Elimination of Mother-to-child Transmission of Syphilis: Challenge and Solution

Analysis of Adverse Pregnancy Outcomes of Pregnant Women with Syphilis and Maternal-Infant Serological Association in Changzhou, China, 2015-2019

Background

Although the prevention of mother-to-child transmission of syphilis program in China has achieved national coverage for 7 years, controversy still exists regarding the treatment of syphilis and the serological significance of syphilis.

Objective

To explore the occurrence and influencing factors of adverse pregnancy outcomes among pregnant women with syphilis in Changzhou from 2015-2019 and to further analyze the impact of syphilis serologic titers on perinatal outcomes and neonatal serologic outcomes.

Methods

Syphilis-infected pregnant women reported in Changzhou City from 2015 to 2019 were selected as the study population (data were obtained from the "China Information System for Prevention of Mother-to-child Transmission of AIDS, Syphilis and Hepatitis B." Demographic characteristics, laboratory tests, and medication were collected to describe adverse pregnancy outcomes and the distribution of non-pale leptospiral antibody titers during pregnancy. Multivariate logistic regression was used to analyze the factors influencing adverse pregnancy outcomes. We also compared differences in syphilis titers among mothers who received different interventions, differences in serologic outcomes of their children, and correlations between them.

Results

For mothers with syphilis infection, we found no treatment during pregnancy (OR =1.70) and an initial titer greater than 1 : 8 (OR =2.28) to be risk factors. For treated pregnant women, increasing age (OR =1.08), lack of standardized treatment (OR =1.87), and initial titer greater than 1 : 8 (OR =1.69) were risk factors, while previous parity was a protective factor (OR =0.62). For untreated pregnant women, marital status (OR =2.40) and initial titers greater than 1 : 8 (OR =3.57) were risk factors. There were statistically significant differences (P < 0.01) in serologic titer changes, time to antibody regression, and time to exclusion of syphilis infection in children of pregnant women with syphilis infection after receiving different interventions during pregnancy, but different time distributions of interventions had no effect on these three indicators.

Conclusion

Pregnant women with syphilis should actively cooperate with their doctors in the standardized treatment of pregnancy, and doctors should also pay more attention to pregnant women with syphilis whose initial titers are greater than 1 : 8. High-quality prenatal care is a key component in interrupting mother-to-child transmission of syphilis and preventing various adverse pregnancy outcomes. The adaptation of standardized treatment protocols for pregnant women with syphilis in China is a strong proof of the progress of precision medicine.

Seroreduction of syphilis nontreponemal titers during pregnancy for women with and without HIV coinfection

OBJECTIVE

To evaluate the effect of HIV coinfection on nontreponemal titers during pregnancy in women with syphilis.

METHODS

This is a secondary analysis of pregnant women with syphilis in the prospective, observational Zambian Preterm Birth Prevention Study (ZAPPS). Treponemal (TPPA) and nontreponemal (RPR) testing were performed on serum biospecimens, resulting in 47 participants with serologically-confirmed syphilis (27 HIV-positive, 20 HIV-negative). The primary outcome, achievement of RPR titer seroreduction during pregnancy, was analyzed by logistic regression. Secondary outcomes included overall titer reduction, seroreduction rate, serologic cure, and adverse pregnancy outcomes.

RESULTS

Seroreduction of RPR titer occurred in 78% (21/27) of women with HIV versus 45% (9/20) of women without (aOR 4.66; 95%CI 1.14-19.08). Overall RPR titer reduction, rates of seroreduction per week, and the proportion achieving serologic cure each trended higher among women with HIV compared to those without HIV. There was a trend toward decreased stillbirth incidence in participants achieving seroreduction (OR 0.15, 95%CI 0.01-1.58).

CONCLUSION

HIV coinfection in this cohort of Zambian women with syphilis was associated with greater odds of RPR titer seroreduction during pregnancy. Pregnant women with syphilis and HIV may not be at increased risk for delayed syphilis treatment response compared to women without HIV.

Intra-urban differentials of congenital and acquired syphilis and syphilis in pregnant women in an urban area in northeastern Brazil

Background

Currently syphilis is considered an epidemic disease worldwide. The objective of this study was to identify intra-urban differentials in the occurrence of congenital and acquired syphilis and syphilis in pregnant women in the city of Natal, in northeast Brazil.

Methods

Cases of syphilis recorded by the municipal surveillance system from 1 January 2011 to 30 December 2018 were analysed. Spatial statistical analyses were performed using the kernel density estimator of the quadratic smoothing function (weighted). SaTScan software was applied for the calculation of risk based on a discrete Poisson model.

Results

There were 2163 cases of acquired syphilis, 738 cases of syphilis in pregnant women and 1279 cases of congenital syphilis. Kernel density maps showed that the occurrence of cases is more prevalent in peripheral areas and in areas with more precarious urban infrastructure. In 2011–2014 and 2015–2018, seven statistically significant clusters of acquired syphilis were identified. From 2011 to 2014, the most likely cluster had a relative risk of 3.54 (log likelihood ratio [LLR] 38 895; p<0.001) and from 2015 to 2018 the relative risk was 0.54 (LLR 69 955; p<0.001).

Conclusions

In the municipality of Natal, there was a clustered pattern of spatial distribution of syphilis, with some areas presenting greater risk for the occurrence of new cases.