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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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Fuertes-Bucheli JF, Buenaventura-Alegría DP, Rivas-Mina AM, Pacheco-López R. Congenital Syphilis Prevention Challenges, Pacific Coast of Colombia, 2018-2022. Emerg Infect Dis 2024; 30:890-899. [PMID: 38666579 PMCID: PMC11060441 DOI: 10.3201/eid3005.231273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018-2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having >1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.
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Peters RPH, Nel JS, Sadiq E, Kufa T, Smit DP, Sorour G, Garrett N, Gill K, Makhakhe L, Chandiwana NC, Moran NF, Cohen K, Wattrus C, Moosa MY. Southern African HIV Clinicians Society Guideline for the clinical management of syphilis. South Afr J HIV Med 2024; 25:1577. [PMID: 38725703 PMCID: PMC11079416 DOI: 10.4102/sajhivmed.v25i1.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024] Open
Abstract
Syphilis, 'the great imitator', caused by Treponema pallidum infection, remains a complex and multifaceted disease with a rich history of clinical diversity. This guideline aims to be a comprehensive guide for healthcare workers in Southern Africa, offering practical insights into the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, therapeutic principles, and public health responses to syphilis. Although the syphilis burden has declined over the years, recent data indicate a troubling resurgence, particularly among pregnant women and neonates. This guideline highlights the diagnostic challenges posed by syphilis, stemming from the absence of a single high-sensitivity and -specificity test. While treatment with penicillin remains the cornerstone of treatment, alternative regimens may be used for specific scenarios. We highlight the importance of thorough patient follow-up and management of sex partners to ensure optimal care of syphilis cases. In the context of public health, we emphasise the need for concerted efforts to combat the increasing burden of syphilis, especially within high-risk populations, including people living with HIV.
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Affiliation(s)
- Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jeremy S Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Helen Joseph Hospital, Johannesburg, South Africa
| | - Eitzaz Sadiq
- Helen Joseph Hospital, Johannesburg, South Africa
- Department of Neurosciences, Division of Neurology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gillian Sorour
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lehlohonolo Makhakhe
- Department of Dermatology, University of the Free State, Bloemfontein, South Africa
- The South African Institute of Dermatology, Bloemfontein, South Africa
| | - Nomathemba C Chandiwana
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil F Moran
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Karen Cohen
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Camilla Wattrus
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
| | - Mahomed Yunus Moosa
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
- Department of Infectious Disease, Division of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Maqwar ZB, Alalawi AS. Congenital Syphilis: A Case Report Presenting a Rare Clinical Manifestation in Two-Month-Old Newborn in Bahrain. Cureus 2024; 16:e56005. [PMID: 38606270 PMCID: PMC11007584 DOI: 10.7759/cureus.56005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Congenital syphilis, caused by the Gram-negative obligate bacterium Treponema pallidum, can manifest as early- or late-onset infection, typically exhibiting classic symptoms such as a maculopapular rash, failure to thrive, and hepatosplenomegaly. This case report presents rare clinical manifestations of congenital syphilis not typically observed during early onset infection in a newborn in Bahrain. Additionally, it details the physical findings and investigations conducted to diagnose the disease.
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Foles AI, Eiras Dias M, Figueiredo M, Marçal M. Congenital syphilis: the re-emergence of a forgotten disease. BMJ Case Rep 2024; 17:e257694. [PMID: 38233003 PMCID: PMC10806924 DOI: 10.1136/bcr-2023-257694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality.
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Affiliation(s)
- Ana Isabel Foles
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mariana Eiras Dias
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Melissa Figueiredo
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mónica Marçal
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
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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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Eallonardo SJ, Freitag NE. Crossing the Barrier: A Comparative Study of Listeria monocytogenes and Treponema pallidum in Placental Invasion. Cells 2023; 13:88. [PMID: 38201292 PMCID: PMC10778170 DOI: 10.3390/cells13010088] [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: 07/20/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Vertically transmitted infections are a significant cause of fetal morbidity and mortality during pregnancy and pose substantial risks to fetal development. These infections are primarily transmitted to the fetus through two routes: (1) direct invasion and crossing the placenta which separates maternal and fetal circulation, or (2) ascending the maternal genitourinary tact and entering the uterus. Only two bacterial species are commonly found to cross the placenta and infect the fetus: Listeria monocytogenes and Treponema pallidum subsp. pallidum. L. monocytogenes is a Gram-positive, foodborne pathogen found in soil that acutely infects a wide variety of mammalian species. T. pallidum is a sexually transmitted spirochete that causes a chronic infection exclusively in humans. We briefly review the pathogenesis of these two very distinct bacteria that have managed to overcome the placental barrier and the role placental immunity plays in resisting infection. Both organisms share characteristics which contribute to their transplacental transmission. These include the ability to disseminate broadly within the host, evade immune phagocytosis, and the need for a strong T cell response for their elimination.
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Affiliation(s)
- Samuel J. Eallonardo
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Nancy E. Freitag
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA;
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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