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Abstract
INTRODUCTION Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis. METHODOLOGY All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated. RESULTS Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy. CONCLUSIONS In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.
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Affiliation(s)
- Maxson Lifigao
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Titus Nasi
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Carol Titiulu
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Steven Lumasa
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Parkville, 3052, Australia.,School of Medicine and Health Sciences, University of Papua New Guinea, Taurama, National Capital District, Papua New Guinea
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Congenital Syphilis Prevention: Strategies, Evidence, and Future Directions. Sex Transm Dis 2019; 45:S29-S37. [PMID: 29624562 DOI: 10.1097/olq.0000000000000846] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Congenital syphilis (CS)-the preventable transmission of Treponema pallidum from infected mother to fetus-remains a significant problem worldwide. METHODS From July through November 2017, 239 articles relevant to CS prevention were identified via keyword searches in PubMed and Google Scholar, ancestry searches, and expert recommendation. Articles were then assessed for (1) measurement of a specified CS or adverse pregnancy outcomes (APOs) and (2) geographic setting in high/upper middle income countries according to United Nations criteria. In total, 119 articles met inclusion criteria. These were then vetted for 1 of 3 arms of CS prevention, after which additional ancestral searches were conducted within each arm to arrive at the final collection of articles per CS prevention strategy-maternal prenatal treatment (n = 33), prenatal screening (n = 24), and public health interventions that support screening and treatment (n = 15). RESULTS Of the 7 studies that evaluated treatment with benzathine penicillin G (BPG) use within the context of a modern health care system, all showed BPG to be highly effective in CS prevention; 3 additional studies demonstrated BPG effectiveness in preventing APOs. Ten studies revealed early disease detection through prenatal screening significantly reduces CS and APOs when paired with BPG. There was limited literature evaluating public health interventions, such as partner notification, surveillance, and prenatal screening laws. CONCLUSIONS Congenital syphilis is a preventable disease, effectively avoided with appropriate prenatal screening and BPG therapy. Increasing syphilis rates among all adults, accompanied by gaps in the provision of prenatal care to women at high risk of infection, are major contributors to CS persistence.
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Nathan LM, Shi Q, Plewniak K, Zhang C, Nsabimana D, Sklar M, Mutimura E, Merkatz IR, Einstein MH, Anastos K. Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study. Matern Child Health J 2015; 19:1949-55. [PMID: 25652061 PMCID: PMC4522213 DOI: 10.1007/s10995-015-1702-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB.
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Affiliation(s)
- Lisa M Nathan
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA,
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Tan NX, Rydzak C, Yang LG, Vickerman P, Yang B, Peeling RW, Hawkes S, Chen XS, Tucker JD. Prioritizing congenital syphilis control in south China: a decision analytic model to inform policy implementation. PLoS Med 2013; 10:e1001375. [PMID: 23349624 PMCID: PMC3551934 DOI: 10.1371/journal.pmed.1001375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 12/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Syphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing concern. The Chinese Ministry of Health recently announced a comprehensive 10-y national syphilis control plan focusing on averting CS. The decision analytic model presented here quantifies the impact of the planned strategies to determine whether they are likely to meet the goals laid out in the control plan. METHODS AND FINDINGS Our model incorporated data on age-stratified fertility, female adult syphilis cases, and empirical syphilis transmission rates to estimate the number of CS cases associated with prenatal syphilis infection on a yearly basis. Guangdong Province was the focus of this analysis because of the availability of high-quality demographic and public health data. Each model outcome was simulated 1,000 times to incorporate uncertainty in model inputs. The model was validated using data from a CS intervention program among 477,656 women in China. Sensitivity analyses were performed to identify which variables are likely to be most influential in achieving Chinese and international policy goals. Increasing prenatal screening coverage was the single most effective strategy for reducing CS cases. An incremental increase in prenatal screening from the base case of 57% coverage to 95% coverage was associated with 106 (95% CI: 101, 111) CS cases averted per 100,000 live births (58% decrease). The policy strategies laid out in the national plan led to an outcome that fell short of the target, while a four-pronged comprehensive syphilis control strategy consisting of increased prenatal screening coverage, increased treatment completion, earlier prenatal screening, and improved syphilis test characteristics was associated with 157 (95% CI: 154, 160) CS cases averted per 100,000 live births (85% decrease). CONCLUSIONS The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals.
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Affiliation(s)
- Nicholas X Tan
- Harvard Institute for Global Health, Cambridge, Massachusetts, USA
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Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2011; 11:684-91. [PMID: 21683653 DOI: 10.1016/s1473-3099(11)70104-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND About 2·1 million pregnant women have active syphilis every year. Without screening and treatment, 69% of these women will have an adverse outcome of pregnancy. The objectives of this study were to review the literature systematically to determine the effectiveness of screening interventions to prevent congenital syphilis and other adverse pregnancy outcomes. METHODS We searched four electronic databases and selected studies to examine evidence for effectiveness of interventions on three outcomes: increased uptake of syphilis testing, increased treatment rates, and reduction in adverse pregnancy outcomes. We used fixed effects meta-analysis to estimate pooled relative risks if no or little evidence of heterogeneity between trials existed. FINDINGS Ten studies met the inclusion criteria, including two randomised trials. Only two studies aimed to encourage women to seek care earlier in pregnancy. Nine studies included decentralisation of screening and treatment. The effects of the interventions on uptake of testing for antenatal syphilis and receiving at least one dose of penicillin were variable and could not be combined statistically. Study interventions were associated with a reduction in perinatal death (pooled risk ratio [RR] from three studies 0·46, 95% CI 0·26-0·82) and stillbirth (pooled RR from three studies 0·42, 95% CI 0·19-0·93). The incidence of congenital syphilis was reduced in all four studies that measured this outcome with heterogeneous results. INTERPRETATION Interventions to improve the coverage and effect of screening programmes for antenatal syphilis could reduce the syphilis-attributable incidence of stillbirth and perinatal death by 50%. The resources required to roll out antenatal screening programmes would be a worthwhile investment for reduction of adverse pregnancy outcomes and improvement of neonatal and child survival. FUNDING None.
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Ollé Goig JE. [Haiti, before and after]. Med Clin (Barc) 2011; 136:549-52. [PMID: 21354579 DOI: 10.1016/j.medcli.2010.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 11/04/2010] [Accepted: 11/09/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Jaime E Ollé Goig
- Asociación Catalana para el Control de la Tuberculosis en el Tercer Mundo (ACTMON), Barcelona, España.
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Victora CG, Rubens CE. Global report on preterm birth and stillbirth (4 of 7): delivery of interventions. BMC Pregnancy Childbirth 2010; 10 Suppl 1:S4. [PMID: 20233385 PMCID: PMC2841777 DOI: 10.1186/1471-2393-10-s1-s4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. BARRIERS TO SCALING UP INTERVENTIONS Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. STRATEGIES AND EXAMPLES Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. CONCLUSION Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.
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Munkhuu B, Liabsuetrakul T, Chongsuvivatwong V, McNeil E, Janchiv R. One-Stop Service for Antenatal Syphilis Screening and Prevention of Congenital Syphilis in Ulaanbaatar, Mongolia: A Cluster Randomized Trial. Sex Transm Dis 2009; 36:714-20. [DOI: 10.1097/olq.0b013e3181bc0960] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chaudhary M, Kashyap B, Bhalla P. Congenital syphilis, still a reality in 21st century: a case report. J Med Case Rep 2007; 1:90. [PMID: 17877837 PMCID: PMC2034583 DOI: 10.1186/1752-1947-1-90] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 09/19/2007] [Indexed: 11/10/2022] Open
Abstract
Congenital syphilis is a preventable disease and its presence reflects a failure of prenatal care delivery systems, as well as syphilis control programmes. The procedure to prevent congenital syphilis through antenatal screening and treatment is well established. But implementation of effective programmes has proved very difficult especially in resource constrained countries.
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Affiliation(s)
- Monica Chaudhary
- Department of Microbiology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Bineeta Kashyap
- Department of Microbiology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Preena Bhalla
- Department of Microbiology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
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Hossain M, Broutet N, Hawkes S. The Elimination of Congenital Syphilis: A Comparison of the Proposed World Health Organization Action Plan for the Elimination of Congenital Syphilis With Existing National Maternal and Congenital Syphilis Policies. Sex Transm Dis 2007; 34:S22-30. [PMID: 17592387 DOI: 10.1097/01.olq.0000261049.84824.40] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Building upon a critical assessment of national policies, programs, and treatment options, the World Health Organization (WHO) recently developed an action plan for the elimination of congenital syphilis (CS). The objective of the review was to identify areas of commonality or divergence between the national strategies and the WHO plan, thereby helping to target the development of national-level policies in light of the forthcoming recommendations of the proposed WHO action plan to eliminate CS. STUDY DESIGN The 4 strategic pillars of the proposed WHO action plan were used as a comparative framework to examine the policy, programmatic, and monitoring components of a sample of 14 existing national-level congenital or maternal control policies. The countries were chosen to represent a range of resource and prevalence levels. RESULTS The majority of countries do not meet every element proposed in the WHO action plan. Political commitment (pillar 1) across the 14 countries is varied. CS elimination goals were rare but all had universal screening. Linkages to appropriate case management services were identified in 11 countries, although a national governing body was not generally evident. Efforts to increase and improve access to care (pillar 2) were noted in 8 countries with recommendations to ensure all pregnant women were screened and treated. Low-resource settings have formed international partnerships. Guidelines for the diagnosis and treatment of pregnant women and partners (pillar 3) found in high-resource settings were lacking in low-resource and high CS prevalence countries. Surveillance programs were active in 10 countries while comprehensive details on monitoring and evaluation (pillar 4) components including proxy CS indicators were unavailable for nearly all. CONCLUSIONS The elimination of CS can be achieved through the implementation of a series of proven measures but requires technical support, funding, and a commitment among political forces, health officials, and the public to prevent and treat all CS cases and help countries reach their Millennium Development Goals. Stronger partnerships with clearly defined responsibilities should be developed among agencies responsible for national STI control, HIV/AIDS control, and Making Pregnancy Safer initiatives to ensure the universal coverage of CS control interventions.
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Affiliation(s)
- Mazeda Hossain
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Abstract
Congenital syphilis was rare in most affluent countries but there has been a slight resurgence recently in several European countries. In large parts of the world and particularly sub-Saharan Africa congenital syphilis is a significant public health problem. The cornerstone of congenital syphilis control is antenatal screening and treatment of mothers with penicillin, which is a cost-effective intervention. In affluent countries it should be strengthened among those at high risk. Clinicians should be more vigilant for the possibility of babies being born with congenital syphilis, which is often asymptomatic. In developing countries not only does antenatal care screening need to be strengthened by implementing point-of-care decentralised screening and treatment but alternative innovative approaches to controlling congenital syphilis should be explored. There is an urgent need for international health agencies to support focused approaches to tackling the tragedy of continuing congenital syphilis. This could be a part of a pro-poor strategy to meet the Millennium Development Goals.
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Affiliation(s)
- Godfrey J A Walker
- c/o Cochrane Pregnancy and Childbirth Group, Division of Perinatal and Reproductive Medicine, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK
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Mabey D, Peeling RW, Ballard R, Benzaken AS, Galbán E, Changalucha J, Everett D, Balira R, Fitzgerald D, Joseph P, Nerette S, Li J, Zheng H. Prospective, multi-centre clinic-based evaluation of four rapid diagnostic tests for syphilis. Sex Transm Infect 2007; 82 Suppl 5:v13-6. [PMID: 17215274 PMCID: PMC2563907 DOI: 10.1136/sti.2006.022467] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate prospectively four rapid, point-of-care serological tests for syphilis in prenatal or high risk populations in four countries. METHODS Tests were performed on consecutive clinic attenders, using whole blood in the clinic, and whole blood and serum in the laboratory. The sensitivity and specificity of each test was evaluated, using a standard treponemal test (Treponema pallidum haemagglutination assay (TPHA) or fluorescent treponemal antibody, absorbed (FTA-ABS) as gold standard. Non-treponemal tests (rapid plasma reagin (RPR) or venereal diseases research laboratory (VDRL) tests) were also performed on all subjects at three sites. RESULTS The specificity of each rapid test was >95% at each site. Sensitivities varied from 64-100% and, in most cases, were lower when whole blood was used rather than serum. CONCLUSIONS Rapid serological tests for syphilis are an acceptable alternative to conventional laboratory tests. Since they do not require equipment or electricity, they could increase coverage of syphilis screening, and enable treatment to be given at the first clinic visit.
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Affiliation(s)
- D Mabey
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Abstract
Sexually transmitted infections other than HIV are important global health issues. They have, however, been neglected as a public-health priority and control efforts continue to fail. Sexually transmitted infections, by their nature, affect individuals, who are part of partnerships and larger sexual networks, and in turn populations. We propose a framework of individual, partnership, and population levels for examining the effects of sexually transmitted infections and interventions to control them. At the individual level we have a range of effective diagnostic tests, treatments, and vaccines. These options are unavailable or inaccessible in many resource-poor settings, where syndromic management remains the core intervention for individual case management. At the partnership level, partner notification and antenatal syphilis screening have the potential to prevent infection and re-infection. Interventions delivered to whole populations, or groups in whom the risks of infection and onward transmission are very high, have the greatest potential effect. Improvements to the infrastructure of treatment services can reduce the incidence of syphilis and gonorrhoea or urethritis. Strong evidence for the effectiveness of most other interventions on population-level outcomes is, however, scarce. Effective action requires a multifaceted approach including better basic epidemiological and surveillance data, high quality evidence about effectiveness of individual interventions and programmes, better methods to get effective interventions onto the policy agenda, and better advocacy and more commitment to get them implemented properly. We must not allow stigma, prejudice, and moral opposition to obstruct the goals of infectious disease control.
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Affiliation(s)
- Nicola Low
- Department of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Peeling RW, Holmes KK, Mabey D, Ronald A. Rapid tests for sexually transmitted infections (STIs): the way forward. Sex Transm Infect 2006; 82 Suppl 5:v1-6. [PMID: 17151023 PMCID: PMC2563912 DOI: 10.1136/sti.2006.024265] [Citation(s) in RCA: 367] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2006] [Indexed: 11/03/2022] Open
Abstract
In the developing world, laboratory services for sexually transmitted infections (STIs) are either not available, or where limited services are available, patients may not be able to pay for or physically access those services. Despite the existence of national policy for antenatal screening to prevent congenital syphilis and substantial evidence that antenatal screening is cost-effective, implementation of syphilis screening programmes remains unacceptably low because of lack of screening tools that can be used in primary health care settings. The World Health Organization Sexually Transmitted Diseases Diagnostics Initiative (SDI) has developed the ASSURED criteria as a benchmark to decide if tests address disease control needs: Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free and Deliverable to end-users. Rapid syphilis tests that can be used with whole blood approach the ASSURED criteria and can now be deployed in areas where no previous screening has been possible. Although rapid tests for chlamydia and gonorrhoea lack sensitivity, more tests are in development. The way forward for STI diagnostics requires a continuing quest for ASSURED tests, the development of a road map for test introduction, sustainable programmes for quality assurance, and the creation of a robust infrastructure linked to HIV prevention that ensures sustainability of STI control efforts that includes viral STIs.
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Affiliation(s)
- R W Peeling
- Sexually Transmitted Diseases Diagnostics Initiative (SDI), UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
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Abstract
Many molecular diagnostic tests for sexually transmitted diseases (STDs) have been described recently but are not often accessible to clinicians in practice. There is a need for rapid, easy-to-perform, and accurate diagnostic tests for clinicians, especially for use in developing countries, where sophisticated laboratory support is often unavailable. Rapid tests, often termed "point-of-care" (POC) tests, can be performed in less than an hour in the doctor's office, clinic, or in a field setting. If simple laboratory equipment is available, a health care worker or clinician can make an immediate diagnosis of a STD. Progress has been made in the development of POC tests for HIV, syphilis, trichomonas, and bacterial vaginosis, but more work is needed for chlamydia and gonorrhea. Improvements in POCs will allow for faster treatment or provision of interventions in infected persons, in order to prevent transmission to partners or infants, thereby enabling effective control efforts for STDs.
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Affiliation(s)
- Charlotte Ann Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 1159 Ross Building, 720 Rutland Ave., Baltimore, MD 21205, USA.
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Abstract
Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.
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Affiliation(s)
- B T Goh
- The Ambrose King Centre, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
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Saraceni V, Leal MDC, Hartz ZMDA. Avaliação de campanhas de saúde com ênfase na sífilis congênita: uma revisão sistemática. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2005. [DOI: 10.1590/s1519-38292005000300002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Campanhas têm sido instrumentos de políticas públicas de saúde, freqüentemente utilizadas no Brasil para esclarecer, motivar ou conseguir o apoio da população e/ou dos profissionais de saúde, em ações relevantes para a saúde pública. Esta revisão procurou levantar subsídios para a avaliação de campanhas de saúde, particularizando-se as metodologias utilizadas, tendo em vista a avaliação de campanhas dirigidas ao controle da sífilis congênita. Os conjuntos de palavras-chave utilizados foram "sífilis congênita + avaliação"; "campanhas de saúde + avaliação" e, "campanha + saúde + avaliação". As bases de dados pesquisadas foram a Medline (Medical Literature Analysis and Retrieval System Online) da National Library of Medicine (EUA), a LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e da PAHO (Pan-American Health Organization), no período de 1980 e 2003. Foram incluídos 37 artigos nessa revisão, sendo 15 referentes à sífilis congênita e avaliação e 22 à campanha de saúde e avaliação. A revisão realizada mostrou que existe um espaço a ser preenchido neste campo, principalmente no que se refere à construção metodológica. Apesar da palavra avaliação constar nesses vários artigos, a fundamentação teórica encontrada não foi totalmente condizente com as propostas apresentadas.
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Affiliation(s)
- Rosanna W Peeling
- Diagnostics Research and Development, UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, WHO, CH-1211 Geneva 27, Switzerland.
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:522-8. [PMID: 12858868 DOI: 10.1002/pd.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nicholas SW. Haiti's Hospital Albert Schweitzer: the legacy of Larimer and Gwen Mellon. Am J Public Health 2003; 93:527-9. [PMID: 12660189 PMCID: PMC1447782 DOI: 10.2105/ajph.93.4.527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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