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Gong T, Zhong Y, Ding Y, Wu Q, Yao M, Yin J, Shao Y, Liu J. Growth and development of syphilis-exposed and -unexposed uninfected children during their first 18 months of life in Suzhou, China: a nested case-control study with propensity score matching. Front Public Health 2023; 11:1263324. [PMID: 38145074 PMCID: PMC10748380 DOI: 10.3389/fpubh.2023.1263324] [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: 07/19/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
Background With the successful implementation of Prevention of Mother-to-Child Transmission (PMTCT) policies, the proportion of infants with exposure to both syphilis and antibiotic medication in utero has increased in China, but there is limited evidence about the early growth and development of such infants. Methods We conducted a retrospective nested case-control study based on data from the China PMTCT program conducted in Suzhou from 2016 to 2021. Propensity score matching (PSM) was employed to extract 826 syphilis-exposed but uninfected (SEU) infants and 1,652 syphilis-unexposed uninfected (SUU) infants from a total of 712,653 infants. Maternal characteristics were collected through questionnaires, such as parity, age, education level, smoking and drinking habits during pregnancy. Infantile characteristics were retrieved from medical records or via questionnaires, such as gestational age, gender, mode of delivery, Apgar scores, birth weight and length, outdoor time, vitamin D intake, and feed pattern. Mixed effects models, adjusting for potential influencing factors, were used to investigate the early infantile growth pattern of SEU and SUU infants. All statistical analysis were conducted using R (version 4.2.0). Results Length and weight were slightly higher in SEU infants than in the SUU infants at some time points (months 0 and 18 for length, p-values <0.05; months 0, 6, and 18 for weight, p < 0.05). In the mixed effects model, SEU group was found to be associated with higher weight [exponentiated beta exp.(β) = 1.15, 95% Confidence Interval (CI) = 1.06, 1.25], length [exp(β) = 1.42, 95% CI = 1.14, 1.77], and BMI z-score [exp(β) = 1.09, 95% CI = 1.00, 1.19]. Conclusion With the effective prevention of congenital syphilis under the PMTCT program, SEU infants have non-inferior growth patterns during their first 18 months of life compared with SUU controls in Suzhou, China.
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Affiliation(s)
- Tian Gong
- Suzhou Maternal and Child Healthcare Center, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yi Zhong
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yaling Ding
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qianlan Wu
- Suzhou Maternal and Child Healthcare Center, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Mengxin Yao
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jieyun Yin
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yan Shao
- Suzhou Maternal and Child Healthcare Center, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Juning Liu
- Suzhou Maternal and Child Healthcare Center, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
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Tong H, Heuer A, Walker N. The impact of antibiotic treatment for syphilis, chlamydia, and gonorrhoea during pregnancy on birth outcomes: A systematic review and meta-analysis. J Glob Health 2023; 13:04058. [PMID: 37325885 DOI: 10.7189/jogh.13.04058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background Sexually transmissible infections are important causes of loss of health and lives in women and infants worldwide. This paper presents the methods and results of a systematic review that focuses on the impact of antibiotic treatment for syphilis, chlamydia, and gonorrhoea during pregnancy on birth outcomes for the Lives Saved Tool (LiST). Methods We searched PubMed, Embase, Cochrane Libraries, Global Health and Global Index Medicus for articles available until May 23rd, 2022. The search criteria focused on the impact of treatment for the three sexually transmitted infection among pregnant women. Nearly all the articles found were non-randomized studies. Results Treatment for pregnant women with active syphilis reduced the risk of preterm birth by 52% (95% CI = 42%-61%; 11 043 participants, 15 studies; low quality); stillbirth by 79% (95% CI = 65%-88%; 14 667 participants, eight studies; low quality); and low birth weight by 50% (95% CI = 41%-58%; 9778 participants, seven studies; moderate quality). Treatment for pregnant women with chlamydia infection reduced the risk of preterm birth by 42% (95% CI = 7%-64%; 5468 participants, seven studies; low quality) and might reduce the risk of low birth weight by 40% (95% CI = 0%-64%; 4684 participants, four studies; low quality). No studies provided data on treatment of gonorrhoea therefore no meta-analysis was conducted. Conclusions Because few studies adjusted for potential confounding factors, the overall quality of evidence was considered low. However, given the consistent and large effects, we recommend updating the estimated effect of timely detection and treatment for syphilis on preterm birth and stillbirth in the LiST model. More research is required to ascertain the effect of antibiotic treatment for chlamydia and gonorrhoea infection in pregnancy.
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Han L, Xiong W, Li M, Li R, Wu J, Tang X, Ling L, Liu X. Couple-level determinants of syphilis infection among heterosexual married couples of reproductive age in Guangdong Province, China: A population-based cross-sectional study. Front Public Health 2022; 10:1004246. [PMID: 36324455 PMCID: PMC9620861 DOI: 10.3389/fpubh.2022.1004246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background Syphilis remains a major public health problem worldwide, and its prevention requires knowledge of factors that go beyond the individual-level. However, most syphilis-related studies have focused on individual-level and regional-level factors, neglecting couple-level factors. Thus, this study aimed to explore couple-level determinants of syphilis infection among heterosexual married couples. Methods This population-based cross-sectional study used data from heterosexual married couples who participated in the National Free Preconception Health Examination Project in Guangdong Province, China during 2014-2019. The syphilis infection was tested by the rapid plasma reagin test. Couple-level data were obtained by combining information provided by the man and woman living in the same household. Multivariate logistic models were employed to explore the couple-level determinants of syphilis infection by gender after adjusting for potential confounders. Results A total of 1,755,156 couples were recruited in this analysis. The seroprevalence was 0.25% (95%CI: 0.24-0.25%) and 0.26% (95%CI: 0.25-0.27%) among men and women, respectively. The median age was 28.0 (interquartile range, IQR: 25.0-31.0) years, and the median duration of marriage was 0.2 (IQR: 0.0-2.5) years. After adjusting for individual and regional-level variables, duration of marriage was a protective factor for syphilis infection in men (adjusted odds ratios, AOR: 0.97; 95% CI: 0.96-0.98) and women (AOR: 0.95, 95% CI: 0.94-0.96). The age gap and the difference in education level between the husband and wife were associated with syphilis infection, but these associations were somewhat different between men and women. Condom use was negatively associated with syphilis infection in men (AOR: 0.77; 95% CI: 0.70-0.84) and women (AOR: 0.77, 95% CI: 0.71-0.84). Our results also showed that couple mobility and the number of children were not statistically significant determinants of syphilis infection among heterosexual married couples. Conclusion This study contributes to a more comprehensive understanding of syphilis outcomes in individuals in the context of marriage in China. Several couple-level factors are indeed associated with syphilis infection, but these associations differ between men and women. Couple-based strategies that engage both women and men and efforts to promote condom use among heterosexual married couples need to be developed and further evaluated for syphilis prevention.
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Affiliation(s)
- Lu Han
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China
| | - Wenxue Xiong
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Mingzhen Li
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China
| | - Rui Li
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiabao Wu
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China
| | - Xijia Tang
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China,Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Li Ling
| | - Xiaohua Liu
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China,*Correspondence: Xiaohua Liu
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O'Connor NP, Burke PC, Worley S, Kadkhoda K, Goje O, Foster CB. Outcomes After Positive Syphilis Screening. Pediatrics 2022; 150:188942. [PMID: 36000336 DOI: 10.1542/peds.2022-056457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Syphilis screening during pregnancy helps prevent congenital syphilis. The harms associated with false positive (FP) screens and whether screening leads to correct treatments has not been well determined. METHODS The population included mothers and infants from 75 056 pregnancies. Using laboratory-based criteria we classified initial positive syphilis screens as FP or true positive (TP) and calculated false discovery rates. For mothers and infants we determined treatments, clinical characteristics, and syphilis classifications. RESULTS There were 221 positive screens: 183 FP and 38 TP. The false discovery rate was 0.83 (95% confidence interval [CI], 0.78-0.88). False discovery rates were similar for traditional 0.83 [95% CI, 0.72-0.94] and reverse algorithms 0.83 (95% CI, 0.77-0.88), and for syphilis Immunoglobin (Ig) G 0.79 (95% CI, 0.71-0.86) and total 0.90 (95% CI, 0.82-0.97) assays. FP screens led to treatment in 2 women and 1 infant. Two high-risk women were not rescreened at delivery and were diagnosed after hospital discharge; 1 infant developed congenital syphilis. Among 15 TP women with new syphilis, the diagnosis was before the late third trimester in 14 (93%). In one-half of these women, there was concern for reinfection, treatment failure, inadequate treatment or follow-up care, or late treatment, and their infants did not achieve an optimal syphilis classification. CONCLUSIONS Syphilis screening identifies maternal syphilis, but limitations include FP screens, which occasionally lead to unnecessary treatment, inconsistent risk-based rescreening, and among TP mothers failure to optimize care to prevent birth of infants at higher risk for congenital syphilis.
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Affiliation(s)
- Nicola P O'Connor
- Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio
| | | | | | | | | | - Charles B Foster
- Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio
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Denman J, Hodson J, Manavi K. Infection Risk in Sexual Contacts of Syphilis: A Systematic Review and Meta-analysis. J Infect 2022; 84:760-769. [PMID: 35447230 DOI: 10.1016/j.jinf.2022.04.024] [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: 02/10/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Current guidelines recommend offering epidemiological treatment to asymptomatic contacts of early syphilis. This is on the expectation that up to 60% of sexual contacts of patients with syphilis will be infected. However, the evidence for this figure is sparse. We performed a systematic review and meta-analysis, to estimate the proportion of sexual contacts of syphilis that are infected with syphilis. METHODS Two electronic databases (Medline and Embase) were reviewed in March 2021, to identify studies that reported rates of infection in sexual contacts of syphilis. RESULTS Of 3,051 Embase and 1,828 Medline articles identified, 32 were included in the meta-analysis. In total 36,397 contacts were tested. The proportion of contacts infected varied across the studies, ranging from 10.7% to 97.5%, resulting in considerable heterogeneity (I2=98.5%). Pooling the studies gave an estimated proportion of infected contacts of 32.6% (95% confidence interval: 26.2% - 39.7%). CONCLUSIONS The risk of infection in sexual contacts of syphilis reported in the literature is highly variable, with a pooled estimate of 32.6%. This will help guide decisions regarding epidemiological treatment of sexual contacts of patients with syphilis. These decisions are increasingly important in this era of antibiotic resistance, with increasing emphasis being placed on antimicrobial stewardship.
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Affiliation(s)
- Johanna Denman
- Department of Genitourinary Medicine, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK.
| | - James Hodson
- Institute of Translational Medicine and Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kaveh Manavi
- Department of Genitourinary Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Enbiale M, Getie A, Haile F, Tekabe B, Misekir D. Magnitude of syphilis sero-status and associated factors among pregnant women attending antenatal care in Jinka town public health facilities, Southern Ethiopia, 2020. PLoS One 2021; 16:e0257290. [PMID: 34506600 PMCID: PMC8432762 DOI: 10.1371/journal.pone.0257290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Syphilis is one of the leading causes of perinatal morbidity and mortality and is one of the most important public health problems. There was no study showing syphilis serostatus and its related factors among pregnant women in the current study area. This study was aimed to assess the magnitude of syphilis serostatus and associated factors among pregnant women attending antenatal care in Jinka town public health facilities. METHOD Institution based cross-sectional study design was conducted in Jinka town public health facilities, southern Ethiopia from the 1st July to the 1st September, 2020. A systematic sampling technique was used to select 629 study subjects. Data were collected using a structured questionnaire through face-to-face interviews and records were reviewed to check syphilis test results. Data were coded and entered by using Epi-data version 4.432 and analyzed using SPSS version 25. The binary logistic regression model was used to investigate factors associated with syphilis. A p-value of < 0.05 at multivariable analysis was considered statistically significant. RESULT In this study, syphilis sero-prevalence among pregnant women attending antenatal care clinics was 4.8% (95% CI: 3.12, 6.48). Rural residence [AOR: 2.873; 95%CI (1.171, 7.050)], alcohol use [AOR: 3.340; 95% CI (1.354, 8.241)] and having multiple sexual partner [AOR: 5.012; 95% CI (1.929, 13.020)] were statistically significantly associated with syphilis. CONCLUSION Sero-prevalence of syphilis was high. Being a rural residence, having multiple sexual partners, alcohol use were factors associated with syphilis. Therefore, substantial efforts have to be made to provide regular health education for pregnant women at the antenatal clinic on the avoidance of risky behaviors and the risk of syphilis on their pregnancy.
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Affiliation(s)
- Mulusew Enbiale
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Asmare Getie
- School of Nursing, Arba Minch University, Arba Minch, Ethiopia
| | - Frehiwot Haile
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Beemnet Tekabe
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Direslgn Misekir
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
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Liew ZQ, Ly V, Olson-Chen C. An old disease on the rise: new approaches to syphilis in pregnancy. Curr Opin Obstet Gynecol 2021; 33:78-85. [PMID: 33337615 DOI: 10.1097/gco.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology of T. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options. RECENT FINDINGS A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely. SUMMARY Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.
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Affiliation(s)
- Zi-Qi Liew
- University of Rochester Medical Center, Department of Obstetrics and Gynecology, Rochester, NY
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