnancy in 2022 in Japan, and compared the results with those in 2016. We requested 2,005 obstetric institutes to provide information on syphilis infection in pregnant women who delivered in 2022. A total of 1,346 obstetrical facilities responded with valid information. We compared the results with those in our previous study. The prevalence of syphilis-infected pregnant women was 1/1,215. The incidence of preterm delivery, intrauterine fetal demise and congenital syphilis in surviving neonates in the syphilis-infected pregnancy were 9%, 2% and 7%, respectively. The prevalence of syphilis-infected pregnant women has increased significantly, while the incidence of congenital syphilis seems to have decreased clinically.

The incidence of Jarisch-Herxheimer reactions and associated risk factors in pregnant women and nonpregnant women: A retrospective chart review at a university hospital in Japan

AIMS

Jarisch-Herxheimer reactions (JHR) is a transient adverse event that occurs during initial antimicrobial treatment for syphilis patients, and is known to develop uterine contractions and fetal distress in pregnant women complicated with syphilis. The aim of this study is to identify risk factors for JHR in patients with syphilis, and to clarify whether pregnancy status is a risk factor for JHR, and to describe the characteristics of pregnant women who develop JHR.

METHODS

This was a retrospective chart review in a singleton university hospital in Japan. We collected data of syphilis patients who were diagnosed and treated at department of obstetrics and gynecology, dermatology between January 2010 and May 2022. There were no validated diagnostic criteria for JHR, we defined JHR as one or more of the following in addition to raised body temperature (≧38.0°C) within 24 h of initial antibiotic treatment: headache, chills, myalgias, tachycardia (≧110 bpm), new rash.

RESULTS

There were 30 syphilis patients. Of whom nine (30%) were pregnant women and all their neonates were not diagnosed with congenital syphilis. Five patients (17%) developed JHR at the time of initial treatment (JHR group, n = 5). There was no difference between JHR group and non-JHR group (n = 25) in pregnancy status. Secondary syphilis was an only significant risk factor for JHR. Two pregnant women with JHR were both treated for secondary syphilis in the third trimester of pregnancy.

CONCLUSION

Pregnancy status was not a risk factor for JHR in syphilis patients. Further research is needed.

Awareness of Infectious Disease Screening During Early Pregnancy and Knowledge About its Vertical Transmission in Japan: A Report from the Pregnant Women Health Initiative

OBJECTIVES

We aimed to clarify the accuracy of pregnant women's knowledge and understanding regarding infectious disease screening in early pregnancy and clarify the roles that should be played by health care providers in promoting the health of pregnant women and their children.

METHODS

A cross-sectional questionnaire survey was conducted in 25 hospitals across Japan from May 2018 to September 2019. We compared the agreement rates regarding screening results for hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, human T-cell leukemia virus-1 (HTLV-1), and cervical cytology in the medical records and understanding of their results by pregnant women. We then investigated whether participants had knowledge regarding the risk of mother-to child transmission in these diseases and factors associated with their knowledge.

RESULTS

We enrolled 2,838 respondents in this study. The rates of agreement for HBV and cervical cancer screening related to human papillomavirus infection were "substantial," those for syphilis was "moderate," and those for HCV and HTLV-1 were "fair," according to the Kappa coefficient. The rate of knowledge regarding mother-to-child transmission of syphilis was highest (37.0%); this rate for the other items was approximately 30%. Increased knowledge was associated with higher educational level and higher annual income.

CONCLUSIONS FOR PRACTICE

Pregnant women in Japan had generally good levels of understanding regarding their results in early-pregnancy infectious disease screening. However, they had insufficient knowledge regarding mother-to-child transmission of these diseases. Health care providers should raise awareness in infectious disease prevention among pregnant women and the general public, providing appropriate measures and implementing effective perinatal checkups and follow-ups for infectious diseases.

Increased cervical Chlamydia trachomatis and syphilis infections in Japanese females of reproductive age in the late 2010s: Possible cause

From 2000 to 2019, Japan's reproductive-age population gradually declined by 24%. In comparison, the Chlamydia trachomatis infection rate increased from 2016, with the syphilis infection rate increasing more sharply from 2014. Since 2013, the numbers of foreign tourists to Japan have also increased. From 2011 to 2018, the rate of increase in tourists was 5.02 times, while the rate of increase in syphilis patients was higher at 22.4 times. The lack of a one-to-one relationship between foreign tourists and syphilis cases suggests that cases of syphilis were transmitted to others. Although the prevalence of syphilis in the tourists' home countries (Korea in 2014 and China in 2013) was 20-30 times higher than that in Japan, the Japanese sex industry did not discriminate against foreign tourists, leading to increased STI infections in Japanese female sex workers. Indeed, from 2017 to 2018, a history of working in the sex industry for six months was identified as a risk factor for syphilis. The rise in Chlamydia trachomatis infections has lagged behind that of syphilis by two years, with the rate of increase lower. We suspect the difference in increasing rates of syphilis and chlamydial infections is due to the different methods of infection: syphilis can be transmitted by light physical contact, such as a kiss, whereas chlamydia requires close sexual contact, such as oral sex or sexual intercourse. Regardless, examinations and infection control are necessary to prevent the spread of STIs in Japan due to inbound tourists.

Syphilis in heterosexual women: case characteristics and risk factors for recent syphilis infection in Tokyo, Japan, 2017-2018

In response to an increase in heterosexual syphilis notifications in Tokyo, we conducted a questionnaire-based case-control study among women aged ≥20 years and sexually active in the past six months who sought a syphilis test in Tokyo during 2017-2018. Cases were women diagnosed as recent syphilis infection based on serological tests. Controls were serologically non-reactive or those with only a past syphilis infection. We described cases and assessed for risk factors of recent syphilis using logistic regression. A total of 524 women (60 cases, 464 controls) were enrolled. Notably, among cases, 10 (16.7%) were students, 3 (5.0%) had a history of syphilis, and 14 (23.3%) had a single sex partner in the past six months. Female sex worker (FSW) status was strongly associated with syphilis (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.96-5.90). In multivariable analysis, recent syphilis was associated with inconsistent condom use for vaginal/anal sex among FSWs (adjusted OR [aOR] = 3.42; 95%CI = 0.92-12.70) and among non-FSWs, with younger age (aOR = 0.36; 95%CI = 0.19-0.70; increase per category from 20-24, 25-29 to ≥30 years) and ≤high school education (aOR = 5.24; 95%CI = 1.95-14.10). A notable proportion of cases were those with first time infection and those with only a single partner. Moreover, risk factors differed between FSWs and non-FSWs, and a multi-pronged approach to prevent syphilis is required.

Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand

BACKGROUND

The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention.

METHODS

A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria.

RESULTS

From 2013 to 2017, 69 syphilis-infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18-32) years and 12 (17%) women had human immunodeficiency virus co-infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non-reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non-reactive rapid plasma reagin at the age of 7 months.

CONCLUSIONS

Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care.

Case report of eight pregnant women with syphilis

Congenital syphilis may lead to severe sequelae in affected infants. The prevalence of syphilis in women of childbearing age has increased worldwide. From 2015 to 2018, we encountered eight pregnant women with syphilis including six with late latent and two with early latent syphilis. Seven pregnant women with syphilis received antibiotic therapies of oral amoxicillin, intravenous penicillin G, or the both. The syphilotherapies in four cases were considered effective, because rapid plasma reagin titers decreased. None of the seven pregnant women who received syphilotherapies had congenital syphilis. The remaining one woman who did not undergo a maternity checkup or syphilotherapy delivered a stillbirth with congenital syphilis at 29 gestational weeks.

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.

Análise epidemiológica e espacial dos casos de sífilis gestacional e congênita

RESUMO O presente estudo teve como objetivo analisar o perfil epidemiológico e a distribuição espacial dos casos de sífilis gestacional e congênita. Trata-se de uma pesquisa descritiva, exploratória e retrospectiva, com abordagem quantitativa, realizada em Caxias (MA). Utilizaram-se os dados das fichas de investigação dos casos confirmados de sífilis gestacional e congênita do Sistema de Informação de Agravos de Notificação no período de 2013 a 2017. Com a tecnologia Global Positioning System (Sistema de Posicionamento Global), foram coletadas as coordenadas dos casos, e com o programa Quantum GIS, versão 1.7.0, os mapas foram construídos. Foram 149 casos de sífilis gestacional, apresentando crescimento de 73% no período. As maiores prevalências ocorreram em mulheres jovens, pardas, com baixa escolaridade e donas de casa. Evidenciou-se maior frequência do diagnóstico no terceiro trimestre gestacional, com maior prevalência de sífilis primária. Foram 18 casos de sífilis congênita, com redução de 33% na taxa de detecção e prevalência na idade entre 1 e 28 dias de vida. Na análise espacial, as zonas Oeste e Leste, periferia do município, concentraram o maior número de casos. Revelou-se frágil o manejo de investigação, tornando necessária a educação permanente para qualificar os profissionais, com o intuito de instituir a identificação precoce, o tratamento oportuno e o acompanhamento efetivo.

Current status of Neisseria gonorrhoeae cervicitis in pregnant women in Japan

We evaluated the current prevalence of gonococcal cervicitis among pregnant women in institutes that either do or do not routinely screen for gonococcal infection in Japan. We requested 2,330 obstetrical facilities to provide information on Neisseria gonorrhoeae cervicitis in pregnant women. A total of 1,876 (80.5%) of them responded. The universal screening test for gonococcal cervicitis, involving nucleic acid amplification for all pregnant women, was performed in 281 institutes (13.9% of institutes across Japan). The total rate of pregnant women with gonococcal cervicitis was 1.3% in the institutes performing the screening test during pregnancy, while it was only 0.2% (p < 0.01) in those not performing it. This suggests that 84% of infected women may have been missed in the institutes that do not routinely perform the screening test for gonococcal cervicitis. It may be time to examine the cost-effectiveness of providing gonococcal screening for all pregnant women in Japan.