Congenital syphilis: still a reality in 1996

Addressing the crisis of congenital syphilis: Key findings from an evaluation of the management of syphilis in pregnancy and the newborn in South-East Queensland

BACKGROUND

Syphilis in pregnancy and congenital syphilis (CS) are increasing in Australia. Prevention of adverse outcomes requires adherence to management guidelines.

AIMS

The aim is to evaluate the management of syphilis in pregnant women and their newborns.

MATERIALS AND METHODS

A retrospective study of public health notifications, clinical records and testing results of women with positive syphilis serology in pregnancy requiring treatment from 2016 to 2018 inclusive across South-East Queensland was conducted. Management was described and compared with contemporary guidelines from the Australasian Society of Infectious Diseases, the Communicable Diseases Network Australia and the United States Centers for Disease Control and Prevention.

RESULTS

Of 30 women identified, 22 (73%) had management consistent with the guidelines (stage-appropriate penicillin regimen, appropriate dosing interval and treatment completed greater than 30 days before delivery). Only 14 (47%) women had documentation of partner testing and/or treatment. Of 26 mother-infant pairs with complete data, 16 (62%) had investigations at delivery consistent with recommendations (parallel maternal-infant rapid plasma reagin, infant syphilis immunoglobulin M, placental histopathology +/- syphilis polymerase chain reaction and infant clinical examination). One infant met the criteria for confirmed CS. Five infants received penicillin therapy. Only seven (27%) infants had serological monitoring after discharge.

CONCLUSIONS

Management can be optimised with timely maternal testing and treatment, comprehensive partner screening and treatment, strict adherence to seven-day penicillin dosing for late latent syphilis and thorough maternal and infant testing after treatment and delivery. If maternal treatment was inadequate in pregnancy, consideration needs to be given to close evaluation and empiric treatment of the infant.

Neonatal pustular dermatosis: an overview

Neonatal pustular eruption is a group of disorders characterized by various forms of pustulosis seen in first 4 weeks of life. Its presentation is often similar with some subtle differences, which can be further established by few simple laboratory aids, to arrive at a definite diagnosis. Given their ubiquitous presentation, it is sometimes difficult to differentiate among self-limiting, noninfectious, pustular dermatosis such as erythema toxicum neonatorum, transient neonatal pustular melanosis, miliaria pustulosa, etc., and potentially life threatening infections such as herpes simplex virus and varicella zoster virus infections. This review article tries to address the chronological, clinical, morphological, and histological differences among the various pustular eruptions in a newborn, in order to make it easier for a practicing dermatologist to diagnose and treat these similar looking but different entities of pustulation with a clear demarcation between the physiological benign pustular rashes and the infectious pustular lesions.

Congenital syphilis, still a reality in 21st century: a case report

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.

Prevalence of sexually transmitted infections in pregnant urban Aboriginal and Torres Strait Islander women in northern Australia

OBJECTIVE

To assess the prevalence of sexually transmitted infections (STI) in a cohort of pregnant urban Indigenous women and association of STI with preterm birth, low birthweight birth and perinatal mortality.

DESIGN

Prospective intervention program in a cohort of women attending Townsville Aboriginal and Islander Health Services (TAIHS) for shared antenatal care between 1 January 2000 and 31 December 2003 incorporating routine screening for chlamydia, gonorrhoea, trichomoniasis, hepatitis B and syphilis.

SETTING

Townsville is a provincial urban centre with a regional Indigenous population of over 16 000.

PARTICIPANTS

Four hundred and fifty-six pregnant women who were screened for bacterial STI and other viral infections.

MAIN OUTCOME MEASURES

Prevalence of STI, associated risk factors and perinatal outcomes.

RESULTS

Of the 456 women, 403 (88.4%) were screened for chlamydia, gonorrhoea and trichomonas and 432 (94.7%) were screened for syphilis. A total of 92 cases of STI (20.2%, 95% CI 16.5-23.9) were detected, with 21 concurrent infection(s). The overall prevalence of chlamydia was 14.4%, gonorrhoea 6.1%, trichomoniasis 7.2% and infectious syphilis 2.5%. Predictors for STI were young age, harmful/hazardous alcohol use and unwanted pregnancy. Low birthweight and perinatal death were significantly associated with the presence of STI and infectious syphilis during pregnancy.

CONCLUSION

The prevalence of STI among pregnant women in this urban Indigenous community is high, suggesting that screening for STI should be included in all antenatal care protocols for Indigenous women in Australia. Strategies to reach the whole Indigenous community of child-bearing age, especially those aged less than 25 years, are needed to improve perinatal outcome.

Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence

BACKGROUND

Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developing-country communities has not been reported.

OBJECTIVE

This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.

METHODS

Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.

RESULTS

A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.

CONCLUSIONS

This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.

Antenatal screening for sexually transmitted infections in remote Australia

BACKGROUND

Antenatal screening for, and prompt management of, sexually transmitted infections (STI) can prevent adverse maternal, fetal and perinatal outcomes. This is particularly important in areas of high STI endemicity.

AIMS

To assess adherence with antenatal STI screening guidelines in a large remote region, and whether completeness of antenatal syphilis screening improved after the onset of a regional syphilis outbreak in April 2001.

METHODS

Data from the regional antenatal syphilis screening database from 1997 to 2002 were analysed to identify time trends in the completeness of antenatal syphilis screening. Adherence to antenatal screening guidelines was assessed by examining pathology request forms of women undergoing antenatal syphilis screening to determine whether screening for gonorrhoea, chlamydia, hepatitis B and HIV had also been carried out. Logistic regression was used to analyse associations between adherence to the guidelines and patient's age and race, and health service characteristics.

RESULTS

Adherence to syphilis screening guidelines improved from 44.6% in 1997 to 68.9% in 2001 and 81.4% in 2002. After controlling for the time interval between the first antenatal syphilis test and date of delivery, being younger and Aboriginal, and delivering after the syphilis outbreak had been identified were positively associated with adherence to syphilis screening guidelines. Proportions of antenates screened for gonorrhoea/chlamydia, hepatitis B and HIV at booking and for gonorrhoea/chlamydia in the third trimester were 69%, 91%, 68% and 77%, respectively. Aboriginal women were more likely to have been screened for gonorrhoea and chlamydia. Women seen by a doctor were more likely to have undergone HIV screening than those who saw a nurse.

CONCLUSIONS

Significant improvement in adherence to antenatal syphilis screening guidelines occurred after identification of a syphilis outbreak. This achievement is reason for optimism regarding the potential to achieve more complete antenatal screening of other STI.