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Carcamo CP, Velasquez C, Rocha SC, Centurion-Lara A, Lopez-Torres L, Parveen N. Sociodemographic and clinical characteristics associated with maternal and congenital syphilis - A prospective study in Peru. Int J Infect Dis 2024; 143:107041. [PMID: 38583824 PMCID: PMC11109506 DOI: 10.1016/j.ijid.2024.107041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES The objective of this study was to explore the factors and outcomes associated with gestational syphilis in Peru. METHODS Women from the miscarriage, vaginal delivery, and C-section wards from a large maternity hospital in Lima with or without syphilis diagnosis were enrolled and their pregnancy outcomes compared. Maternal syphilis status using maternal blood and child serostatus using cord blood were determined by rapid plasma reagin (RPR) and rapid syphilis tests. The newborns' clinical records were used to determine congenital syphilis. RESULTS A total of 340 women were enrolled, 197 were positive and 143 were negative for RPR/rapid syphilis tests. Antibody titers in sera from cord and maternal blood were comparable with RPR titers and were highly correlated (rho = 0.82, P <0.001). Young age (P = 0.009) and lower birth weight (P = 0.029) were associated with gestational syphilis. Of the women with gestational syphilis, 76% had received proper treatment. Mothers of all newborns with congenital syphilis also received appropriate treatment. Treatment of their sexual partners was not documented. CONCLUSIONS Syphilis during pregnancy remains a major cause of the fetal loss and devastating effects of congenital syphilis in newborns.
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Affiliation(s)
- Cesar P Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - Sandra C Rocha
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, USA
| | - Arturo Centurion-Lara
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lorena Lopez-Torres
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nikhat Parveen
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, USA.
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Chirombo J, Majamanda A, Gunsaru V, Yosefe S, Ozituosauka W, Mchoma C, Morroni C, Chipeta E, MacPherson P, Freyne B. The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors. Front Public Health 2024; 11:1242870. [PMID: 38292384 PMCID: PMC10825961 DOI: 10.3389/fpubh.2023.1242870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
Background Mother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission. Methods We collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas. Results Overall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27-0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89-1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12-1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10-1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80-1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15-49 years) in 2022. Conclusion Maternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs.
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Affiliation(s)
- James Chirombo
- Statistical Support Unit, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Vester Gunsaru
- Statistical Support Unit, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Simeon Yosefe
- Digital Health Department, Ministry of Health, Lilongwe, Malawi
| | | | - Christina Mchoma
- Reproductive Health Department, Ministry of Health of Malawi, Lilongwe, Malawi
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Effie Chipeta
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Peter MacPherson
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bridget Freyne
- Department of Paediatric Infectious Diseases, Children’s Health Ireland, Dublin, Ireland
- Division of Women and Children’s Health, School of Medicine, University College Dublin, Dublin, Ireland
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Freyne B, Nourse C, Walls T. Congenital Syphilis: Controversies and Questions: A Global Perspective. Pediatr Infect Dis J 2023; 42:e166-e169. [PMID: 36728111 DOI: 10.1097/inf.0000000000003808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Bridget Freyne
- From the Department of Paediatric Infectious Diseases, Children's Health Ireland, Dublin, Ireland
- Division of Women & Children's Health, School of Medicine, University College Dublin, Ireland
| | - Clare Nourse
- Division of Women & Children's Health, School of Medicine, University College Dublin, Ireland
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Research for Children Aotearoa, New Zealand https://www.healthprecinct.org.nz/research-for-children-aotearoa/
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4
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Shaw S, Plourde P, Klassen P, Stein D. A descriptive study of syphilis testing in Manitoba, Canada, 2015-2019. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:95-101. [PMID: 35342365 PMCID: PMC8889925 DOI: 10.14745/ccdr.v48i23a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In 2018, Manitoba had the highest reported rate of infectious syphilis in Canada, at over three times the national average. Infectious syphilis in Manitoba is centred on young, marginalized heterosexual couples in Winnipeg's inner-city. Subsequently, a public health crisis involving congenital syphilis emerged in Manitoba, just prior to the coronavirus disease 2019 pandemic. Testing and screening (in the case of pregnancy) for syphilis is thought to be an effective measure to reduce the incidence of syphilis and its sequelae. The aim of this study is to describe syphilis testing practices in the general population and amongst pregnant women, during a period of shifting syphilis epidemiology. METHODS We used population-based syphilis testing data from Cadham Provincial Laboratory (Winnipeg, Manitoba) for 2015 to 2019. Directly age-standardized rates are reported, and Poisson regression used to model the determinants of testing rates. Rates of prenatal screening are also reported. RESULTS From 2015 to 2019, a total of 386,350 individuals were tested for syphilis. The rate increased annually, from 462 per 10,000 population in 2015 to 704 per 100,000 in 2019, while the female-to-male ratio decreased from 1.8 to 1.6. Prior to 2019, the majority of pregnant women (approximately 60%) were screened once, during the first trimester; however, 2019 saw more women having more than two tests during the course of their pregnancy. CONCLUSION An overall increase in the number of individuals tested was observed, reflecting the increased rate of syphilis in Manitoba. Prenatal screening patterns shifted in 2019, likely in response to rising congenital syphilis numbers.
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Affiliation(s)
- Souradet Shaw
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
| | - Pierre Plourde
- Population and Public Health, Winnipeg Regional Health Authority, Winnipeg, MB
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB
| | | | - Derek Stein
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB
- Cadham Provincial Laboratory, Winnipeg, MB
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5
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Hoque M, Hoque ME, van Hal G, Buckus S. Prevalence, incidence and seroconversion of HIV and Syphilis infections among pregnant women of South Africa. S Afr J Infect Dis 2021; 36:296. [PMID: 34917677 PMCID: PMC8661397 DOI: 10.4102/sajid.v36i1.296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/30/2021] [Indexed: 12/04/2022] Open
Abstract
Background Pregnant women in South Africa suffer from HIV and syphilis infections resulting in negative pregnancy outcomes. Little is known about the prevalence, incidence, seroconversion, and associated risk factors for those attending a midwife run obstetric unit. Methods A retrospective cohort study was undertaken among pregnant women attending antenatal clinic from January to December 2018. Logistic regression was conducted to determine the risk factors for HIV and syphilis. Results The prevalence of HIV and syphilis were 44.3% (95% confidence interval [CI]; 41.6:46.7) and 3.8% (95% CI; 3.1:4.1), respectively. The seroconversion and incidence for HIV were 4.0% (95% CI; 3.6:4.6) and 17.1 per 100 person-years, and for syphilis 2.6% (95% CI; 2.3:2.8) and 10.9 per 100 person-years, respectively. Significant predictors for HIV prevalence were ages: ages < 20 years, Odds ratio (OR) = 0.11 (p < 0.05), ages 20–24 years, OR = 0.19 (p < 0.05) and ages 25–29 years, OR = 0.38 (p < 0.05); gestational age: second trimester, OR = 0.68 (p < 0.05) and non-reactive syphilis, OR = 0.45 (p < 0.05). Age was the predictor for HIV incidence or seroconversion (age < 20 year, OR = 0.12, p = 0.01). Predictors for syphilis were ages < 20 years, OR = 0.11 (p < 0.05), ages 20–24 years and HIV status. Gestational age > 27 weeks were nine times (OR = 9.2, p = 0.03) more likely to seroconvert to syphilis. Conclusions The present study found high rates of seroprevalence, seroconversion and incidence of HIV and syphilis among pregnant women.
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Affiliation(s)
| | - Muhammad E Hoque
- Research Department, Management College of Southern Africa, Durban, South Africa
| | - Guido van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Somaya Buckus
- Kwadabeka Community Health Centre, Durban, South Africa
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Adawiyah RA, Saweri OPM, Boettiger DC, Applegate TL, Probandari A, Guy R, Guinness L, Wiseman V. The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:939-954. [PMID: 33693731 PMCID: PMC8227996 DOI: 10.1093/heapol/czab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/18/2022] Open
Abstract
Around two-thirds of all new HIV infections and 90% of syphilis cases occur in low- and middle-income countries (LMICs). Testing is a key strategy for the prevention and treatment of HIV and syphilis. Decision-makers in LMICs face considerable uncertainties about the costs of scaling up HIV and syphilis testing. This paper synthesizes economic evidence on the costs of scaling up HIV and syphilis testing interventions in LMICs and evidence on how costs change with the scale of delivery. We systematically searched multiple databases (Medline, Econlit, Embase, EMCARE, CINAHL, Global Health and the NHS Economic Evaluation Database) for peer-reviewed studies examining the costs of scaling up HIV and syphilis testing in LMICs. Thirty-five eligible studies were identified from 4869 unique citations. Most studies were conducted in Sub-Saharan Africa (N = 17) and most explored the costs of rapid HIV in facilities targeted the general population (N = 19). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost-benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N = 25) and assumed costs increased linearly with scale. Ten studies examined cost efficiencies associated with scale, most reporting short-run economies of scale. Important drivers of the costs of scaling up included testing uptake and the price of test kits. The 'true' cost of scaling up testing is likely to be masked by the use of short-term decision frameworks, linear unit-cost projections (i.e. multiplying an average cost by a factor reflecting activity at a larger scale) and availability of health system capacity and infrastructure to supervise and support scale up. Cost data need to be routinely collected alongside other monitoring indicators as HIV and syphilis testing continues to be scaled up in LMICs.
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Affiliation(s)
- Rabiah Al Adawiyah
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Olga P M Saweri
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,Population Health and Demography, Papua New Guinea Institute of Medical Research, PO Box 60 Homate Street, Goroka, Papua New Guinea
| | - David C Boettiger
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A. Surakarta, 57126, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.,Centre for Global DevelopmentEurope, Great Peter House, Great College St, London SW1P 3SE, UK
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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7
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Hu F, Guo SJ, Lu JJ, Hua NX, Song YY, Lin SF, Zhu S. New screening approach to detecting congenital syphilis in China: a retrospective cohort study. Arch Dis Child 2021; 106:231-237. [PMID: 33355158 PMCID: PMC7907569 DOI: 10.1136/archdischild-2020-320549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.
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Affiliation(s)
- Fang Hu
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuai-Jun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jian-Jun Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China,Department of Medical Affairs, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Ning-Xuan Hua
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan-Yan Song
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sui-Fang Lin
- Department of Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sui Zhu
- Department of Medical Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong, China
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8
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Mathebula R, Kuonza L, Musekiwa A, Kularatne R, Puren A, Reubenson G, Sherman G, Kufa T. Trends in RPR Seropositivity among Children Younger than 2 Years in South Africa, 2010-2019. J Trop Pediatr 2021; 67:6178988. [PMID: 33742203 DOI: 10.1093/tropej/fmab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A positive rapid plasma reagin (RPR) result in children under the age of 2 years indicates either passive transplacental transfer of maternal antibodies or active infection with syphilis (possible congenital syphilis). We describe trends in RPR seropositivity in this population using centralized laboratory data. A secondary analysis of laboratory data collected through the National Health Laboratory Service, Corporate Data Warehouse from 2010 to 2019 was conducted. Of the 127 150 children <2 years included in the analysis, 10 969 [8.6%; 95% confidence interval (95% CI) 85-88]) were RPR seropositive. RPR seropositivity increased from 6.5% to 13.0% between 2010 and 2019. Overall, the annual rate of RPR seropositivity was relatively stable between 2010 and 2018 with a range of 89-127/100 000 live births, increasing sharply to 165/100 000 livebirths in 2019. KwaZulu-Natal and North West provinces recorded the largest increases in annual seropositivity rate, while Eastern Cape and Western Cape had the most significant declines. Although this analysis is limited to laboratory results, in the absence of major changes in testing practices, there may be a rise in the burden of antenatal syphilis exposure in utero indicating an increase in maternal syphilis and syphilis transmission in the general population. South Africa needs to intensify Mother-to-Child Transmission of syphilis elimination efforts to reach the WHO target of ≤50 cases per 100 live births by 2030.
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Affiliation(s)
- Rudzani Mathebula
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lazarus Kuonza
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Health Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ranmini Kularatne
- Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian Puren
- Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa.,Division of Virology, School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gayle Sherman
- Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- School of Health Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa
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9
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Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2020; 35:574-588. [PMID: 33094521 DOI: 10.1111/jdv.16946] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: -The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) -The development of dual treponemal and non-treponemal point-of-care (POC) tests -The progress in non-treponemal test (NTT) automatization -The regular episodic shortage of benzathine penicillin G (BPG) in some European countries -The exclusion of azithromycin as an alternative treatment at any stage of syphilis -The pre-exposure or immediate post-exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.
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Affiliation(s)
- M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Örebro University, Örebro, Sweden
| | - N Dupin
- Syphilis National Reference Center, Hôpital Tarnier-Cochin, AP-HP, Paris, France
| | - G S Tiplica
- 2nd Dermatological Clinic, Carol Davila University, Colentina Clinical Hospital, Bucharest, Romania
| | - M Potočnik
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - R Patel
- Department of Genitourinary Medicine, the Royal South Hants Hospital, Southampton, UK
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10
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The Effect of Different Treatment Regimens and Multiple Risk Factors on Adverse Pregnancy Outcomes among Syphilis-Seropositive Women in Guangzhou: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7626274. [PMID: 32462016 PMCID: PMC7222490 DOI: 10.1155/2020/7626274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
Background To eliminate mother-to-child transmission of syphilis, the Chinese government recommends a treatment regimen that slightly differs from the World Health Organization- (WHO-) recommended treatment. However, little is known about their difference in efficacy. This study is aimed at comparing the effect of China-recommended and WHO-recommend treatment regimens on adverse pregnancy outcomes (APOs) and at examining associated risk factors of APOs among syphilis-seropositive women. Methods Using the syphilis registry data, we retrospectively collected data from 4488 syphilis-infected pregnant women in Guangzhou during 2011-2018. Multivariate analyses were used to investigate the association between treatment regimens and APOs (ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth or low birth weight, newborn smaller than gestational age, congenital syphilis, and infant death) and the association between risk factors and APOs. Results Of 3474 participants, 27.3% had at least one APO. Compared to those receiving WHO-recommended treatment, women who received China-recommended treatment were less likely to have APOs (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.38-0.57), whereas those who received no treatment had 1.6 times higher odds of experiencing APOs. One common risk factor across different APOs was high levels of log2-transformed toluidine red unheated serum test (TRUST) titers before treatment (OR 1.14, 95% CI 1.10-1.19). China-recommended treatment was effective in reducing APOs for those with TRUST ≥ 1 : 8 (OR 0.21, 95% CI 0.14-0.29) and those with TRUST < 1 : 8 (OR 0.62, 95% CI 0.50-0.77). Conclusions Syphilis-seropositive women receiving China-recommended treatment had lower odds of APOs, especially when TRUST titers before treatment were high. Findings can be used to guide health professionals to reduce APOs among syphilis-infected mothers and promote nationwide use of China-recommended treatment.
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11
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Cárdenas Dávila E, Bedoya Marrugo EA, Domínguez YA, Elin Manrique J. Identificación de acciones de salud en el Programa de Control de Sífilis en gestantes, Cartagena de Indias, 2016. NOVA 2020. [DOI: 10.22490/24629448.3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fundamento. La Sífilis Congénita es una infección causada por la diseminación hematógena del Treponema pallidum de la gestante infectada al feto. Se conoce que la transmisión materna puede ocurrir en cualquier momento del embarazo, por lo que el control de la enfermedad en la gestante es vital en la atención prenatal. Objetivo. Identificar el cumplimiento de acciones de salud comprendidas en el Programa de Control de Sífilis en gestantes de la ciudad de Cartagena de Indias, primer semestre del 2016. Materiales y métodos: Estudio observacional descriptivo transversal. Se evaluaron 781 gestantes inscritas en control prenatal de la ciudad, a través de las instituciones prestadoras de servicios de salud (IPS) y empresas promotoras de salud (EPS). Resultados: Concluyeron la gestación 358 (45.8%) de las gestantes estudiadas. 25 (6.5%) del total, no se realizaron la VDRL intraparto. Durante el primer trimestre del embarazo, el 99.6% de las evaluadas resultaron VDRL no reactivas (NR). Mientras que en el segundo trimestre fueron evaluadas, el 67.5% y el 57,4%, respectivamente; resultando VDRL reactiva (R) una (0.1%) durante ambos semestres. Del segundo al tercer trimestre de la gestación no se incrementó el número de gestantes no evaluadas (98; 12,5%) y (63; 8, 1%), sin embargo, sí se incrementó (55; 19.8%) (269; 34.4%), respectivamente, el número de las gestantes que están a la espera del tiempo para realizar la prueba. No existió co-infección Sífilis/VIH/SIDA. Conclusiones. El control de la sífilis durante la atención prenatal fue deficiente dado por la alta tasa de no adherencia al cumplimiento de asistencia a la consulta por la gestante, como la no realización de la prueba acorde al tiempo establecido por parte del equipo de salud.
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Hopkins AO, Trinh T, Fakile YF, Pillay A, Taylor MM, Kersh E, Kamb M. Evaluation of the WHO/CDC Syphilis Serology Proficiency Programme to support the global elimination of mother-to-child transmission of syphilis: an observational cross-sectional study, 2008-2015. BMJ Open 2020; 10:e029434. [PMID: 31924629 PMCID: PMC6955536 DOI: 10.1136/bmjopen-2019-029434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Syphilis morbidity is high among pregnant women in lower income countries with limited laboratory capacity. We evaluated a long-standing global Syphilis Serology Proficiency Programme (SSPP) that supports testing quality in national reference laboratories to determine if participation affects congenital syphilis elimination strategies. DESIGN In this observational cross-sectional study, we calculated coverage on type, frequency and quality of syphilis testing reported by laboratories enrolled in the SSPP from 2008 to 2015. We used country-reported data to WHO on four congenital syphilis (CS) indicators and World Bank country economic data to compare coverage and completeness of reporting of indicators in lower income countries with and without an SSPP-enrolled laboratory. PARTICIPANTS From 2008-2015, 78 laboratories from 51 countries participated in >1 SSPP evaluation; 56% were national reference laboratories, of which most (93%) participated for >3 years and 11 (22%) in all 24 cycles. RESULTS Median proficiency performance score was >95% regardless of test conducted. Of the 51 countries with an SSPP-enrolled laboratory, 22 (43%) were lower-income countries, of which 21 reported CS data during 2008-2015. Comparing CS data from 87 (90% of total) lower income countries with and without an SSPP-enrolled laboratory, countries with an SSPP-laboratory had stronger reporting on antenatal syphilis testing (p=0.04). For 2015, an estimated 74% of prenatal syphilis tests and 63% of positive tests reported to WHO from countries with an SSPP-enrolled laboratory. CONCLUSION The SSPP has focused well on national reference laboratories, but has been only partially successful in recruiting laboratories from lower income countries. The finding that over half of syphilis infections in pregnant women living in countries with SSPP-enrolled laboratories suggests wide reach of the current quality assurance programme. However, reach could expand with focussed recruitment of laboratories from lower income countries.
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Affiliation(s)
- André O Hopkins
- NCEZID/ DFWED, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thuy Trinh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yetunde F Fakile
- Laboratory Reference Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allan Pillay
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melanie M Taylor
- Organisation mondiale de la Sante, Geneve, Switzerland
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen Kersh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Kamb
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Chen XS. Turning off the tap: sustaining elimination of congenital syphilis through the programme targeting high-risk groups. J Glob Health 2019; 9:020312. [PMID: 31656601 PMCID: PMC6812977 DOI: 10.7189/jogh.09.020312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Nanjing, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
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Abstract
Syphilis, caused by the spirochete Treponema pallidum subspecies pallidum, continues to be a prevalent disease in low- and middle-income countries, and has reemerged in key populations, including men who have sex with men, in high-income nations. The rising number of cases shows that syphilis elimination will require augmentation of public health screening and treatment campaigns with syphilis vaccine development and implementation initiatives. Optimal vaccine candidates, deciphered from careful consideration of the pathogenic mechanisms used by T. pallidum, will need to be paired with appropriate human-track adjuvants designed to elicit the correlates of protection needed to prevent infection/disease. This article provides an overview of the development pipeline customized for a syphilis vaccine, including the preferred product characteristics, the investment case, and a proposed vaccinogen selection strategy outlining the essential qualities that need to be targeted by a syphilis vaccine.
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Evaluation of the Protective Ability of the Treponema pallidum subsp. pallidum Tp0126 OmpW Homolog in the Rabbit Model of Syphilis. Infect Immun 2019; 87:IAI.00323-19. [PMID: 31182617 DOI: 10.1128/iai.00323-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
In silico analyses of Treponema pallidum subsp. pallidum genomes and predicted proteomes to search for homologs of known bacterial outer membrane proteins (OMPs) led to the identification of tp0126 as a gene encoding a putative member of the OmpW family of porins/virulence factors. Our previous investigations on the role of Tp0126 in T. pallidum biology and syphilis pathogenesis showed that Tp0126 is fully conserved among T. pallidum strains and that transcription of tp0126 is driven by σ70 These initial results pointed to a housekeeping function for this protein. We also demonstrated that a guanosine homopolymer of various lengths located between the -10 and -35 consensus sequences in the tp0126 promoter modulates transcription consistently with phase variation, a mechanism that we also previously described for other T. pallidum genes encoding putative OMPs/virulence factors and that is often employed as a strategy for immune evasion. Circular dichroism spectra of recombinant Tp0126 also supported its structural homology with OmpW. Here we further investigated the humoral and cellular responses to Tp0126 during experimental and natural syphilis and the ability of Tp0126 to confer protection against syphilis in immunized rabbits. B-cell epitope mapping showed that compared to sera from experimentally infected animals, immunizations enhanced humoral immunity to sequences located in the putative Tp0126 surface-exposed loops, while phagocytosis assays showed that postimmunization sera opsonized T. pallidum Despite such promising results, no significant protection was seen following infectious challenge in immunized animals versus controls. Functional redundancy and phase variation might explain the lack of effectiveness of this vaccine candidate and/or design.
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Banong-le M, Ofosu SK, Anto F. Factors associated with syphilis infection: a cross-sectional survey among outpatients in Asikuma Odoben Brakwa District, Ghana. BMC Infect Dis 2019; 19:360. [PMID: 31035953 PMCID: PMC6489217 DOI: 10.1186/s12879-019-3967-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/08/2019] [Indexed: 11/15/2022] Open
Abstract
Background Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease affects all ages and both sexes but more prevalent among the sexually active age group of 15–49 years. The purpose of the current study was to determine the prevalence and factors associated with syphilis infection among outpatients 15–49 years in the Asikuma Odoben Brakwa District of Ghana where high levels of infection were earlier reported among antenatal women. Methods A descriptive cross-sectional study was carried out in 13 randomly selected health facilities. Blood samples were collected and tested for syphilis infection and a questionnaire administered to determine factors associated with the disease. Results A total 277 patients aged 15–49 years participated in the study. The overall prevalence of syphilis infection was 3.2% (9/277), with 5.7% (6/105) and 1.7% (3/172) among males and females respectively. Significant factors associated with syphilis infection included sub-district of residence, (χ2 (4) = 31.20, p < 0.001) and history of coerced sexual intercourse (χ2 (1) =7.49, p = 0.006). Conclusions The prevalence of syphilis infection was high among male patients who lived in rural areas. Having a history of coerced sexual intercourse was a strong predictor for syphilis infection. Access to sexually transmitted infection control interventions in rural communities including health education may help control the disease. Electronic supplementary material The online version of this article (10.1186/s12879-019-3967-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Banong-le
- School of Public Health, University of Ghana, Legon, Accra, Ghana.,Ministry of Health, College of Nursing and Midwifery, Nalerigu, Northern Region, Ghana
| | - Samuel Kwabena Ofosu
- District Health Directorate, Ghana Health Service, Breman Asikuma, Central Region, Ghana
| | - Francis Anto
- School of Public Health, University of Ghana, Legon, Accra, Ghana.
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Newton L, Necochea R, Palm D, Taylor J, Barr L, Patel H, Nathan A, Gerrard J, Sylla L, Brown B, Dubé K. Revisiting the 'sterilising cure' terminology: a call for more patient-centred perspectives on HIV cure-related research. J Virus Erad 2019; 5:122-124. [PMID: 31191916 PMCID: PMC6543486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The literature on HIV therapeutics research is rife with terminology associating 'sterilisation' with HIV cure. We find connotations of the word 'sterilising' problematic for the HIV cure research field. In this viewpoint, we review associations of sterilising with concepts of disinfection or cleansing, as well as coerced sterilisation. We discuss emerging findings from socio-behavioural research that show aversion from people living with HIV towards the 'sterilising cure' nomenclature. We call for more collaborations with people with HIV as partners to help define what would be a more acceptable terminology for describing an HIV cure.
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Affiliation(s)
- Luke Newton
- UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
| | - Raúl Necochea
- Department of Social Medicine,
UNC School of Medicine,
Chapel Hill,
NC,
USA
| | - David Palm
- Global HIV Prevention and Treatment Unit Clinical Trials Community Advisory Board,
University of North Carolina at Chapel Hill,
NC,
USA
- Collaboratory of AIDS Researchers for Eradication (CARE) Community Advisory Board,
University of North Carolina at Chapel Hill,
Chapel Hill,
NC,
USA
| | - Jeff Taylor
- Collaboratory of AIDS Researchers for Eradication (CARE) Community Advisory Board,
University of North Carolina at Chapel Hill,
Chapel Hill,
NC,
USA
- HIV + Aging Research Project – Palm Springs (HARP-PS),
Palm Springs,
CA,
USA
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Scientific Sub-Committee Representative,
John Hopkins University,
Baltimore,
MD,
USA
| | - Hursch Patel
- UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
| | - Anshula Nathan
- UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
| | - Jo Gerrard
- University of California Riverside School of Medicine,
Riverside,
CA,
USA
| | - Laurie Sylla
- defeatHIV Community Advisory Board,
Seattle,
WA,
USA
| | - Brandon Brown
- Center for Healthy Communities,
Department of Social Medicine, Population and Public Health,
University of California Riverside School of Medicine,
Riverside,
CA,
USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
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Plagens-Rotman K, Przybylska R, Gerke K, Piskorz-Szymendera M, Tomaszewska M, Sadowska-Przytocka A, Adamski Z, Czarnecka-Operacz M. Syphilis and a pregnant woman: a real danger for the woman and the child. Postepy Dermatol Alergol 2019; 36:119-124. [PMID: 30858792 PMCID: PMC6409870 DOI: 10.5114/ada.2019.82833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Katarzyna Plagens-Rotman
- Department of Mother’s and Child’s Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Renata Przybylska
- Department of Neurological Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Gerke
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Magdalena Tomaszewska
- Department of Mother’s and Child’s Health, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Balla E, Donders GGG. Features of syphilis seropositive pregnant women raising alarms in Hungary, 2013-2016. Eur J Obstet Gynecol Reprod Biol 2018; 228:274-278. [PMID: 30053759 DOI: 10.1016/j.ejogrb.2018.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The incidence of syphilis has been on the rise in Hungary over the last decades. We aimed to assess the syphilis seroprevalence in pregnant women during 2013-2016. The secondary aims were to describe seropositivity by age and gestational age, to estimate infectivity rates in different age groups, and to compare the efficacy of mandatory prenatal screening versus individual venereological testing in revealing syphilis. STUDY DESIGN During the above mentioned period the reactive serum samples (N = 527) of 49,965 pregnant women undergoing routine screening were submitted for syphilis verification to the Bacterial STI Reference Laboratory, National Center for Epidemiology, Budapest, Hungary. The confirmation process included titrated RPR and TPHA tests performed simultaneously. The tested women were considered seronegative if both tests gave negative results. When any of these tests proved indeterminate or positive, anti-Treponema pallidum IgG and IgM ELISA tests were performed. Patients confirmed for the presence for specific IgG were judged seropositive. Further evaluation of potential infectivity of seropositive patients was carried out on RPR reactivity. RESULTS Syphilis seropositivity was detected in overall 2.9‰ (N = 148) of the cases. RPR-negative cases, i.e. past infections were confirmed in 36% (53/148); weak-reactive RPR (titres≤8) cases, i. e. past/early acute infections in 37% (55/148); strong-reactive RPR (titres>8) cases suggesting recent syphilis in 27% (40/148). Half of the infectious syphilis cases (20/40) belonged to the 15-24 age group. The gestational age at screening was available of 123 seropositive women, out of whom 27 (22%) were diagnosed late, in the third trimester. Nineteen (13%) out of all seropositives were detected via individual venereological testing before/instead of general prenatal screening. CONCLUSIONS The majority of infected pregnants may remain undetected due to the lack of mandatory general prenatal screening. The seropositivity for syphilis in pregnancy of 2.9/1000, of which one quarter were recent and infectious, the late diagnosis of syphilis in one in five, and the low pick-up rate of individualised instead of generalized screening are alarming signals and call for more effective prevention strategies, focusing on the most vulnerable adolescents, as well as on the first trimester of pregnancy.
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Affiliation(s)
- Eszter Balla
- Department of Bacteriology II., National Public Health Institute (former National Center for Epidemiology), Budapest, Hungary.
| | - Gilbert G G Donders
- Femicare Clinical Research for Women, Tienen, Belgium; Department of Obstetrics and Gynaecology, University Hospital Antwerp, Edegem, Belgium
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Fredrickson JS, Holmes J, Cathcart JN, Lynch AM, Kolfenbach JR, Palestine AG. Specialty management differences of syphilis and toxoplasmosis surrounding pregnancy: a prospective cross-sectional study. J Ophthalmic Inflamm Infect 2018; 8:10. [PMID: 29971681 PMCID: PMC6029981 DOI: 10.1186/s12348-018-0152-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/11/2018] [Indexed: 11/27/2022] Open
Abstract
Background Syphilis and toxoplasmosis are two infectious conditions that can occur during pregnancy. Both these diseases can have ocular manifestations and thus are treated by ophthalmologists and obstetricians. We hypothesized that specialty training would affect the way physicians selected therapy. Results A total of 209 uveitis specialists and approximately 2500 obstetricians across the USA were surveyed using an online questionnaire distributed via listserv and social media posts. Survey respondents were given a series of clinical vignettes containing case examples of a female patient who was either contemplating pregnancy or in the first trimester and was diagnosed with either syphilis or toxoplasmosis. The questionnaire included a total of four case scenarios with questions relating to the management of these diseases, as well as pregnancy counseling. For the syphilis vignette, a total of 97 physicians responded to the survey questions. Choices of therapy between physician specialty differed significantly (p = 0.0001); however, pregnancy status did not seem to affect therapy choice in syphilis. A total of 96 physicians responded to the survey questions pertaining to the toxoplasmosis vignette. For a non-pregnant patient diagnosed with toxoplasmosis, the differences in therapy choice between specialties were not significant; however, when the patient was pregnant, therapy choice was significantly different between specialties (p = 0.0001). Conclusions Differences exist between ophthalmologists and obstetricians concerning the therapy for syphilis and toxoplasmosis during pregnancy. Inter-specialty collaboration is needed to develop consistent criteria to improve the management of these patients.
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Affiliation(s)
- Jared S Fredrickson
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, Mail Stop F731, Aurora, CO, 80045, USA
| | - Jennifer Holmes
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 1635 Aurora Court, 3rd Floor, Aurora, CO, 80045, USA
| | - Jennifer N Cathcart
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, Mail Stop F731, Aurora, CO, 80045, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, Mail Stop F731, Aurora, CO, 80045, USA
| | - Jason R Kolfenbach
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, 1775 Aurora Court, Mail Stop B115, Aurora, CO, 80045, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, Mail Stop F731, Aurora, CO, 80045, USA.
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Uptake of Home-Based Syphilis and Human Immunodeficiency Virus Testing Among Male Partners of Pregnant Women in Western Kenya. Sex Transm Dis 2018; 44:533-538. [PMID: 28809770 DOI: 10.1097/olq.0000000000000649] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few men are tested for syphilis or human immunodeficiency virus (HIV) during their partner's pregnancy, a high-risk period for HIV and syphilis transmission. Offering home-based rapid testing of syphilis to couples during pregnancy can support prevention efforts to reduce transmission of sexually transmitted diseases and adverse pregnancy outcomes. METHODS We assessed men's uptake of paired (separate tests, single blood draw) point-of-care syphilis and HIV tests within a randomized controlled trial of pregnant women who received clinic or home partner HIV testing. We evaluated acceptance of paired HIV-syphilis testing during pregnancy or at 6 months postpartum, and evaluated whether addition of syphilis testing affected the uptake of HIV testing among men. RESULTS Of 601 women, we were unable to meet 101 male partners, and 180 tested before syphilis tests were available. Paired syphilis and HIV testing was offered at home to 80 men during pregnancy and to 230 men postpartum. For syphilis, 93% of men agreed to test during pregnancy and 98% agreed postpartum. For paired syphilis and HIV testing, 91% of men tested for both during pregnancy and 96% tested postpartum. Before syphilis test introduction, 96% of men accepted HIV testing, compared with 95% of men who accepted HIV testing when paired testing was offered. CONCLUSIONS Uptake of syphilis and HIV testing was high among male partners offered couple testing at home. Introducing syphilis testing did not adversely affect HIV testing among men. Point-of-care diagnostics outside facilities can increase testing of male partners who rarely accompany women to antenatal clinics.
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[Educating health workers is key in congenital syphilis elimination in Colombia]. BIOMEDICA 2017; 37:416-424. [PMID: 28968019 DOI: 10.7705/biomedica.v37i3.3397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/21/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Colombia promotes the diagnosis and treatment of gestational syphilis in a single visit using rapid diagnostic tests to prevent mother-to-child transmission. Additionally, integrated health programs pursue the coordinated prevention of mother-to-child transmission of syphilis/HIV. OBJECTIVE To identify knowledge gaps among health workers in the prevention of mother-to-child transmission of syphilis/HIV and to provide recommendations to support these programs. MATERIALS AND METHODS We conducted a descriptive study based on 306 surveys of health workers in 39 health institutions in the city of Cali. Surveys inquired about planning, management and implementation of services for pregnant women, clinical knowledge of HIV/syphilis rapid diagnostic tests, and prior training. RESULTS Knowledge deficits in the management of gestational syphilis were detected among the surveyed health workers, including physicians. Rapid tests for syphilis are currently used in clinical laboratories in Cali, however, procedural deficiencies were observed in their use, including quality control assurance. During the two years prior to the survey, training of health workers in the prevention of mother-to-child transmission of syphilis/HIV had been limited. Health workers are interested in identifying and treating gestational syphilis in a single event, in using rapid diagnostic tests and in receiving training. CONCLUSIONS Intensive training targeting health workers, policy/decision makers and academic groups is needed to ensure adequate implementation of new strategies for the prevention of mother-to-child transmission of syphilis/HIV.
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Introducing onsite antenatal syphilis screening in Burkina Faso: implementation and evaluation of a feasibility intervention tailored to a local context. BMC Health Serv Res 2017; 17:378. [PMID: 28558812 PMCID: PMC5450306 DOI: 10.1186/s12913-017-2325-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice. METHODS In Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources. RESULTS An intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators included political environment, ease of use of test and acceptability to pregnant women. CONCLUSIONS Onsite testing for antenatal syphilis is a feasible and acceptable intervention in ANC at primary health facility in Burkina Faso. The point-of care test for syphilis is more likely to be acceptable by health workers as routine service and incorporated as a normal practice. TRIAL REGISTRATION The study was retrospectively registered on ClinicalTrials.gov under the Trial Registration Number NCT03156751 .
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Miranda AE, Saraceni V, Pereira GFM, da Silveira MF, Araujo MAL. Vigilância epidemiológica da transmissão vertical da sífilis: dados de seis unidades federativas no Brasil. Rev Panam Salud Publica 2017. [PMID: 28614467 PMCID: PMC6612729 DOI: 10.26633/rpsp.2017.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Descrever o perfil epidemiológico dos casos notificados de sífilis em gestantes e sífilis congênita nos estados brasileiros do Amazonas, Ceará, Espírito Santo, Rio de Janeiro e Rio Grande do Sul e no Distrito Federal a partir de dados do Sistema Nacional de Agravos de Notificação (SINAN).
Métodos. Estudo descritivo incluindo avaliação ecológica e transversal. Foram utilizados dados do SINAN Net. Foram calculadas a taxa de detecção de sífilis em gestantes e a taxa de incidência de sífilis congênita por 1 000 nascidos vivos. Para identificar as gestantes notificadas com sífilis com desfecho de sífilis congênita, as duas bases do SINAN foram relacionadas por meio do software RecLink. Como os dados eram de representatividade regional, as comparações foram feitas entre as unidades da federação, e não com a soma dos casos.
Resultados A taxa de detecção de sífilis em gestantes cresceu entre 21% (Amazonas) e 75% (Rio de Janeiro). A incidência de sífilis congênita seguiu o mesmo perfil de incremento, variando de 35,6% no Distrito Federal a 639,9% no Rio Grande do Sul, com redução de 0,7% no Amazonas. A realização de pré-natal nas mulheres com desfecho de sífilis congênita variou de 67,3% no Amazonas a 83,3% no Distrito Federal. Das gestantes com sífilis, 43% tiveram desfecho notificado de sífilis congênita. Nas gestantes com sífilis e desfecho de sífilis congênita, o diagnóstico materno ocorreu durante o pré-natal em 74% e no parto em 18%. Em 8% das mulheres ignorava-se o momento do diagnóstico.
Conclusão. O incremento nas taxas de detecção de sífilis pode ter resultado do aumento na notificação. O monitoramento constante em gestantes é essencial para a eliminação desses agravos.
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Affiliation(s)
- Angelica Espinosa Miranda
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Saúde Coletiva, Vitória (ES), Brasil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Superintendência de Vigilância em Saúde, Rio de Janeiro (RJ), Brasil
| | | | | | - Maria Alix Leite Araujo
- Universidade de Fortaleza, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza (CE), Brasil
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Cardoso ARP, Araújo MAL, Andrade RFV, Saraceni V, Miranda AE, Dourado MIC. Underreporting of Congenital Syphilis as a Cause of Fetal and Infant Deaths in Northeastern Brazil. PLoS One 2016; 11:e0167255. [PMID: 27941983 PMCID: PMC5152812 DOI: 10.1371/journal.pone.0167255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/12/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Of all syphilis-related pregnancy outcomes, fetal death is certainly the most common one, being directly related to the availability, accessibility and quality of prenatal care. The present study aimed to analyze the underreporting of fetal and infant deaths and other maternal factors associated with congenital syphilis (CS) death. Methods This cross-sectional study integrated data of infants that were diagnosed and/or died of CS from the Sistema de Informação de Agravos de Notificação–Sinan (Notifiable Diseases Information System) and the Sistema de Informação de Mortalidade–SIM (Mortality Information System) in Fortaleza, Northeastern Brasil to identify unreported cases of congenital syphilis. We assessed data during the period from 2007 to 2013. Results The underreporting of CS as a cause of fetal or infant death increased from 41 to 415 cases (90.1%) during 2007–2013. Exactly 3,209 cases of CS were identified in Sinan and 6,578 deaths in SIM. After database linkage, we identified 382 cases that were reported in the SIM and SINAN databases consisting of 309 fetal deaths and 73 infant deaths related to CS. From the children notified at Sinan that born alive, 3.0% (78/2,542) died; Out of these, 39 (50.0%) were early and 25 (32.1%) were late neonatal deaths. The proportion of death by CS increased from 0.62 to 5.8 from 2007 to 2013. At logistic regression, the variable that maintained statistical significance with fetal and infant death outcomes was the presence of CS signs and/or symptoms at birth (OR = 3.20; IC 95% 1.54–6.62; p = 0.002). Conclusions Neonatal and Infant deaths following CS-associated live births are underreported in Northeastern Brazil. Data base linkage identified unreported fetal and neonatal deaths due to CS leading to an increased awareness of fetal/infant mortality due to this infection.
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Affiliation(s)
- Ana Rita Paulo Cardoso
- Collective Health Post Graduation Program. University of Fortaleza, Fortaleza, Brazil
- * E-mail:
| | | | | | - Valéria Saraceni
- Rio de Janeiro Municipal Secretary of Health, Rio de Janeiro, Brazil
| | - Angelica E. Miranda
- Department of Social Medicine. Federal University of Espírito Santo, Vitória, Brazil
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Dallé J, Baumgarten VZ, Ramos MC, Jimenez MF, Acosta L, Bumaguin DB, Antonello VS. Maternal syphilis and accomplishing sexual partner treatment: still a huge gap. Int J STD AIDS 2016; 28:876-880. [PMID: 27810981 DOI: 10.1177/0956462416678710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study - which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data - evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007-2008 to 87.5% in 2013-2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.
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Affiliation(s)
- Jessica Dallé
- 1 Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.,2 Post-graduate Program in Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Z Baumgarten
- 3 Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil
| | | | - Mirela F Jimenez
- 2 Post-graduate Program in Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,3 Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil.,5 Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Lisiane Acosta
- 6 Surveillance Health Department of Porto Alegre, Brazil
| | - Daniela B Bumaguin
- 7 Statistics Advisory Center, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicente S Antonello
- 1 Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.,4 Department of STDs and AIDS, Porto Alegre, Brazil
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28
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Bristow CC, Larson E, Anderson LJ, Klausner JD. Cost-effectiveness of HIV and syphilis antenatal screening: a modelling study. Sex Transm Infect 2016; 92:340-6. [PMID: 26920867 PMCID: PMC4956558 DOI: 10.1136/sextrans-2015-052367] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/23/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The WHO called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonised approach for the improvement of health outcomes for mothers and children. Testing early in pregnancy, treating seropositive pregnant women and preventing syphilis reinfection can prevent MTCT of HIV and syphilis. We assessed the health and economic outcomes of a dual testing strategy in a simulated cohort of 100 000 antenatal care patients in Malawi. METHODS We compared four screening algorithms: (1) HIV rapid test only, (2) dual HIV and syphilis rapid tests, (3) single rapid tests for HIV and syphilis and (4) HIV rapid and syphilis laboratory tests. We calculated the expected number of adverse pregnancy outcomes, the expected costs and the expected newborn disability-adjusted life years (DALYs) for each screening algorithm. The estimated costs and DALYs for each screening algorithm were assessed from a societal perspective using Markov progression models. Additionally, we conducted a Monte Carlo multiway sensitivity analysis, allowing for ranges of inputs. RESULTS Our cohort decision model predicted the lowest number of adverse pregnancy outcomes in the dual HIV and syphilis rapid test strategy. Additionally, from the societal perspective, the costs of prevention and care using a dual HIV and syphilis rapid testing strategy was both the least costly ($226.92 per pregnancy) and resulted in the fewest DALYs (116 639) per 100 000 pregnancies. In the Monte Carlo simulation the dual HIV and syphilis algorithm was always cost saving and almost always reduced DALYs compared with HIV testing alone. CONCLUSIONS The results of the cost-effectiveness analysis showed that a dual HIV and syphilis test was cost saving compared with all other screening strategies. Updating existing prevention of mother-to-child HIV transmission programmes in Malawi and similar countries to include dual rapid testing for HIV and syphilis is likely to be advantageous.
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Affiliation(s)
- Claire C. Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA 92093 USA
| | - Elysia Larson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Laura J. Anderson
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 640 Charles E Young Dr S, Los Angeles, CA 90024 USA
| | - Jeffrey D. Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 640 Charles E Young Dr S, Los Angeles, CA 90024 USA
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
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29
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Madrid L, Varo R, Sitoe A, Bassat Q. Congenital and perinatally-acquired infections in resource-constrained settings. Expert Rev Anti Infect Ther 2016; 14:845-61. [PMID: 27442227 DOI: 10.1080/14787210.2016.1215913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Congenital and perinatal infections are a leading cause of neonatal and infant morbidity and mortality. Maternal screening, vaccines or treatment where available, constitute effective prevention strategies to reduce the burden of these diseases. Data on the burden of congenital and perinatal infections are very limited for low and middle-income regions. AREAS COVERED This review aims to summarize the burden of congenital and perinatal infections and the main challenges for their control in resource-limited settings. Articles were identified through the main electronic databases and cover the period 1971-2016. Expert commentary: Estimates from low and middle-income countries indicate that the burden of congenital infections may be higher in these regions than in industrialized countries. As preventive and curative strategies are available to tackle some of these infections, efforts at the international and national levels must be made to implement those and thus reduce their burden in resource-limited countries.
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Affiliation(s)
- Lola Madrid
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - Rosauro Varo
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - Antonio Sitoe
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique
| | - Quique Bassat
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
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30
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Lago EG. Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis. Cureus 2016; 8:e525. [PMID: 27081586 PMCID: PMC4829408 DOI: 10.7759/cureus.525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/09/2016] [Indexed: 12/21/2022] Open
Abstract
This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy.
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Affiliation(s)
- Eleonor G Lago
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS ; Edipucrs University Publisher, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS
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31
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Rapid Syphilis Testing Is Cost-Effective Even in Low-Prevalence Settings: The CISNE-PERU Experience. PLoS One 2016; 11:e0149568. [PMID: 26949941 PMCID: PMC4780822 DOI: 10.1371/journal.pone.0149568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
Studies have addressed cost-effectiveness of syphilis testing of pregnant women in high-prevalence settings. This study compares costs of rapid syphilis testing (RST) with laboratory-based rapid plasma reagin (RPR) tests in low-prevalence settings in Peru. The RST was introduced in a tertiary-level maternity hospital and in the Ventanilla Network of primary health centers, where syphilis prevalence is approximately 1%. The costs per woman tested and treated with RST at the hospital were $2.70 and $369 respectively compared with $3.60 and $740 for RPR. For the Ventanilla Network the costs per woman tested and treated with RST were $3.19 and $295 respectively compared with $5.55 and $1454 for RPR. The cost per DALY averted using RST was $46 vs. $109 for RPR. RST showed lower costs compared to the WHO standard costs per DALY ($64). Findings suggest syphilis screening with RST is cost-effective in low-prevalence settings.
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32
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Ballah NJ, Kuonza LR, De Gita G, Musekiwa A, Williams S, Takuva S. Decline in syphilis seroprevalence among females of reproductive age in Northern Cape Province, South Africa, 2003-2012: utility of laboratory-based information. Int J STD AIDS 2016; 28:564-572. [PMID: 26924504 DOI: 10.1177/0956462416636727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Strengthening current surveillance systems for syphilis is important to track and monitor disease burden. We used routinely collected laboratory information to generate surveillance estimates for syphilis trends among women of reproductive age (12-49 years) in the Northern Cape Province, a high syphilis burden region (2003 [8.6%] to 2011 [3.8%]) in South Africa. We extracted records meeting inclusion criteria from the National Health Laboratory Service electronic database for the period 2003-2012. A total of 286,024 women were included in the analysis. Syphilis seropositivity decreased between 2003 (5.7%) and 2012 (1.8%); p trend = 0.001, which was largely consistent with findings reported in the annual national syphilis and HIV survey from 2003 (8.6%) to 2011 (3.8%). Annually for the period from 2003 to 2012 there was an approximate 14% reduction in the prevalence ratio of syphilis seroprevalence (PR = 0.86, 95% CI = 0.85-0.87, p < 0.001). Three of five districts had significant decreases in syphilis seropositivity over this period. There were also declines in prevalence ratios for syphilis seropositivity for the various age groups for the period. This study shows that the national laboratory database in South Africa can be used as a complimentary surveillance tool to describe and understand trends in syphilis seroprevalence in South Africa.
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Affiliation(s)
- Ngormbu J Ballah
- 1 South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, National Health Laboratory Service, South Africa
- 2 Centre for HIV and STI, National Institute for Communicable Diseases, National Health Laboratory Service, South Africa
- 3 Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, South Africa
| | - Lazarus R Kuonza
- 1 South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, National Health Laboratory Service, South Africa
- 3 Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, South Africa
| | - Gloria De Gita
- 2 Centre for HIV and STI, National Institute for Communicable Diseases, National Health Laboratory Service, South Africa
| | - Alfred Musekiwa
- 4 US Centers for Disease Control and Prevention, Global Disease Detection Program, Pretoria, South Africa
| | - Seymour Williams
- 4 US Centers for Disease Control and Prevention, Global Disease Detection Program, Pretoria, South Africa
- 5 Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Simbarashe Takuva
- 2 Centre for HIV and STI, National Institute for Communicable Diseases, National Health Laboratory Service, South Africa
- 6 Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Kashyap B, Sagar T, Kaur IR. Utility of immunochromatographic assay as a rapid point of care test for screening of antenatal syphilis. Indian J Sex Transm Dis AIDS 2015; 36:162-5. [PMID: 26692609 DOI: 10.4103/0253-7184.167159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. MATERIALS AND METHODS Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL), Treponema pallidum hemagglutination assay (TPHA) and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. RESULTS The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. CONCLUSIONS Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.
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Affiliation(s)
- Bineeta Kashyap
- Deparment of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Tanu Sagar
- Deparment of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Iqbal R Kaur
- Deparment of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Kang SH, Lee JH, Choi SH, Lee J, Yoon HS, Cha SH, Choi YS. Recent change in congenital syphilis in Korea: Retrospective 10 year study. Pediatr Int 2015; 57:1112-5. [PMID: 25916174 DOI: 10.1111/ped.12663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 03/02/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to evaluate recent clinical and anthropologic features of neonates with reactive serology for syphilis and their mothers from three institutions in Korea over an 11-year-period. METHOD The medical records of 20 neonates with reactive serology for syphilis and their mothers at three centers (Kyung Hee University Hospital, Kyung Hee University Hospital at Gangdong, and Korea Electric Power Corporation Hospital) seen between January 2000 and December 2010 were reviewed retrospectively. RESULTS Among 20 mothers, 16 (80%) were native Korean and four (20%) were foreign-born immigrants. Two mothers (10%) were unmarried. The annual distribution of cases was three (15%) in 2000, one each (5%) in 2005 and 2006, respectively, two each (10%) in 2007 and 2008, respectively, six (30%) in 2009, and five (25%) in 2010. Just over half (55%) occurred across 2009 and 2010. All neonates, by definition, were diagnosed with presumptive congenital syphilis (CS). Among the neonates, four had positive cerebrospinal fluid venereal disease research laboratory test, and three exhibited symptoms and signs. CONCLUSIONS In three centers in Seoul, Korea, the observed number of CS cases was higher in 2009 and 2010 than in previous years. This finding is consistent with a trend toward increasing prevalence of international marriage and suggests that more meticulous screening of CS is needed.
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Affiliation(s)
- Sung-Han Kang
- Department of Pediatrics, Chungju Medical Center, Chungju
| | - Ji-Hyun Lee
- Department of Pediatrics, Kyung Hee University School of Medicine
| | - Sun-Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine
| | - Jin Lee
- Department of Pediatrics, Korea Electric Power Corporation (KEPCO) Hospital, Seoul, Korea
| | - Hoi Soo Yoon
- Department of Pediatrics, Kyung Hee University School of Medicine
| | - Sung-Ho Cha
- Department of Pediatrics, Kyung Hee University School of Medicine
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine
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Bonawitz RE, Duncan J, Hammond E, Hamomba L, Nambule J, Sambambi K, Musonda V, Calise A, Knapp A, Mwale J, McCauley J, Thea D, Herlihy JM. Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia. Int J Gynaecol Obstet 2015; 130 Suppl 1:S58-62. [PMID: 25968492 PMCID: PMC8991823 DOI: 10.1016/j.ijgo.2015.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. METHODS In March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6months prior to RST introduction), midline (0-6 months after RST introduction), and endline (7-12 months after RST introduction). RESULTS Data collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P<0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P=0.199) RST introduction with low treatment rates throughout. CONCLUSION With RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis.
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Affiliation(s)
- Rachael E Bonawitz
- Center for Global Health and Development, Boston University, Boston, MA, USA; Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Julie Duncan
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Emily Hammond
- Center for Global Health and Development, Boston University, Boston, MA, USA
| | - Leoda Hamomba
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Jane Nambule
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Kennedy Sambambi
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Victor Musonda
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Alana Calise
- Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anna Knapp
- Center for Global Health and Development, Boston University, Boston, MA, USA
| | - Jonas Mwale
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - James McCauley
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Donald Thea
- Center for Global Health and Development, Boston University, Boston, MA, USA; Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Julie M Herlihy
- Center for Global Health and Development, Boston University, Boston, MA, USA; Department of Pediatrics, Boston Medical Center, Boston, MA, USA; Global Health, Boston University School of Public Health, Boston, MA, USA
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Yin YP, Ngige E, Anyaike C, Ijaodola G, Oyelade TA, Vaz RG, Newman LM, Chen XS. Laboratory evaluation of three dual rapid diagnostic tests for HIV and syphilis in China and Nigeria. Int J Gynaecol Obstet 2015; 130 Suppl 1:S22-6. [PMID: 25975869 DOI: 10.1016/j.ijgo.2015.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the laboratory-based performance and operational characteristics of three dual rapid diagnostic tests (RDTs) for testing HIV and syphilis. METHODS Three dual RDTs (SD Bioline, Chembio, and MedMira) were evaluated using 1514 serum specimens archived at laboratories or collected from clinics in China and Nigeria to determine sensitivity and specificity, with 95% confidence intervals. Concordance of testing results read by two technicians, stability of testing results read at two time points, and test operation characteristics were also assessed. RESULTS All three of the evaluated RDTs gave excellent performance with a combined sensitivity ranging from 99.0%-99.6% for HIV and 98.3%-99.0% for syphilis, and a combined specificity ranging from 97.9%-99.0% for HIV and 97.2%-99.6% for syphilis. Concordance of testing results between two technicians and stability of testing results read within and one hour past the recommended reading period showed excellent agreement, with Kappa greater than or equal to 0.98. CONCLUSIONS All the tests were found to be very or fairly easy to use and easy to interpret the results. Further evaluations of these dual RDTs with whole blood in field settings, and more studies on the implication of introduction of these tests in HIV and syphilis control programs are needed.
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Affiliation(s)
- Yue-Ping Yin
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Evelyn Ngige
- National AIDS and STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Chukwuma Anyaike
- National AIDS and STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Gbenga Ijaodola
- National AIDS and STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Xiang-Sheng Chen
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
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Shimelis T, Tadesse E. The diagnostic performance evaluation of the SD BIOLINE HIV/syphilis Duo rapid test in southern Ethiopia: a cross-sectional study. BMJ Open 2015; 5:e007371. [PMID: 25908677 PMCID: PMC4410125 DOI: 10.1136/bmjopen-2014-007371] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the diagnostic performance of the SD BIOLINE HIV/syphilis Duo rapid test. DESIGN A hospital-based cross-sectional study. SETTING This evaluation was conducted at one of the largest hospitals in southern Ethiopia. PARTICIPANTS Serum samples obtained from clients attending the antiretroviral therapy and voluntary counselling and testing centres were used. Sera were originally collected for the purpose of investigating syphilis epidemiology. The performance of the test to detect HIV was evaluated using 400 sera (200 HIV positives and 200 HIV negatives). Also, its performance to detect syphilis was evaluated using 85 syphilis positive and 100 syphilis negative serum samples. Individuals <15 years of age or syphilis treated or those with ≤50 cells/µL CD4 cell count were originally excluded. OUTCOME MEASURES HIV screening was carried out according to the national rapid diagnostic testing (RDT) algorithm: Shenghai Kehua Bioengineering (KHB) test kit as a screening test, followed by the HIV1/2 STAT-PAK assay if positive. Where the result of the STAT-PAK is discordant with KHB, Unigold HIV is used as a tiebreaker to determine the result. We also used ELISA to resolve discordant HIV results. Syphilis serostatus was determined using the Treponema pallidum haemagglutination assay (TPHA). RESULTS The respective sensitivity, specificity, positive predictive value and negative predictive value of the SD BIOLINE HIV/syphilis Duo test were 100, 99.5, 99.5 and 100% for HIV and 97.6, 96, 95.4 and 98% for syphilis testing, respectively. In reference to TPHA, the test kit reported 4 false positives and 2 false negative results for syphilis. The κ values were 0.99 for HIV testing and 0.94 for syphilis testing. CONCLUSIONS The excellent performance of the SD BIOLINE HIV/syphilis Duo test to detect HIV as well as syphilis facilitates the integration of syphilis testing and treatment to the already established HIV prevention programme, ultimately contributing to the dual HIV and syphilis elimination goal.
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Affiliation(s)
- Techalew Shimelis
- Department of Medical Laboratory Science, Hawassa University, Hawassa, Ethiopia
| | - Endale Tadesse
- Department of Medical Laboratory Science, Hawassa University, Hawassa, Ethiopia
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Shimelis T, Lemma K, Ambachew H, Tadesse E. Syphilis among people with HIV infection in southern Ethiopia: sero-prevalence and risk factors. BMC Infect Dis 2015; 15:189. [PMID: 25884178 PMCID: PMC4406018 DOI: 10.1186/s12879-015-0919-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022] Open
Abstract
Background Syphilis facilitates both HIV (human immunodeficiency virus) transmission and acquisition, reflecting the complex interplay between the two infections. Scarce information exists regarding syphilis epidemiology in Ethiopian context. Thus, this study determined the sero-prevalence of syphilis and associated risk factors in people with HIV infection. Methods A cross-sectional study was conducted at Hawassa Referral Hospital, southern Ethiopia from January to May, 2014. A consecutive 993 HIV–infected participants were studied; but individuals under 15 years of age or treated for syphilis or those with a CD4+ T–cell count below 50 cells/μl were excluded. Structured questionnaires were used to collect data on socio-demography and potential risk factors for syphilis. Moreover, blood samples were collected from all participants and screened for syphilis using rapid plasma reagin (RPR) test, and those found sero-positive were confirmed using treponema pallidum haemagglutination assay (TPHA). Results The sero-prevalence of syphilis was found to be 7.3% (95% CI 5.7– 9%). The rate of infection was significantly higher among participants who were ART (antiretroviral therapy) naive (odds ratio (OR) = 2.2; 95% CI 1.22 – 4.1), men (OR = 2.2; 95% CI 1.22 – 3.87), older than 50 years of age (OR = 3.9; 95% CI 1.45 – 6.94), had only primary school level education (OR = 7.8; 95% CI 2.63 – 23.2) and had a history of blood transfusion (OR = 3.9; 95% CI 1.5 – 10.4). Conclusion The high prevalence of syphilis among HIV-infected population warrants integrating syphilis screening with HIV care to limit the clinical consequences of untreated syphilis as well as its adverse impact on HIV transmission.
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Affiliation(s)
- Techalew Shimelis
- Department of Medical Laboratory Science, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Kinfe Lemma
- Department of Internal Medicine, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Henock Ambachew
- Department of Medical Laboratory Science, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Endale Tadesse
- Department of Medical Laboratory Science, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
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Causer LM, Kaldor JM, Conway DP, Leslie DE, Denham I, Karapanagiotidis T, Ryan C, Wand H, Anderson DA, Robertson PW, McNulty AM, Donovan B, Fairley CK, Guy RJ. An evaluation of a novel dual treponemal/nontreponemal point-of-care test for syphilis as a tool to distinguish active from past treated infection. Clin Infect Dis 2015; 61:184-91. [PMID: 25810288 DOI: 10.1093/cid/civ243] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/14/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most syphilis point-of-care (POC) tests detect treponemal antibodies, which persist after successful treatment. Subsequent POC tests are positive, despite no active infection, and can lead to unnecessary treatment. We evaluated a new POC test, incorporating a nontreponemal component, to distinguish active from past infection. METHODS Sera stored at 2 Australian laboratories were tested with DPP Screen and Confirm Assay. Treponemal and nontreponemal test lines were compared to corresponding conventional treponemal and nontreponemal reference test results: immunoassays and rapid plasma reagin (RPR), respectively, with RPR quantification by endpoint titration. POC test outcome concordance with conventional test results was assessed according to serological and clinical categories. RESULTS Among 1005 serum samples tested, DPP treponemal line sensitivity was 89.8% (95% confidence interval [CI], 87.3%-91.9%) and specificity was 99.3% (95% CI, 97.0%-99.9%). DPP nontreponemal line sensitivity was 94.2% (95% CI, 91.8%-96.0%) and specificity was 62.2% (95% CI, 57.5%-66.6%). DPP test outcome (pair of test lines) was concordant with both reference test results for 94.3% of 404 high-titer infections, 90.1% of 121 low-titer infections, 27.5% of 211 past/treated infections, and 78.1% of 242 infections classified as not syphilis. Among 211 past/treated infections, 49.8% were incorrectly identified as active infection and a further 22.8% as not syphilis. CONCLUSIONS DPP test use would result in identification of >93% of active syphilis infections, whereas just over half of past infections would be diagnosed as past or not syphilis, avoiding unnecessary treatment compared with other POC tests. This may be at the expense of missing some active infections; thus, its potential benefits will depend on the prevalence of past vs active infection in a population.
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Affiliation(s)
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney
| | | | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, Melbourne
| | | | | | | | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney
| | | | | | | | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney
| | | | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney
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Punguyire D, Mahama E, Letsa T, Akweongo P, Sarfo B. Factors associated with syphilis screening uptake among pregnant women in health facilities in Brong Ahafo Region of Ghana. Matern Health Neonatol Perinatol 2015; 1:7. [PMID: 27057324 PMCID: PMC4823680 DOI: 10.1186/s40748-015-0009-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Congenital syphilis is a consequence of undiagnosed, untreated, or inadequately treated maternal syphilis and results in serious adverse outcomes. It is easily diagnosed and in Ghana it is treated at points of care free; yet most pregnant women attending antenatal clinic (ANC) in Ghana are not screened. This study identified some factors influencing syphilis screening uptake at medical facilities during pregnancy in the Brong Ahafo Region of Ghana. Method A cross-sectional study was conducted in two districts in Brong Ahafo Region of Ghana. All the health facilities in the selected districts that run antenatal services were assessed on their preparedness to screen syphilis for pregnant women. Interviews were conducted among 390 pregnant women attending ANC at five hospitals in the two districts to identify individual and community level barriers to syphilis screening. Results In all 37 health facilities conducted antennal clinics in the two districts in 2013, 75.7% of the health facilities were public; Techiman had the higher number of health facilities (64.9%), test kits were available in only 29.7% of the health facilities and 43.2% of 37 health facilities were conducting syphilis screening. Majority of the pregnant women (57.7%) were within the age range of 20–29 years, 53.1% were in their third trimester, 32.6% in second trimester and 14.3% were in the first trimester. Syphilis screening was 52.4% among 37 health facilities. Among 390 pregnant women who participated in the study syphilis screening was 21.1%. At the health facility level, screening was significantly associated with the type of hospital (whether private or public), availability of test kits, and trained personnel, such as doctors/midwives and syphilis education. At the individual level, attending a public hospital (OR=5.49; 95% CI=1.71-17.65), willingness to request screening (OR=2.72; 95% CI=1.09-5.88), and being in the third trimester of pregnancy (OR=16.47; 95% CI=2.02-132.81) were significantly associated with syphilis screening uptake. Conclusion Despite government’s free screening policy for syphilis among pregnant women, the coverage of antenatal screening is still low. Training of lower level health workers and regular supply of logistics are crucial for the success of the syphilis prevention programme.
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Affiliation(s)
- Damien Punguyire
- Department of Epidemiology and Disease Control, Municipal Health Directorate, Techiman, University of Ghana, Legon, Ghana ; Department of Epidemiology and Disease, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Emmanuel Mahama
- Department of Epidemiology and Disease, Kintampo Health Research Center, University of Ghana, Legon, Ghana
| | - Timothy Letsa
- Department of Epidemiology and Disease, Regional Health Directorate, Brong Ahafo Region, University of Ghana, Legon, Ghana
| | - Patricia Akweongo
- Department of Epidemiology and Disease, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bismark Sarfo
- Department of Epidemiology and Disease, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
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Bristow CC, Larson E, Javanbakht M, Huang E, Causer L, Klausner JD. A review of recent advances in rapid point-of-care tests for syphilis. Sex Health 2015; 12:119-25. [PMID: 25622292 DOI: 10.1071/sh14166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022]
Abstract
Syphilis is a curable disease, yet over 10million people worldwide are infected with syphilis each year. Syphilis case finding and subsequent treatment are key steps in syphilis control and prevention efforts. The advent of rapid point-of-care tests - which require minimal equipment, are easy to perform and are relatively low cost - have the potential to improve syphilis control by allowing for more widespread testing in clinical and non-clinical settings. However, strategies to maximise the potential public health impact of those tests are needed, and those include regulatory oversight, effective supply-chain management and quality assurance systems.
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Affiliation(s)
- Claire C Bristow
- Fielding School of Public Health, University of California Los Angeles, 640 Charles E Young Drive South, Los Angeles, CA 90024, USA
| | - Elysia Larson
- Harvard School of Public Health, 677 Huntington Avenue, Cambridge, Boston, MA 02115, USA
| | - Marjan Javanbakht
- Fielding School of Public Health, University of California Los Angeles, 640 Charles E Young Drive South, Los Angeles, CA 90024, USA
| | - Emily Huang
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Louise Causer
- The Kirby Institute, Wallace Wurth Building, UNSW Australia,Sydney, NSW 2052, Australia
| | - Jeffrey D Klausner
- Fielding School of Public Health, University of California Los Angeles, 640 Charles E Young Drive South, Los Angeles, CA 90024, USA
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Kashyap B, Sagar T, Kaur IR. Utility of immunochromatographic assay as a rapid point of care test for screening of antenatal syphilis. Indian J Sex Transm Dis AIDS 2015. [PMID: 26692609 PMCID: PMC4660557 DOI: 10.4103/2589-0557.167159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. MATERIALS AND METHODS Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL), Treponema pallidum hemagglutination assay (TPHA) and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. RESULTS The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. CONCLUSIONS Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.
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Affiliation(s)
- Bineeta Kashyap
- Deparment of Microbiology, Maulana Azad Medical College, New Delhi, India,Address for correspondence: Dr. Bineeta Kashyap, Flat No: C-402, Vimal CGHS Ltd., Plot 3, Sector-12, Dwarka, New Delhi, India. E-mail:
| | - Tanu Sagar
- Deparment of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Iqbal R. Kaur
- Deparment of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Janier M, Hegyi V, Dupin N, Unemo M, Tiplica G, Potočnik M, French P, Patel R. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2014; 28:1581-93. [PMID: 25348878 DOI: 10.1111/jdv.12734] [Citation(s) in RCA: 254] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/04/2014] [Indexed: 12/30/2022]
Affiliation(s)
- M. Janier
- STD Clinic; Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph; Paris France
| | - V. Hegyi
- Department of Pediatric Dermatovenereology; Comenius University; Bratislava Slovak Republic
| | - N. Dupin
- Syphilis National Reference Center; Hôpital Tarnier-Cochin; AP-HP; Paris France
| | - M. Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections; Department of Laboratory Medicine; Microbiology; Örebro University Hospital; Örebro Sweden
| | - G.S. Tiplica
- 2nd Dermatological Clinic; Carol Davila University; Colentina Clinical Hospital; Bucharest Romania
| | - M. Potočnik
- Department of Dermatovenereology; University Medical Centre; Ljubljana Slovenia
| | - P. French
- Central and North West London NHS Trust and University College; London UK
| | - R. Patel
- Department of Genitourinary Medicine; the Royal South Hants Hospital; Southampton UK
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Qin J, Yang T, Xiao S, Tan H, Feng T, Fu H. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis. PLoS One 2014; 9:e102203. [PMID: 25025232 PMCID: PMC4099012 DOI: 10.1371/journal.pone.0102203] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/13/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To estimate probability of adverse pregnancy outcomes (APOs) among women with and without syphilis through a systematic review of published literatures. METHODOLOGY/PRINCIPAL FINDINGS Chinese and English literatures were searched for studies assessing pregnancy outcomes in the presence of maternal syphilis through August 2013. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-four literatures involving 11398 syphilitic women and 43342 non-syphilitic women were included from 4187 records initially found. Among untreated mothers with syphilis, pooled estimates were 76.8% for all APOs, 36.0% for congenital syphilis, 23.2% for preterm, 23.4% for low birth weight, 26.4% for stillbirth or fetal loss, 14.9% for miscarriage and 16.2% for neonatal deaths. Among syphilitic mother receiving treatment only in the late trimester (>28 weeks), pooled estimates were 64.4% for APOs, 40.6% for congenital syphilis, 17.6% for preterm, 12.4% for low birth weight, and 21.3% for stillbirth or fetal loss. Among syphilitic mothers with high titers (≥1∶8), pooled estimates were 42.8% for all APOs, 25.8% for congenital syphilis, 15.1% for preterm, 9.4% for low birth weight, 14.6% for stillbirth or fetal loss and 16.0% for neonatal deaths. Among non-syphilitic mothers, the pooled estimates were 13.7% for all APOs, 7.2% for preterm birth, 4.5% for low birth weight, 3.7% for stillbirth or fetal loss, 2.3% for miscarriage and 2.0% for neonatal death. Begg's rank correlation test indicated little evidence of publication bias (P>0.10). Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (I2 = 93.9%; P<0.0001) and women without syphilis (I2 = 94.8%; P<0.0001). CONCLUSIONS/SIGNIFICANCE Syphilis continues to be an important cause of substantial perinatal morbidity and mortality, which reminds that policy-makers charged with resource allocation that the elimination of mother-to-child transmission of syphilis is a public health priority.
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Affiliation(s)
- Jiabi Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine, School of Public Health, Central South University, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China
| | - Tiejian Feng
- Department of Dermatology and Venereal Disease, Shenzhen Center for Chronic Disease Control and Prevention, Shenzhen, China
| | - Hanlin Fu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China
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Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China. Eur J Clin Microbiol Infect Dis 2014; 33:2183-98. [PMID: 24973132 DOI: 10.1007/s10096-014-2186-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this investigation was to assess the effectiveness of an intervention program on mother-to-child transmission (MTCT) of syphilis and investigate determinants of congenital syphilis (CS) and adverse pregnancy outcomes (APOs). The Shenzhen local government initiated an intervention program of MTCT of syphilis in 2001. Based on this program, maternal and paternal factors associated with CS and APOs among syphilitic women were investigated from 2007 to 2012 by a prospective cohort study. From 2002 to 2012, 2,441,237 pregnant women were screened and screening coverage reached 97.2 % in 2012. In the background of continuing growth of CS in China, CS in Shenzhen significantly decreased from 109.3 cases in 2002 to 9.9 cases in 2012 per 100,000 live births. Maternal education (adjusted odds ratio [aOR]CS = 0.65; aORAPOs = 0.79) and history of syphilis (aORCS = 0.28; aORAPOs = 0.61), as well as paternal age (aORCS = 0.62; aORAPOs = 0.86) and education (aORCS = 0.66; aORAPOs = 0.86) were negatively associated with CS and APOs, but maternal unmarried status (aORCS = 1.95; aORAPOs = 2.61), inadequate antenatal care (ANC) (aORCS = 3.61; aORAPOs = 1.79), more sexual partners (aORCS = 1.51; aORAPOs = 1.39), every week of delay in treatment (aORCS = 2.82; aORAPOs = 1.27), higher baseline titers of nontreponemal antibodies (aORCS = 5.65; aORAPOs = 1.47), early syphilis (aORCS = 23.24; aORAPOs = 26.95), and non-penicillin treatment (aORCS = 3.00; aORAPOs = 2.16), as well as paternal history of cocaine use (aORCS = 2.70; aORAPOs = 2.44) and positive (aORCS = 4.14; aORAPOs = 1.50) or unknown (aORCS = 2.37; aORAPOs = 2.06) status of syphilis increased the risk of CS and APOs. Condom use (aOR = 0.70) decreased MTCT of syphilis. A ten-year program consisting of screening and treatment, early ANC, health education, partners tracking, detection, and treatment, follow-up visits, and information management is an effective means to block MTCT of syphilis. Maternal and paternal factors constituted two separate profiles associated with MTCT of syphilis.
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Taylor MM, Ebrahim S, Abiola N, Kinkodi DK, Mpingulu M, Kabuayi JP, Ekofo F, Newman DR, Peterman TA, Kamb ML, Sidibe K. Correlates of syphilis seropositivity and risk for syphilis-associated adverse pregnancy outcomes among women attending antenatal care clinics in the Democratic Republic of Congo. Int J STD AIDS 2014; 25:716-25. [PMID: 24452733 DOI: 10.1177/0956462413518194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Screening and treatment for syphilis among pregnant women is the primary means of prevention of congenital syphilis. Sentinel surveillance for syphilis can inform these prevention efforts. We reviewed antenatal syphilis screening results to assess trends and to identify correlates of seropositivity among women attending antenatal care clinics in the Democratic Republic of Congo during 2011. Syphilis seropositivity among the 17,669 women attending the antenatal care clinics during 2011 was 4.2% (range 0.4%-16.9%). Syphilis seropositivity was significantly higher among women attending rural clinics (5.0%) as compared to urban clinics (3.0%) and those tested in antenatal care clinics in the provinces of Equateur (7.6%) and Orientale (7.7%) as compared to other provinces (p < 0.001). Based on the antenatal care syphilis seroprevalence and national pregnancy estimates, we estimate that approximately 128,591 pregnant women countrywide would have tested seropositive for syphilis during 2011. Over 85,000 adverse pregnancy outcomes would have resulted from these maternal infections, assuming prenatal syphilis diagnosis and treatment were not available. The prevalence of syphilis was highest in rural areas, but exceeded 1% in every area, indicating a need to assure screening and treatment throughout Democratic Republic of Congo. These sentinel surveillance estimates can be used to guide national congenital syphilis prevention efforts.
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Affiliation(s)
- Melanie M Taylor
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | - Shahul Ebrahim
- Centers for Disease Control and Prevention, Global AIDS Program, Kinshasa, DRC
| | - Nadine Abiola
- Centers for Disease Control and Prevention, Global AIDS Program, Kinshasa, DRC
| | | | - Minlangu Mpingulu
- Centers for Disease Control and Prevention, Global AIDS Program, Kinshasa, DRC
| | - Jean Pierre Kabuayi
- Ministère de la Santé Publique, Program National de Lutte Contre le VIH/SIDA, Kinshasa, DRC
| | - Felly Ekofo
- Ministère de la Santé Publique, Program National de Lutte Contre le VIH/SIDA, Kinshasa, DRC
| | - Daniel R Newman
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | - Thomas A Peterman
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | - Mary L Kamb
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | - Kassim Sidibe
- Centers for Disease Control and Prevention, Global AIDS Program, Kinshasa, DRC
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Bocoum FY, Kouanda S, Zarowsky C. Barriers to antenatal syphilis screening in Burkina Faso. Pan Afr Med J 2014; 17 Suppl 1:12. [PMID: 24624245 PMCID: PMC3946229 DOI: 10.11694/pamj.supp.2014.17.1.3423] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/09/2013] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Despite advances in treatment and management, syphilis remains a major public health problem in Burkina Faso. Syphilis in pregnancy poses major health risks for the mother and the fetus and also increases the risk for HIV transmission. Despite its potential benefits, antenatal syphilis screening is often poorly implemented in many sub-Saharan African countries. The purpose of the study is to identify and understand barriers affecting health system performance for syphilis screening among pregnant women in Burkina Faso. METHODS We conducted in-depth interviews and observations in the Kaya health district, Burkina Faso. Participants were purposively selected to capture a range of perspectives across different actors with different roles and responsibilities. Seventy-five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers. Interviews were transcribed and organized into codes and categories using NVivo software. RESULTS Participants identified multiple barriers at health providers and community levels. Key barriers at provider level included fragmentation of services, poor communication, low motivation for prescription, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level. CONCLUSION The study highlights barriers such as distance, cost of testing, and knowledge about syphilis. The introduction of point of care testing for syphilis could be an entry point for improving coverage of antenatal syphilis screening.
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Affiliation(s)
- Fadima Yaya Bocoum
- Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso ; School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Seni Kouanda
- Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso ; Institut Africain de santé publique, Ouagadougou, Burkina Faso
| | - Christina Zarowsky
- School of Public Health, University of Western Cape, Cape Town, South Africa
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The Impact of Integration of Rapid Syphilis Testing during Routine Antenatal Services in Rural Kenya. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:674584. [PMID: 26316963 PMCID: PMC4437431 DOI: 10.1155/2013/674584] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/23/2013] [Indexed: 11/17/2022]
Abstract
We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011–February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (P < 0.001); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (P < 0.001). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 28 RST-positive women and recorded 34 treatment kits as used. Individual-level data from three high-volume clinics supported that the intervention did not negatively affect HIV test uptake. Integrating RSTs into rural ANC services increased syphilis testing and detection. Record keeping on treatment of syphilis in RST-positive women remains challenging.
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Maternal and paternal factors associated with congenital syphilis in Shenzhen, China: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2013; 33:221-32. [DOI: 10.1007/s10096-013-1948-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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García PJ, Cárcamo CP, Chiappe M, Valderrama M, La Rosa S, Holmes KK, Mabey DCW, Peeling RW. Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru. PLoS One 2013; 8:e66905. [PMID: 23840552 PMCID: PMC3694115 DOI: 10.1371/journal.pone.0066905] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/12/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. Methods The study was implemented from September 2009–November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. Results Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the “two for one strategy”, offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. Conclusions Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing.
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Affiliation(s)
- Patricia J. García
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - César P. Cárcamo
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marina Chiappe
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Valderrama
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sayda La Rosa
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - King K. Holmes
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - David C. W. Mabey
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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