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Salomè S, Cambriglia MD, Scarano SM, Capone E, Betts I, Pacella D, Sansone M, Mazzarelli LL, Lo Vecchio A, Ranucci G, Marinosci GZ, Capasso L, Salvatore P, Raimondi F. Congenital syphilis in the twenty-first century: an area-based study. Eur J Pediatr 2023; 182:41-51. [PMID: 36376519 DOI: 10.1007/s00431-022-04703-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
UNLABELLED The resurgence of syphilis and subsequent risk for newborns has been described worldwide; however, European data on this congenital infection is lacking. We report the activity of a multidisciplinary specialized unit assisting a large area in the Southern Italy. A retrospective cohort study has been conducted at the Perinatal and Pediatric Infectious Diseases Units of the Federico II University of Naples, enrolling all newborns and children referred from January 2010 to June 2022 exposed to Treponema pallidum in utero and/or congenitally infected. A total of 323 patients were included in the analysis. Twenty (6.2%) received a diagnosis of confirmed congenital syphilis (CS) and one died. Fifteen CS cases had typical clinical features. Since 2017, the number of referred neonates tripled while the rate of late maternal diagnoses did not significantly differ. When compared with mothers of exposed infants, mothers of CS cases were younger (25 ± 7.2 vs 29.9 ± 6 years, p = 0.041), had less previous pregnancies (0.64 vs 1.11, p = 0.044), and received a diagnosis of syphilis at a later stage of pregnancy (86% vs 20%, from third trimester or later on; p < 0.001). Appropriate maternal therapy was protective against vertical transmission (- 1.2; - 1.4, - 1 95% CI; p < 0.001). Paternal syphilis status was known in 36% of cases. CONCLUSION CS has still a significant impact. Prevention should be implemented towards specific maternal risk profiles. A specialized unit is the preferable model to improve surveillance and healthcare for this neglected population. WHAT IS KNOWN • The resurgence of syphilis and subsequent risk for newborns has been described worldwide. • European data on this congenital infection is lacking. WHAT IS NEW • Congenital syphilis has a significant impact still in Europe and prevention should be implemented towards specific maternal risk profiles. • A specialized unit is the preferable model to improve surveillance and healthcare for this neglected population.
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Valentim RAM, Caldeira-Silva GJP, da Silva RD, Albuquerque GA, de Andrade IGM, Sales-Moioli AIL, Pinto TKDB, Miranda AE, Galvão-Lima LJ, Cruz AS, Barros DMS, Rodrigues AGCDR. Stochastic Petri net model describing the relationship between reported maternal and congenital syphilis cases in Brazil. BMC Med Inform Decis Mak 2022; 22:40. [PMID: 35168629 PMCID: PMC8845404 DOI: 10.1186/s12911-022-01773-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/02/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum subspecies pallidum. In 2016, it was declared an epidemic in Brazil due to its high morbidity and mortality rates, mainly in cases of maternal syphilis (MS) and congenital syphilis (CS) with unfavorable outcomes. This paper aimed to mathematically describe the relationship between MS and CS cases reported in Brazil over the interval from 2010 to 2020, considering the likelihood of diagnosis and effective and timely maternal treatment during prenatal care, thus supporting the decision-making and coordination of syphilis response efforts. METHODS The model used in this paper was based on stochastic Petri net (SPN) theory. Three different regressions, including linear, polynomial, and logistic regression, were used to obtain the weights of an SPN model. To validate the model, we ran 100 independent simulations for each probability of an untreated MS case leading to CS case (PUMLC) and performed a statistical t-test to reinforce the results reported herein. RESULTS According to our analysis, the model for predicting congenital syphilis cases consistently achieved an average accuracy of 93% or more for all tested probabilities of an untreated MS case leading to CS case. CONCLUSIONS The SPN approach proved to be suitable for explaining the Notifiable Diseases Information System (SINAN) dataset using the range of 75-95% for the probability of an untreated MS case leading to a CS case (PUMLC). In addition, the model's predictive power can help plan actions to fight against the disease.
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Affiliation(s)
- Ricardo A M Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Gleyson J P Caldeira-Silva
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Rodrigo D da Silva
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Gabriela A Albuquerque
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ion G M de Andrade
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil.,Public Health School of Rio Grande do Norte, Natal, Brazil
| | - Ana Isabela L Sales-Moioli
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Talita K de B Pinto
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Angélica E Miranda
- Postgraduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Leonardo J Galvão-Lima
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Agnaldo S Cruz
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Daniele M S Barros
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil.
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Abstract
Syphilis in neonates and infants remains a significant public health problem because it is a major cause of fetal and neonatal morbidity and mortality globally. Despite decades of experience with syphilis in adults and infants, maternal and congenital syphilis are increasing substantially in the United States. The vertical transmission, clinical manifestations, diagnosis, evaluation, treatment, and follow-up are reviewed to guide the health care professional in understanding the optimal management of this preventable disease.
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Onyangunga OA, Naicker T, Moodley J. A clinical audit of maternal syphilis in a regional hospital in KwaZulu-Natal, South Africa. S Afr J Infect Dis 2020; 35:115. [PMID: 34485469 PMCID: PMC8377802 DOI: 10.4102/sajid.v35i1.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/13/2019] [Indexed: 11/03/2022] Open
Abstract
Background Despite the availability of screening guidelines and effective treatment for maternal syphilis (MS), its prevalence remains high and is re-emerging in many parts of the world. This might be because of varying screening tests and algorithms for the laboratory diagnosis and treatment of syphilis. In addition, HIV co-infection may compromise the elimination of MS. The present study is a clinical audit of the prevalence of MS in KwaZulu-Natal, South Africa, using the 'Traditional Algorithm' screening. Methods This was a retrospective audit in which data on syphilis testing were obtained over a 1-year period (2016) at a large regional hospital in South Africa. The standard screening test at the study site was the non-treponemal antigen, rapid plasma reagin (RPR). Data on the prevalence of MS and comorbidity with HIV infection were analysed. Results There were 10 680 deliveries in the study period of which 118 were RPR reactive, giving an MS prevalence of 1.1%. MS occurred predominantly in the age groups < 18 and > 35 years (p = 0.001). The prevalence of HIV infection was 41.2% (n = 4451). Seventy-two (61.0%) had both HIV and MS infection, whilst 46 (39.0%) had discordant results (p = 0.001). Conclusion We report an increase in the prevalence of MS compared to previous South African National Antenatal Syphilis Surveillance studies. This may be because of the prozone effect caused by HIV infection on the sensitivity of the RPR. We propose a change in MS screening, using a Rapid DUO (Dual HIV and syphilis point of care test) and Reverse Algorithm for screening that could improve the sensitivity, detection and management of both diseases.
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Affiliation(s)
- Onankoy A Onyangunga
- Optics and Imaging Centre, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Nakku-Joloba E, Kiguli J, Kayemba CN, Twimukye A, Mbazira JK, Parkes-Ratanshi R, Birungi M, Kyenkya J, Byamugisha J, Gaydos C, Manabe YC. Perspectives on male partner notification and treatment for syphilis among antenatal women and their partners in Kampala and Wakiso districts, Uganda. BMC Infect Dis 2019; 19:124. [PMID: 30727950 PMCID: PMC6366113 DOI: 10.1186/s12879-019-3695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background Syphilis screening can be successfully integrated into antenatal clinics, and potentially avert significant morbidity and mortality to unborn infants. A minority of male partners report for testing and treatment, increasing the likelihood of reinfection. We conducted a qualitative study to understand factors influencing male partners to seek treatment after syphilis notification by their pregnant partners. Methods A purposeful sample of 54 adults who participated in the STOP (Syphilis Treatment of Partners) study was stratified by gender (24 women, 30 male partners) and enrolled for in-depth interviews which were audio recorded, transcribed, and analyzed using the thematic approach. Results The participants’ median age (IQR) was 32 years (25–44), 87% were married, and 57.4% (31/74) had attained secondary education. Fourteen of 22 (63%) female participants reported that they sometimes experienced domestic violence. Male participant’s knowledge of syphilis and their perception of their valued role as responsible fathers of an unborn baby facilitated return. Female’s fear of partner‘s violence and poor communication between partners, were barriers against delivery of the notification forms to partners and subsequent treatment of partners. For men, fear of injection pain, perceptions of syphilis as a genetic disease and as a woman’s problem, busy work schedules, poor access to good STD services, shared facilities with women in clinics, as well as HIV-related stigma were important barrier factors. Conclusions The return to the clinic for treatment of male partners after partner notification by infected pregnant women, was low due to limited knowledge about syphilis, fear of painful injection, fears of domestic violence, lack of communication skills (individual characteristics) and syphilis disease characteristics such as signs and symptoms. This, combined with health services characteristics such as structural barriers that hinder male partner treatment, low access, low capacity, work/time challenges, inadequate laboratory services and low clinic personnel capacity; threatens efforts to eliminate mother-to-child infection of syphilis. Improved public messaging about syphilis, better services, legal and policy frameworks supporting STD notification and treatment in resource-constrained settings are needed for effective STD control. Trial registration Clinicaltrials.govNCT02262390., Date Registered October 8 2014.
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Affiliation(s)
- Edith Nakku-Joloba
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. .,STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.
| | - Juliet Kiguli
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Adeline Twimukye
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Kimeze Mbazira
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Monica Birungi
- STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.,Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Kyenkya
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Josaphat Byamugisha
- Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Charlotte Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Yukari C Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
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Dallé J, Baumgarten VZ, Ramos MC, Jimenez MF, Acosta L, Bumaguin DB, Antonello VS. Maternal syphilis and accomplishing sexual partner treatment: still a huge gap. Int J STD AIDS 2016; 28:876-880. [PMID: 27810981 DOI: 10.1177/0956462416678710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study - which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data - evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007-2008 to 87.5% in 2013-2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.
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Affiliation(s)
- Jessica Dallé
- 1 Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.,2 Post-graduate Program in Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Z Baumgarten
- 3 Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil
| | | | - Mirela F Jimenez
- 2 Post-graduate Program in Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,3 Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil.,5 Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Lisiane Acosta
- 6 Surveillance Health Department of Porto Alegre, Brazil
| | - Daniela B Bumaguin
- 7 Statistics Advisory Center, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicente S Antonello
- 1 Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.,4 Department of STDs and AIDS, Porto Alegre, Brazil
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de la Calle M, Cruceyra M, de Haro M, Magdaleno F, Montero MD, Aracil J, González A. [Syphilis and pregnancy: study of 94 cases]. Med Clin (Barc) 2013; 141:141-4. [PMID: 23510608 DOI: 10.1016/j.medcli.2012.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the epidemiology, diagnosis, treatment strategies and perinatal outcomes of gestational syphilis. PATIENTS AND METHOD We performed a retrospective study of 94 pregnant women with syphilis whose gestation and delivery were monitored in a Department of Obstetrics from 2002 to 2010 among a total of 85,806 births of women without syphilis in the same period. RESULTS The prevalence of gestational syphilis was 0.11%. Most of the women were foreign and the most prevalent type was late latent syphilis. Only 57 patients underwent right treatment despite adequate prescription. Maternal complications were confirmed in 31 pregnant women and 16 cases had fetal complications. We diagnosed 4 cases of neonatal syphilis, 3 of them with syphilitic meningitis, whose mothers had not completed the treatment correctly. CONCLUSIONS The implementation of a mandatory syphilis serology in the pregnancy has enabled us to diagnose many cases of late latent syphilis. The successful completion of treatment must be ensured to prevent vertical transmission.
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Affiliation(s)
- María de la Calle
- Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Madrid, España.
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