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Salomè S, Cambriglia MD, Montesano G, Capasso L, Raimondi F. Congenital Syphilis: A Re-Emerging but Preventable Infection. Pathogens 2024; 13:481. [PMID: 38921779 PMCID: PMC11206692 DOI: 10.3390/pathogens13060481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.
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Affiliation(s)
- Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (M.D.C.); (G.M.); (L.C.); (F.R.)
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Heiman P, Bhandari V, Davenport S, Hunter K, Micallef M, Kushnir A. Analysis of Maternal and Congenital Syphilis Rates at a New Jersey University Hospital. CHILDREN (BASEL, SWITZERLAND) 2024; 11:697. [PMID: 38929276 PMCID: PMC11202051 DOI: 10.3390/children11060697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Syphilis and congenital syphilis (CS) cases have been rising in the U.S. and internationally since the 2000s. Social factors have been shown to increase the risk of CS transmission. The COVID-19 pandemic may have contributed to increased syphilis transmission. We aimed to quantify the rise in congenital syphilis (CS) rates at a large urban hospital and the impact of the COVID-19 pandemic on CS rates. We completed a retrospective chart review of 61 pregnant women with a positive test or previous diagnosis of syphilis at an urban academic hospital between 1 January 2016 and 1 June 2022. Maternal syphilis and CS rates increased over the 5 years (p < 0.001), particularly pre- and post-COVID-19 (p < 0.001). Of the mothers studied, 34.6% received adequate prenatal care, 62.7% received adequate screening, and 81.3% received adequate treatment. Stillbirth was noted in 6.6% of pregnancies. Of liveborn infants, 97.6% received appropriate treatment, and 45.1% received adequate follow-up. CS development was significantly associated with homelessness (p = 0.028) and past opioid use (p = 0.031). We concluded that maternal syphilis and CS rates have increased at our hospital, particularly during the COVID-19 pandemic. Access to prenatal care and timely maternal treatment are target areas for improvement.
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Affiliation(s)
- Paige Heiman
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (P.H.); (K.H.); (M.M.); (A.K.)
| | - Vineet Bhandari
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (P.H.); (K.H.); (M.M.); (A.K.)
- Division of Neonatology, Department of Pediatrics, Cooper University Hospital, Camden, NJ 08103, USA
| | - Sarah Davenport
- Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Krystal Hunter
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (P.H.); (K.H.); (M.M.); (A.K.)
- Cooper Research Institute, Cooper University Hospital, Camden, NJ 08103, USA
| | - Melissa Micallef
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (P.H.); (K.H.); (M.M.); (A.K.)
- Division of Neonatology, Department of Pediatrics, Cooper University Hospital, Camden, NJ 08103, USA
| | - Alla Kushnir
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (P.H.); (K.H.); (M.M.); (A.K.)
- Division of Neonatology, Department of Pediatrics, Cooper University Hospital, Camden, NJ 08103, USA
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Stafford IA, Workowski KA, Bachmann LH. Syphilis Complicating Pregnancy and Congenital Syphilis. N Engl J Med 2024; 390:242-253. [PMID: 38231625 DOI: 10.1056/nejmra2202762] [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: 01/19/2024]
Affiliation(s)
- Irene A Stafford
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Kimberly A Workowski
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Laura H Bachmann
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
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Wozniak PS, Cantey JB, Zeray F, Leos NK, Michelow IC, Sheffield JS, Wendel GD, Sánchez PJ. The Mortality of Congenital Syphilis. J Pediatr 2023; 263:113650. [PMID: 37536483 DOI: 10.1016/j.jpeds.2023.113650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/09/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To document the case-fatality rate (CFR) of congenital syphilis diagnosed by molecular tools and rabbit infectivity testing (RIT) of clinical specimens in addition to standard evaluation and to compare that with the CFR using the Centers for Disease Control and Prevention (CDC) surveillance case definition. STUDY DESIGN Prospective, single site, cohort study of all cases of syphilis among mothers and their infants from 1984 to 2002. The diagnosis of congenital syphilis was determined using IgM immunoblotting, polymerase chain reaction, and RIT of fetal or infant specimens in addition to clinical, laboratory, and radiographic criteria. Data were retrospectively reviewed to ascertain fetal and neonatal mortality. RESULTS During the 18-year study, there were 191 cases of congenital syphilis confirmed by abnormalities on clinical, laboratory, or radiographic evaluation and/or positive serum IgM immunoblot, blood polymerase chain reaction, or blood/cerebrospinal fluid RIT. Of the 191 cases, 59 died for a CFR of 31%. Of the 59 deaths, 53 (90%) were stillborn and 6 (10%) died in the neonatal period. The majority (74%, 39/53) of stillbirths occurred in the third trimester. The CDC surveillance case definition correctly identified all infants with congenital syphilis, but the CDC CFR was 10% which underestimated the CFR by more than 300%. CONCLUSIONS Our findings corroborate the high sensitivity of the CDC surveillance definition for congenital syphilis but highlight its poor estimation of its associated mortality. The CFR among infected progeny of pregnant women with syphilis was 31%, due mostly to demise in the third trimester and as such highlights the need for detection and appropriate treatment of syphilis during pregnancy.
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Affiliation(s)
- Phillip S Wozniak
- University of Missouri Kansas City, Kansas City, MO; Children's Mercy Hospital, Kansas City, MO; University of Texas Southwestern Medical Center, Dallas, TX; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Joseph B Cantey
- University of Texas Southwestern Medical Center, Dallas, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Fiker Zeray
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Nora K Leos
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian C Michelow
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT
| | - Jeanne S Sheffield
- University of Texas Southwestern Medical Center, Dallas, TX; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Pablo J Sánchez
- University of Texas Southwestern Medical Center, Dallas, TX; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
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Eppes CS, Stafford I, Rac M. Syphilis in pregnancy: an ongoing public health threat. Am J Obstet Gynecol 2022; 227:822-838. [PMID: 35932881 DOI: 10.1016/j.ajog.2022.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Abstract
Syphilis is a treponemal infection that can be acquired sexually, hematogenously, or via vertical transmission from mother to infant. Despite evidence-based curative treatment options with penicillin, it remains a public health threat with increasing prevalence over recent years. Congenital syphilis, a condition where a fetus acquires the infection during pregnancy, can lead to stillbirth, miscarriage, preterm birth, birth defects, and lifelong physical or neurologic changes. Congenital syphilis rates in the United States increased by 261% from 2013 to 2018 and continue to increase in 2021. The only recommended treatment for syphilis in pregnancy is benzathine penicillin G because evidence of decreased risk of congenital syphilis with other modalities is lacking. Testing for syphilis is complex and includes either the reverse-sequence algorithm or the traditional algorithm. Determination of the clinical stage of syphilis includes incorporation of the previous treatment sequence and physical examination. The goal of this review was to discuss the current evidence about optimal treatment and testing during pregnancy to optimize maternal health and prevent congenital syphilis.
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Affiliation(s)
| | - Irene Stafford
- The University of Texas Health Science Center, Houston, TX
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Matthias J, Spencer EC, Bowen VB, Peterman TA. Exploring changes in maternal and congenital syphilis epidemiology to identify factors contributing to increases in congenital syphilis in Florida: a two time-period observational study (2013-2014 vs 2018-2019). BMJ Open 2022; 12:e065348. [PMID: 36008067 PMCID: PMC9422834 DOI: 10.1136/bmjopen-2022-065348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES As, cases of congenital syphilis (CS) and infectious syphilis among women more than doubled in Florida and across the nation during 2013-2019, we sought to understand what may be contributing to these increases in Florida. DESIGN A two time-period observational study. SETTING Pregnant women with reported syphilis infections and their pregnancy outcomes (2013-2014 and 2018-2019) in Florida. PARTICIPANTS 1213 pregnant women with reported syphilis infections living in Florida and 341 infants meeting the CS case definition. OUTCOME MEASURES We assessed what proportion of the increase in CS was from increases in maternal syphilis infections. We examined maternal demographics, infection characteristics and timing of diagnoses that could explain the increase in CS. Finally, we reviewed if changes in presentation or severity of CS cases occurred. RESULTS During 2013-2014, 83 (21%) of 404 pregnant women with syphilis delivered babies with CS. During 2018-2019, 258 (32%) of 809 pregnant women with syphilis delivered babies with CS. Comparing CS prevention rates, it was determined that 65% of the increase in CS was due to the increases in maternal syphilis infections. The proportion of maternal cases staged as primary or secondary increased over time (7%-13%) (p<0.01) and reports of drug use became slightly more common (6%-10%) (p=0.02). During 2018-2019, women delivering CS infants were more likely to be reinfected during the same pregnancy (27 (10%) vs 5 (6%) p=0.23) and more had negative third trimester screening tests (43 (17%) vs 7 (8% p=0.07)). The percentage of infants with CS who had ≥1 sign or symptom increased from 35% to 40%, and the combined total of stillbirths and infant deaths increased from 5 to 26. CONCLUSIONS Recently, more pregnant women are being infected with syphilis and a higher per cent are not being treated to prevent CS. The reasons for this finding are unclear.
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Affiliation(s)
- James Matthias
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA
| | - Emma C Spencer
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA
| | - Virginia B Bowen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas A Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Halfar M. Medical Problems During Pregnancy. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oliveira IMD, Oliveira RPB, Alves RRF. Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017. Rev Saude Publica 2021; 55:68. [PMID: 34730749 PMCID: PMC8522754 DOI: 10.11606/s1518-8787.2021055003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments’ percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms’ data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.
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Anugulruengkitt S, Yodkitudomying C, Sirisabya A, Chitsinchayakul T, Jantarabenjakul W, Chaithongwongwatthana S, Puthanakit T. Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand. Pediatr Int 2020; 62:330-336. [PMID: 31886919 DOI: 10.1111/ped.14132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention. METHODS A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria. RESULTS From 2013 to 2017, 69 syphilis-infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18-32) years and 12 (17%) women had human immunodeficiency virus co-infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non-reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non-reactive rapid plasma reagin at the age of 7 months. CONCLUSIONS Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care.
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Affiliation(s)
- Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
| | - Chatnapa Yodkitudomying
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
| | - Anongnart Sirisabya
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thaninee Chitsinchayakul
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand.,Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Surasith Chaithongwongwatthana
- Division of Infectious Diseases, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
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Pradhan M, Jain S. Syphilis in Pregnancy. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Medical Problems During Pregnancy. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Congenital infections are infections transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum). They have the potential to adversely affect fetal development and long-term neurodevelopmental outcome through inflammatory, destructive, developmental, or teratogenic lesions of the brain. Because the fetal/neonatal brain has a limited capacity to respond to injury, early inflammatory changes may be difficult to visualize and only manifest as neurocognitive disability later in life. Teratogenic effects, which may include aberrations of neuronal proliferation and migration, are more easily visible on imaging, but may be equally difficult to use to predict long-term neurocognitive outcomes. This chapter reviews the general pathophysiology of congenital infection and describes the epidemiology, the antenatal and postnatal diagnosis, and the treatment of congenital infections as well as the long-term neurodevelopmental outcomes.
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Affiliation(s)
- Isabelle Boucoiran
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
| | - Fatima Kakkar
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Christian Renaud
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Microbiology and Immunology, University of Montreal, Montreal, QC, Canada
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Affiliation(s)
| | - Pablo J Sánchez
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Barbara J Stoll
- McGovern Medical School at the University of Texas Health Science Center at Houston
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Elimination of Mother-to-child Transmission of Syphilis: Challenge and Solution. MATERNAL-FETAL MEDICINE 2019. [DOI: 10.1097/fm9.0000000000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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