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Tannis A, Miele K, Carlson JM, O'Callaghan KP, Woodworth KR, Anderson B, Praag A, Pulliam K, Coppola N, Willabus T, Mbotha D, Abetew D, Currenti S, Longcore ND, Akosa A, Meaney-Delman D, Tong VT, Gilboa SM, Olsen EO. Syphilis Treatment Among People Who Are Pregnant in Six U.S. States, 2018-2021. Obstet Gynecol 2024; 143:718-729. [PMID: 38626449 DOI: 10.1097/aog.0000000000005586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/07/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE To describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis. METHODS Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) conducted enhanced surveillance among people with syphilis during pregnancy based on case investigations, medical records, and linkage of laboratory data with vital records. Unadjusted risk ratios (RRs) were used to compare demographic and clinical characteristics by syphilis stage (primary, secondary, or early latent vs late latent or unknown) and treatment status during pregnancy (adequate per the Centers for Disease Control and Prevention's "Sexually Transmitted Infections Treatment Guidelines, 2021" vs inadequate or not treated) and by prenatal care (timely: at least 30 days before pregnancy outcome; nontimely: less than 30 days before pregnancy outcome; and no prenatal care). RESULTS As of September 15, 2023, of 1,476 people with syphilis during pregnancy, 855 (57.9%) were adequately treated and 621 (42.1%) were inadequately treated or not treated. Eighty-two percent of the cohort received timely prenatal care. Although those with nontimely or no prenatal care were more likely to receive inadequate or no treatment (RR 2.50, 95% CI, 2.17-2.88 and RR 2.73, 95% CI, 2.47-3.02, respectively), 32.1% of those with timely prenatal care were inadequately or not treated. Those with reported substance use or a history of homelessness were nearly twice as likely to receive inadequate or no treatment (RR 2.04, 95% CI, 1.82-2.28 and RR 1.83, 95% CI, 1.58-2.13, respectively). CONCLUSION In this surveillance cohort, people without timely prenatal care had the highest risk for syphilis treatment inadequacy; however, almost a third of people who received timely prenatal care were not adequately treated. These findings underscore gaps in syphilis screening and treatment for pregnant people, especially those experiencing substance use and homelessness, and the need for systems-based interventions, such as treatment outside of traditional prenatal care settings.
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Affiliation(s)
- Ayzsa Tannis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, and the Georgia Department of Public Health, Atlanta, Georgia; Eagle Global Scientific, LLC, San Antonio, Texas; Lukos LLC, Tampa, Florida; the Arizona Department of Health Services and Maricopa County Public Health, Phoenix, Arizona; the New Jersey Department of Health, Trenton, New Jersey; the Washington State Department of Health, Bellevue, Washington; and the New York State Department of Health, Albany, New York
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Joseph Davey D, de Voux A, Hlatshwayo L, Nelson A, Frigati L, Bheemraj K, Wara N, Mvududu R, Myer L. Prevention of congenital syphilis within antenatal PrEP services in South Africa: missed opportunities. Lancet Infect Dis 2024; 24:571-572. [PMID: 38734011 DOI: 10.1016/s1473-3099(24)00259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Dvora Joseph Davey
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Alex de Voux
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lerato Hlatshwayo
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Aurelie Nelson
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; City of Cape Town Department of Health, Cape Town, South Africa
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Kalisha Bheemraj
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nafisa Wara
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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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] [What about the content of this article? (0)] [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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Hackett C, Frank L, Heldt-Werle L, Loosier PS. Provider-Reported Barriers in Sexual Health Care Services for Women With Upstream Barriers: The Case of Syphilis and Congenital Syphilis in Southern Colorado, 2022. Sex Transm Dis 2024; 51:337-341. [PMID: 38301636 PMCID: PMC11018457 DOI: 10.1097/olq.0000000000001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Syphilis and congenital syphilis rates have increased sharply in Colorado in the past 5 years. Congenital syphilis is passed during pregnancy in utero and can cause lifelong physical, developmental, and neurologic problems for the child, or can lead to miscarriage, stillbirth, or early infant death. Congenital syphilis is easily prevented if the mother receives timely testing, treatment, and prenatal care. Providers can play a key role in preventing congenital syphilis for women with social vulnerabilities, who have a higher likelihood of syphilis and/or congenital syphilis infection. METHODS We surveyed 23 and interviewed 4 health care providers in southern Colorado in 2022 to record their experiences in providing sexual health care services. We asked providers with direct care experience about perceived barriers in effectively treating syphilis. RESULTS The most significant barriers reported in the survey were the cost of treatment (26%) and the loss to follow-up (22%). Interviews revealed further challenges, including discretionary testing procedures, delays in screening results, treatment referral issues, and stigma around substance use and sexual activity. CONCLUSIONS Elevated syphilis and congenital syphilis rates pose significant public health challenges. Coordinated interventions are necessary to effectively reduce the transmission of syphilis and congenital syphilis among women with upstream barriers. Potential care solutions include expanding rapid, point-of care testing and treatment options, supporting bicillin delivery or web-based inventory systems, offering anti-stigma training for providers, offering mental and behavioral health resources at providers' clinics, and expanding partnerships with syringe access programs.
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Affiliation(s)
- Colleen Hackett
- From the Department of Criminology and Criminal Justice, Northern Arizona University, Flagstaff, AZ
| | - Leslie Frank
- Office of STI, HIV and Viral Hepatitis Colorado Department of Public Health and Environment, Denver, CO
| | - Lindsey Heldt-Werle
- Office of STI, HIV and Viral Hepatitis Colorado Department of Public Health and Environment, Denver, CO
| | - Penny S Loosier
- Division of STD Prevention Centers for Disease Control and Prevention, Atlanta, GA
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Laurentino ACN, Ramos BA, Lira CDS, Lessa IF, Taquette SR. Health care of sexual partners of adolescents with gestational syphilis and their children: an integrative review. Cien Saude Colet 2024; 29:e12162023. [PMID: 38747774 DOI: 10.1590/1413-81232024295.12162023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/16/2023] [Indexed: 05/25/2024] Open
Abstract
Gestational syphilis (GS) in adolescents is a challenge for Brazilian public health, with high incidence rates. Testing, diagnosis and treatment of sexual partners is essential to interrupt the chain of transmission, but since 2017 it is no longer a criterion for the proper treatment of pregnant women. We sought to analyze and synthesize the knowledge produced about the health care of sexual partners of adolescents with GS in Brazil. We carried out a systematic review in the BVS, SciELO and PubMed databases, selecting articles that addressed GS and/or congenital syphilis (CS) in adolescents aged 15 to 19 years and that included information about sexual partners. Forty-one articles were comprehensively analyzed using the WebQDA software and classified into two categories: a) Approach to sexual partners during prenatal care, and b) The role of sexual partners in the transmission cycle of GS and CS. The studies show that the partner's approach is deficient, with a lack of data on the sociodemographic profile and information on testing and treatment. In the context of Primary Health Care, there are no studies that address factors inherent to the context of vulnerability of sexual partners in relation to coping with syphilis.
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Affiliation(s)
- Arnaldo Cezar Nogueira Laurentino
- Faculdade de Ciências Médicas, Universidade de Estado do Rio de Janeiro. Av. Prof. Manoel de Abreu 444, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Beatriz Alves Ramos
- Faculdade de Ciências Médicas, Universidade de Estado do Rio de Janeiro. Av. Prof. Manoel de Abreu 444, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Carollyne da Silva Lira
- Faculdade de Ciências Médicas, Universidade de Estado do Rio de Janeiro. Av. Prof. Manoel de Abreu 444, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Isadora Fiaux Lessa
- Faculdade de Ciências Médicas, Universidade de Estado do Rio de Janeiro. Av. Prof. Manoel de Abreu 444, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Stella Regina Taquette
- Faculdade de Ciências Médicas, Universidade de Estado do Rio de Janeiro. Av. Prof. Manoel de Abreu 444, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
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Feng S, Gao S, Wang Q, Cai M, Huang Z, Huang Y, Hong Y, Yuan L, Liu F, Jiang H. Development and validation of an individualised nomogram to predict mother-to-child transmission in pregnant women with syphilis in China: a retrospective cohort study. BMJ Open 2024; 14:e080211. [PMID: 38589256 PMCID: PMC11015325 DOI: 10.1136/bmjopen-2023-080211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES The elimination of mother-to-child transmission (MTCT) of syphilis has been set as a public health priority. However, an instrument to predict the MTCT of syphilis is not available. We aimed to develop and validate an intuitive nomogram to predict the individualised risk of MTCT in pregnant women with syphilis in China. DESIGN Retrospective cohort study. SETTING Data was acquired from the National Information System of Prevention of MTCT of Syphilis in Guangdong province between 2011 and 2020. PARTICIPANTS A total of 13 860 pregnant women with syphilis and their infants were included and randomised 7:3 into the derivation cohort (n=9702) and validation cohort (n=4158). PRIMARY OUTCOME MEASURES Congenital syphilis. RESULTS Among 13 860 pregnant women with syphilis and their infants included, 1370 infants were diagnosed with congenital syphilis. Least absolute shrinkage and selection operator regression and multivariable logistic regression showed that age, ethnicity, registered residence, marital status, number of pregnancies, transmission route, the timing of syphilis diagnosis, stage of syphilis, time from first antenatal care to syphilis diagnosis and toluidine red unheated serum test titre were predictors of MTCT of syphilis. A nomogram was developed based on the predictors, which demonstrated good calibration and discrimination with an area under the curve of the receiver operating characteristic of 0.741 (95% CI: 0.728 to 0.755) and 0.731 (95% CI: 0.710 to 0.752) for the derivation and validation cohorts, respectively. The net benefit of the predictive models was positive, demonstrating a significant potential for clinical decision-making. We have also developed a web calculator based on this prediction model. CONCLUSIONS Our nomogram exhibited good performance in predicting individualised risk for MTCT of syphilis, which may help guide early and personalised prevention for MTCT of syphilis.
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Affiliation(s)
- Shuaixin Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shuang Gao
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Qian Wang
- Department of Women Healthcare, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Min Cai
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhaoqian Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ying Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yeting Hong
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Li Yuan
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Fenghua Liu
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Institute for Global Health, University College London, London, UK
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de Voux A, Maruma W, Morifi M, Maduma M, Ebonwu J, Sheikh K, Dlamini-Nqeketo S, Kufa T. Gaps in the prevention of mother-to-child transmission of syphilis: a review of reported cases, South Africa, January 2020-June 2022. J Trop Pediatr 2024; 70:fmae010. [PMID: 38733096 PMCID: PMC11087667 DOI: 10.1093/tropej/fmae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Congenital syphilis (CS) is preventable through timely antenatal care (ANC), syphilis screening and treatment among pregnant women. Robust CS surveillance can identify gaps in this prevention cascade. We reviewed CS cases reported to the South African notifiable medical conditions surveillance system (NMCSS) from January 2020 to June 2022. METHODS CS cases are reported using a case notification form (CNF) containing limited infant demographic and clinical characteristics. During January 2020-June 2022, healthcare workers supplemented CNFs with a case investigation form (CIF) containing maternal and infant testing and treatment information. We describe CS cases with/without a matching CIF and gaps in the CS prevention cascade among those with clinical information. FINDINGS During January 2020-June 2022, 938 CS cases were reported to the NMCSS with a median age of 1 day (interquartile range: 0-5). Nine percent were diagnosed based on clinical signs and symptoms only. During January 2020-June 2022, 667 CIFs were reported with 51% (343) successfully matched to a CNF. Only 57% of mothers of infants with a matching CIF had an ANC booking visit (entry into ANC). Overall, 87% of mothers were tested for syphilis increasing to 98% among mothers with an ANC booking visit. Median time between first syphilis test and delivery was 16 days overall increasing to 82 days among mothers with an ANC booking visit. DISCUSSION Only 37% of CS cases had accompanying clinical information to support evaluation of the prevention cascade. Mothers with an ANC booking visit had increased syphilis screening and time before delivery to allow for adequate treatment.
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Affiliation(s)
- Alex de Voux
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, 7925, South Africa
| | - Wellington Maruma
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, 3584, The Netherlands
| | - Mabore Morifi
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
| | - Modiehi Maduma
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
| | - Joy Ebonwu
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
| | - Khadeejah Sheikh
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
| | | | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, 2131, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, 2193, South Africa
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Adhikari EH. Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem. Curr Opin Obstet Gynecol 2024; 36:67-74. [PMID: 38205786 DOI: 10.1097/gco.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
PURPOSE OF REVIEW While the clinical disease of syphilis, its consequences in pregnancy, and its sensitivity to penicillin treatment have remained relatively unchanged for a century or more, new technologies and basic discoveries in syphilis research have translated into tangible advances in clinical diagnosis, treatment, and prevention. The purpose of this review is to help the reader understand some of the recent relevant scientific publications on syphilis and its causative organism in a clinical obstetric context. RECENT FINDINGS Rates of adult and congenital syphilis have risen dramatically in the last decade despite public health efforts. Penicillin shortages and lack of screening or adequate treatment have all contributed to global disease burden. Advances in genomic and microbiological characterization of this spirochete have led to new developments in serologic and molecular diagnosis as well as evaluation of potential vaccine candidates. Until a syphilis vaccine is available, substance use disorders and lack of screening in pregnancy are associated with increased congenital syphilis, and these challenges will require novel solutions to fully address this public health crisis. SUMMARY Addressing the burden of congenital syphilis demands that obstetricians stay well informed of new tools and resources for diagnosis, treatment, and prevention of syphilis now and in the future.
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Affiliation(s)
- Emily H Adhikari
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Pérez Cavazos S, Molina de la Garza JF, Rodríguez Saldivar MM, Espinosa Villaseñor F, Vaquera Aparicio DN, Castillo Bejarano JI, Mascareñas de Los Santos AH, Pérez Barragán E. Clinical-Demographic and Laboratory Profile of the Mother-Child Binomial With Syphilis in a Tertiary-Level Hospital in Mexico. Sex Transm Dis 2024; 51:11-14. [PMID: 37889942 DOI: 10.1097/olq.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Congenital syphilis (CS) remains a major public health problem, and its incidence is increasing worldwide. METHODS Retrospective, observational, and descriptive study of cases with CS and their mothers at a tertiary-level hospital in Mexico from 2017 to 2022. Medical records of patients with CS and a structured collection of epidemiological, clinical, and laboratory data were analyzed and classified in the Centers for Disease Control scenarios as confirmed, probable, less probable, or unlikely. RESULTS One hundred eighty cases were diagnosed with a compatible definition of congenital syphilis, and we identified 43 (21.21%) confirmed proven. Among those proven cases, 15.6% had hematological, 13.3% skin, 12.2% liver, 6.7% pulmonary, 6.6% neurological, 5.8% eye, 5.6% bone, and 0.6% hearing involvements. According to the clinical stages of maternal syphilis, 119 (66.1%) were in the late latent phase, 49 (27.2%) in the early latent phase, 7 (3.9%) in the secondary stage, and 5 (2.8%) in the primary stage. Mothers with tertiary syphilis were not detected. CONCLUSION Regardless of negative antenatal screening, health care workers should consider the diagnosis of congenital syphilis. Infants are still undiagnosed at birth, and only a tiny percentage exhibits symptoms. The wide range of clinical manifestations of this preventable infection can be misdiagnosed for various other diseases, causing diagnostic delays that can have serious consequences.
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Affiliation(s)
- Samantha Pérez Cavazos
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Juan Francisco Molina de la Garza
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - María Mayela Rodríguez Saldivar
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Fernando Espinosa Villaseñor
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Denisse Natalie Vaquera Aparicio
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - José Iván Castillo Bejarano
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | | | - Edgar Pérez Barragán
- Infectious Diseases Department/Infectious Diseases Hospital, Centro Médico Nacional "La Raza"/Ciudad de México, Mexico City, Mexico
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10
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Vital Signs: Missed Opportunities for Preventing Congenital Syphilis-United States, 2022. Pediatr Infect Dis J 2023; 43:39. [PMID: 38048643 DOI: 10.1097/INF.0000000000004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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O'Callaghan KP, Johnson Jones ML, McDonald R, Jackson DA, Grey JA, Kreisel KM, Torrone E. The Congenital Syphilis Prevention Cascade: Reimagining a Missed Prevention Opportunities Framework for Effective Intervention. Sex Transm Dis 2024; 51:8-10. [PMID: 37921849 PMCID: PMC11073550 DOI: 10.1097/olq.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT Congenital syphilis (CS) rates have risen in the United States since 2013. Prevention of CS requires testing and treatment of pregnant and pregnancy-capable persons at high risk for syphilis. We developed a CS Prevention Cascade to assess how effectively testing and treatment interventions reached pregnant persons with a CS outcome.
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Affiliation(s)
- Kevin P O'Callaghan
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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12
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Greenspan J, Akbarali S, Heyer K, Brazeel C, McClure J. Effective Public Health Approaches to Reducing Congenital Syphilis. J Public Health Manag Pract 2024; 30:140-146. [PMID: 37966953 DOI: 10.1097/phh.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Julia Greenspan
- Association of State and Territorial Health Officials, Arlington, Virginia
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Moseley P, Bamford A, Eisen S, Lyall H, Kingston M, Thorne C, Piñera C, Rabie H, Prendergast AJ, Kadambari S. Resurgence of congenital syphilis: new strategies against an old foe. Lancet Infect Dis 2024; 24:e24-e35. [PMID: 37604180 DOI: 10.1016/s1473-3099(23)00314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 08/23/2023]
Abstract
Congenital syphilis is a major global cause of fetal loss, stillbirth, neonatal death, and congenital infection. In 2020, the global rate of congenital syphilis was 425 cases per 100 000 livebirths-substantially higher than WHO's elimination target of 50 cases per 100 000 livebirths. Case rates are rising in many high-income countries, but remain low compared with those in low-income and middle-income settings. This Review aims to summarise the current epidemiology and knowledge on transmission and treatment of syphilis in pregnancy, and proposes measures to reduce the rising incidence seen worldwide. We also describe emerging diagnostic and treatment tools to prevent vertical transmission and improve management of congenital syphilis. Finally, we outline a programme of public health priorities, which include research, clinical, and preventive strategies.
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Affiliation(s)
- Philip Moseley
- University of Queensland Frazer Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Sarah Eisen
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Helena Rabie
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa; Tygerberg Academic Hospital, Cape Town, South Africa
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
| | - Seilesh Kadambari
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
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Shi L, Chen L, Liu X, Hu H, Chen Y, Chen Y, Zhang Z, Zhou Y, Lu J, Yang D, Guan W. Evaluating the effect of the plan of national syphilis control in controlling the syphilis epidemic in Jiangsu, China 2010-2020. Front Public Health 2023; 11:1281229. [PMID: 38186690 PMCID: PMC10768032 DOI: 10.3389/fpubh.2023.1281229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Starting in 2010, the Chinese government initiated a 10-year syphilis control plan, called the national syphilis control plan (NSCP), to address the emerging threat of syphilis. We aimed to evaluate the effect of the NSCP plan on syphilis control in Jiangsu, China. Methods The temporal trends of syphilis incidence, prevalence and rate of condom use were estimated by Joinpoint regression with average annual percent change (APC) and average annual percentage (APPC). A Chi-square test was conducted to analyze the outcomes in different subgroups. ArcGIS was used to analyze the spatiotemporal distribution of syphilis incidence. Results Geographically, early and congenital syphilis incidence decreased significantly in all areas of the province during the period of NSCP. Early syphilis incidence decreased from 21.1 to 8.8 (APC: -7.5, 95%CI: -8.6, -6.5, p < 0.001) per 100,000 people, and congenital syphilis decreased from 63.6 to 4.1 (APC: -14.8, 95%CI: -20.8, -8.4, p < 0.01) per 100,000 newborns from 2010 to 2020. Also, syphilis prevalence reduced from 13.4 to 3.8% (APC: -8.7, 95%CI: -12.1, -5.0, p = 0.001) among men who have sex with men, from 5.3 to 1.7% (APC: -7.9, 95%CI: -11.7, -3.8, p = 0.002) among female sex workers and remained under 1.0% with slight variations among pregnant women (APC: 0.3, 95%CI: -4.3, 5.1, p = 0.877) from 2010 to 2020. 0.2% (2,436) of pregnant women who received free syphilis testing during pregnancy were diagnosed with current syphilis infection, and 97.0% (2,555) of newborns in the province were delivered to women diagnosed with syphilis. 91.8% (2,346) of live babies and about 90% of diagnosed patients received complete standard syphilis diagnosis and treatment services. Conclusion Trends of early syphilis incidence and syphilis prevalence show a considerable decreasing trend among almost all the key populations after implementing NSCP. Congenital syphilis has significantly decreased as well and hence, the NSCP program should be sustained and strengthened to control the syphilis epidemic in China further.
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Affiliation(s)
- Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
- Medical School, Nanjing University, Jiangsu, China
| | - Liping Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Xiaoyan Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Yunting Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Zhi Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Ying Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Jing Lu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Dandan Yang
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Wenhui Guan
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
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15
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Harris E. CDC: 90% of Congenital Syphilis Cases Could Have Been Prevented. JAMA 2023; 330:2145. [PMID: 37991791 DOI: 10.1001/jama.2023.22929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
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16
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Scherler G, Tomaske M, Cannizzaro V, Steppacher A, Zucol F, Theiler M, Toutous Trellu L, Labutin A, Bosshard PP, Berger C, Meyer Sauteur PM. Congenital syphilis in Switzerland: a retrospective cohort study, 2010 to 2019. Swiss Med Wkly 2023; 153:40121. [PMID: 37988348 DOI: 10.57187/smw.2023.40121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
AIMS OF THE STUDY We previously reported a re-emergence of syphilis from 2006 to 2009 with detection of congenital syphilis in Switzerland. This study aimed to reassess the incidence of children exposed to maternal syphilis during pregnancy and congenital syphilis in a following 10-year period in the canton of Zurich, the most populous canton in Switzerland with the highest incidences of syphilis. METHODS Children were identified both by reviewing medical records at the four major neonatal and paediatric hospitals providing acute care in the canton of Zurich and by the serological database of the syphilis reference laboratory. Inclusion criteria for children were (a) date of birth in the period 2010-2019, (b) place of birth in the canton of Zurich, (c) evaluation for syphilis due to positive syphilis pregnancy screening and (d) age <1 year at diagnosis. Results were compared with epidemiological data provided by the Federal Office of Public Health (FOPH). RESULTS We identified and evaluated 17 children after potential exposure to maternal syphilis. Residual antibodies of a past infection were found in 11 mothers. Six children were identified as having had real exposure to asymptomatic maternal syphilis. From an epidemiological perspective, the distribution of the cases followed a similar pattern as confirmed syphilis cases in women of childbearing age reported to the FOPH. No cases of congenital syphilis were observed. CONCLUSIONS In contrast to the rise in syphilis infections, this study identified no cases of congenital syphilis in the canton of Zurich, Switzerland, in the period 2010-2019. Syphilis pregnancy screening may have prevented congenital syphilis by diagnosing and allowing adequate treatment of asymptomatic maternal syphilis.
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Affiliation(s)
- Gioia Scherler
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maren Tomaske
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Steppacher
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Theiler
- Paediatric Skin Centre, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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17
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McDonald R, O'Callaghan K, Torrone E, Barbee L, Grey J, Jackson D, Woodworth K, Olsen E, Ludovic J, Mayes N, Chen S, Wingard R, Johnson Jones M, Drame F, Bachmann L, Romaguera R, Mena L. Vital Signs: Missed Opportunities for Preventing Congenital Syphilis - United States, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1269-1274. [PMID: 37971936 PMCID: PMC10684351 DOI: 10.15585/mmwr.mm7246e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Introduction Congenital syphilis cases in the United States increased 755% during 2012-2021. Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and maternal and infant morbidity; these outcomes can be prevented through appropriate screening and treatment. Methods A cascading framework was used to identify and classify missed opportunities to prevent congenital syphilis among cases reported to CDC in 2022 through the National Notifiable Diseases Surveillance System. Data on testing and treatment during pregnancy and clinical manifestations present in the newborn were used to identify missed opportunities to prevent congenital syphilis. Results In 2022, a total of 3,761 cases of congenital syphilis in the United States were reported to CDC, including 231 (6%) stillbirths and 51 (1%) infant deaths. Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis. Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions. Conclusions and implications for public health practice Addressing missed opportunities for prevention, primarily timely testing and appropriate treatment of syphilis during pregnancy, is important for reversing congenital syphilis trends in the United States. Implementing tailored strategies addressing missed opportunities at the local and national levels could substantially reduce congenital syphilis.
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18
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Couto CE, Castanheira ERL, Sanine PR, Mendonça CS, Nunes LO, Zarili TFT, Dias A. Congenital syphilis: performance of primary care services in São Paulo, 2017. Rev Saude Publica 2023; 57:78. [PMID: 37937652 PMCID: PMC10609639 DOI: 10.11606/s1518-8787.2023057004965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo. METHODS Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated. RESULTS 2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain "diagnosis and treatment of acquired syphilis" had the highest performance (89.8%), followed by "infrastructure and basic resources" (79.5%), "prevention of congenital syphilis in prenatal care" (73.3%) and "educational actions and prevention of sexually transmitted infections" (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements. CONCLUSIONS The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.
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Affiliation(s)
- Caroline Eliane Couto
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuPrograma de Pós-Graduação em Saúde ColetivaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Programa de Pós-Graduação em Saúde Coletiva
.
Botucatu
,
SP
,
Brazil
| | - Elen Rose Lodeiro Castanheira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuDepartamento de Saúde PúblicaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Departamento de Saúde Pública
.
Botucatu
,
SP
,
Brazil
| | - Patrícia Rodrigues Sanine
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuPrograma de Pós-Graduação em Saúde ColetivaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Programa de Pós-Graduação em Saúde Coletiva
.
Botucatu
,
SP
,
Brazil
| | - Carolina Siqueira Mendonça
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuDepartamento de Saúde PúblicaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Departamento de Saúde Pública
.
Botucatu
,
SP
,
Brazil
| | - Luceime Olívia Nunes
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuPrograma de Pós-Graduação em Saúde ColetivaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Programa de Pós-Graduação em Saúde Coletiva
.
Botucatu
,
SP
,
Brazil
| | - Thais Fernanda Tortorelli Zarili
- Universidade Estadual do Oeste do ParanáCentro de Ciências Biológicas e da SaúdeCascavelPRBrazil Universidade Estadual do Oeste do Paraná
.
Centro de Ciências Biológicas e da Saúde
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Cascavel
,
PR
,
Brazil
| | - Adriano Dias
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuDepartamento de Saúde PúblicaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Departamento de Saúde Pública
.
Botucatu
,
SP
,
Brazil
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19
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Paixao ES, Ferreira AJF, Pescarini JM, Wong KLM, Goes E, Fiaccone R, Lopes de Oliveira G, Reboucas P, Cardoso AM, Smeeth L, Barreto ML, Rodrigues LC, Ichihara MY. Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil. Lancet Glob Health 2023; 11:e1734-e1742. [PMID: 37858584 DOI: 10.1016/s2214-109x(23)00405-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study estimated ethnoracial inequalities in maternal and congenital syphilis in Brazil, understanding race as a relational category product of a sociopolitical construct that functions as an essential tool of racism and its manifestations. METHODS We linked routinely collected data from Jan 1, 2012 to Dec 31, 2017 to conduct a population-based study in Brazil. We estimated the attributable fraction of race (skin colour) for the entire population and specific subgroups compared with White women using adjusted logistic regression. We also obtained the attributable fraction of the intersection between two social markers (race and education) and compared it with White women with more than 12 years of education as the baseline. FINDINGS Of 15 810 488 birth records, 144 564 women had maternal syphilis and 79 580 had congenital syphilis. If all women had the same baseline risk as White women, 35% (95% CI 34·89-36·10) of all maternal syphilis and 41% (40·49-42·09) of all congenital syphilis would have been prevented. Compared with other ethnoracial categories, these percentages were higher among Parda/Brown women (46% [45·74-47·20] of maternal syphilis and 52% [51·09-52·93] of congenital syphilis would have been prevented) and Black women (61% [60·25-61·75] of maternal syphilis and 67% [65·87-67·60] of congenital syphilis would have been prevented). If all ethnoracial groups had the same risk as White women with more than 12 years of education, 87% of all maternal syphilis and 89% of all congenital syphilis would have been prevented. INTERPRETATION Only through effective control of maternal syphilis among populations at higher risk (eg, Black and Parda/Brown women with lower educational levels) can WHO's global health initiative to eliminate mother-to-child transmission of syphilis be made feasible. Recognising that racism and other intersecting forms of oppression affect the lives of minoritised groups and advocating for actions through the lens of intersectionality is imperative for attaining and guaranteeing health equity. Achieving health equality needs to be addressed to achieve syphilis control. Given the scale and complexity of the problem (which is unlikely to be unique to Brazil), structural issues and social markers of oppression, such as race and education, must be considered to prevent maternal and congenital syphilis and improve maternal and child outcomes globally. FUNDING Wellcome Trust, CNPq-Brazil. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Enny S Paixao
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil.
| | - Andrêa J F Ferreira
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; The Ubuntu Center on Racism, Global Movements & Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Julia M Pescarini
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Kerry L M Wong
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuelle Goes
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Rosemeire Fiaccone
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Guilherme Lopes de Oliveira
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; Centro Federal de Educação Tecnológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Poliana Reboucas
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | | | - Liam Smeeth
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
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Robinson JL, Donovan A, Gratrix J, Smyczek P, Tse-Chang A. Case Series of Stillbirths Due to Syphilis in Edmonton, Alberta, Canada. Sex Transm Dis 2023; 50:591-594. [PMID: 37255248 DOI: 10.1097/olq.0000000000001838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Data on the incidence and characteristics of stillbirths attributed to congenital syphilis were collected. METHODS We extracted data on stillbirths in the Edmonton Zone on January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. RESULTS Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths were diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (1 of whom was treated early in pregnancy and presumably reinfected), and 1 had a stillbirth in the week after one dose of benzathine penicillin G. CONCLUSIONS Stillbirths due to congenital syphilis were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.
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Affiliation(s)
| | - Anna Donovan
- From the Department of Pediatrics, University of Alberta
| | - Jennifer Gratrix
- Sexually Transmitted Infections Services, Provincial, Population, and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Petra Smyczek
- Sexually Transmitted Infections Services, Provincial, Population, and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
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22
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Gilmour LS, Walls T. Congenital Syphilis: a Review of Global Epidemiology. Clin Microbiol Rev 2023; 36:e0012622. [PMID: 36920205 PMCID: PMC10283482 DOI: 10.1128/cmr.00126-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
In 2007, the World Health Organization (WHO) launched a global health initiative for the elimination of mother-to-child transmission (MTCT) of syphilis. This condition is highly preventable through antenatal identification of syphilis infection and treatment with penicillin during pregnancy. This review summarizes the global status of MTCT of syphilis and concludes that this condition remains a significant issue worldwide. There are large variations in case rates by region, with the highest numbers of cases in the African and Eastern Mediterranean regions, where there are also the least data available. There are also pockets of high-incidence areas within the other regions. Although the general trend is of decreasing rates over time, there are concerning indications of consistently increasing congenital syphilis cases in some areas, particularly in areas which have previously had very low case numbers. A concerted effort will be required to achieve the 2007 WHO goal of worldwide elimination of MTCT of syphilis in the near future.
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Affiliation(s)
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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23
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Freyne B, Nourse C, Walls T. Congenital Syphilis: Controversies and Questions: A Global Perspective. Pediatr Infect Dis J 2023; 42:e166-e169. [PMID: 36728111 DOI: 10.1097/inf.0000000000003808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Bridget Freyne
- From the Department of Paediatric Infectious Diseases, Children's Health Ireland, Dublin, Ireland
- Division of Women & Children's Health, School of Medicine, University College Dublin, Ireland
| | - Clare Nourse
- Division of Women & Children's Health, School of Medicine, University College Dublin, Ireland
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Research for Children Aotearoa, New Zealand https://www.healthprecinct.org.nz/research-for-children-aotearoa/
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Boodman C, Bullard J, Stein DR, Lee S, Poliquin V, Van Caeseele P. Expanded prenatal syphilis screening in Manitoba, Canada: a direct short-term cost-avoidance analysis in an outbreak context. Can J Public Health 2023; 114:287-294. [PMID: 36068434 PMCID: PMC10036678 DOI: 10.17269/s41997-022-00682-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to provide a direct short-term cost-avoidance analysis of expanded three-time prenatal syphilis screening in the context of Manitoba's ongoing outbreak. METHODS A conservative modelling approach increased all financial costs of prenatal screening and minimized the direct costs of congenital syphilis treatment. The cost of syphilis screening was calculated using instrument, reagent and consumable costs as well as laboratory overhead and labour costs as documented by Cadham Provincial Laboratory. The short-term direct costs of treating congenital syphilis were calculated using hospital costs and doctor's billing fees. All costs were calculated in 2021 Canadian dollars. These numbers were applied to Manitoba's 2021 congenital syphilis statistics to provide a pragmatic cost-avoidance analysis. RESULTS The cost of applying three-time prenatal syphilis screening to all 16,800 yearly pregnancies in Manitoba equalled CAD $139,608.00 per year. The direct short-term cost of treating one uncomplicated case of congenital syphilis was $18,151.40. As 81 cases of congenital syphilis were treated in Manitoba in 2021, the short-term direct cost of treating congenital syphilis in Manitoba in 2021 was $1,470,263.40. Applying screening costs to the 125 adequately prevented cases of congenital syphilis in 2021, the screening program is associated with a cost-avoidance ratio of 16.25. If no prenatal syphilis program existed in Manitoba, an expanded screening program would be associated with a cost-avoidance ratio of 26.8. CONCLUSION Expanding prenatal syphilis screening is highly cost-avoidant in Manitoba. The 81 cases of congenital syphilis treated in Manitoba in 2021 highlight the need for novel community-based approaches to increase accessibility and engagement with prenatal care.
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Affiliation(s)
- Carl Boodman
- Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Room 543 Basic Medical Sciences Building, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jared Bullard
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
- Section of Infectious Diseases, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Derek Riley Stein
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
| | - Santina Lee
- Population and Public Health, Manitoba Health and Seniors Care, Government of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Poliquin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
- Section of Infectious Diseases, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Carlson JM, Tannis A, Woodworth KR, Reynolds MR, Shinde N, Anderson B, Hobeheidar K, Praag A, Campbell K, Carpentieri C, Willabus T, Burkhardt E, Torrone E, O’Callaghan KP, Miele K, Meaney-Delman D, Gilboa SM, Olsen EO, Tong VT. Substance Use Among Persons with Syphilis During Pregnancy - Arizona and Georgia, 2018-2021. MMWR Morb Mortal Wkly Rep 2023; 72:63-67. [PMID: 36656787 PMCID: PMC9869742 DOI: 10.15585/mmwr.mm7203a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite universal prenatal syphilis screening recommendations and availability of effective antibiotic treatment, syphilis prevalence during pregnancy and the incidence of congenital syphilis have continued to increase in the United States (1,2). Concurrent increases in methamphetamine, injection drug, and heroin use have been described in women with syphilis (3). CDC used data on births that occurred during January 1, 2018-December 31, 2021, from two states (Arizona and Georgia) that participate in the Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET) to describe the prevalence of substance use among pregnant persons with syphilis by congenital syphilis pregnancy outcome (defined as delivery of a stillborn or live-born infant meeting the surveillance case definition for probable or confirmed congenital syphilis). The prevalence of substance use (e.g., tobacco, alcohol, cannabis, illicit use of opioids, and other illicit, nonprescription substances) in persons with a congenital syphilis pregnancy outcome (48.1%) was nearly double that among those with a noncongenital syphilis pregnancy outcome (24.6%). Persons with a congenital syphilis pregnancy outcome were six times as likely to report illicit use of opioids and four times as likely to report using other illicit, nonprescription substances during pregnancy than were persons with a noncongenital syphilis pregnancy outcome. Approximately one half of persons who used substances during pregnancy and had a congenital syphilis pregnancy outcome had late or no prenatal care. Tailored interventions should address barriers and facilitators to accessing screening and treatment for syphilis among persons who use substances. The need for syphilis screening and treatment should be addressed at any health care encounter during pregnancy, especially among persons who use substances.
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Delvaux T, Ouk V, Samreth S, Yos S, Tep R, Pall C, Keo V, Deng S, Khin Cho WH, Hul S, Chhorn S, Tuot S, Kim R. Challenges and outcomes of implementing a national syphilis follow-up system for the elimination of congenital syphilis in Cambodia: a mixed-methods study. BMJ Open 2023; 13:e063261. [PMID: 36627153 PMCID: PMC9835872 DOI: 10.1136/bmjopen-2022-063261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES We aimed to describe the challenges and outcomes of implementing a national syphilis follow-up system to improve syphilis management in maternal and child health (MCH) services in Cambodia. DESIGN Operational study; quantitative cohort data and cross sectional qualitative data. SETTING Public health facilities at national level and in four provinces with high syphilis prevalence in Cambodia. PARTICIPANTS Pregnant women screened for syphilis; MCH health care providers and managers. METHODS We conducted an operational research using syphilis screening and treatment data collected from a national follow-up system (cohort data) and reported in the health management information system (HMIS) between 2019 and 2020. We also conducted indepth interviews with 16 pregnant women and focus group discussions with 37 healthcare providers and managers. Descriptive statistics and thematic content analysis were used. OUTCOME MEASURES Syphilis testing and treatment results and perceptions regarding these services. RESULTS A total of 470 pregnant women who tested positive in rapid syphilis testing were recorded in the national syphilis follow-up system in 2019-2020. Of these, 71% (332 of 470) received a rapid plasma reagin (RPR) test and 95% (n=315) tested positive; 78% (246 of 315) received any syphilis treatment and only 28% (88 of 315) were treated adequately with benzathine penicillin G (BPG). Data from four provinces with high syphilis prevalence (more closely monitored) showed higher testing and treatment rates than at the national level. HMIS aggregated data reported a higher number of pregnant women screened and treated for syphilis than the follow-up system during the same period. Barriers to syphilis testing and treatment included late antenatal care, long distance to RPR testing and treatment, partners' lack of support to reach the health facility, BPG stockout and poor adherence to oral treatment in the absence of BPG. Providers and managers reported a lack of communication across services, insufficient skills to treat infants and absence of clear guidance regarding the revised follow-up system. Study findings contributed to changes in operating procedures nationwide to facilitate access to syphilis testing and adequate treatment and a systematic follow-up of pregnant women and exposed infants. CONCLUSIONS Study results contributed to informing improvements to syphilis management in MCH services in Cambodia.
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Affiliation(s)
- Thérèse Delvaux
- Department of Publich Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Vichea Ouk
- National Centre for HIV/AIDS Dermatology and STD, Phnom Penh, Cambodia
| | | | - Socheata Yos
- National Maternal and Child Health Center, Phnom Penh, Cambodia
| | | | - Chamroen Pall
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | | | | | - Sivantha Hul
- Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Somnang Chhorn
- National Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Rattana Kim
- National Maternal and Child Health Center, Phnom Penh, Cambodia
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Peng LW, Gao YJ, Cui YL, Xu H, Gao ZX. Missed opportunities for screening congenital syphilis early during pregnancy: A case report and brief literature review. Front Public Health 2023; 10:1073893. [PMID: 36684903 PMCID: PMC9853042 DOI: 10.3389/fpubh.2022.1073893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Congenital syphilis is a significant public health problem. Pregnant women infected with Treponema pallidum present with various clinical manifestations, mainly including skin or visceral manifestations. The extensive clinical manifestations of T. pallidum infection mimic those of many other diseases during pregnancy, which may lead to delayed diagnosis and serious consequences. We report a case of fetal T. pallidum infection and premature delivery in a woman whose syphilis screening was negative at 16 weeks of gestation. Despite presenting to the dermatologist at 24 weeks of gestation with maculopapular rash which is usually associated with secondary syphilis, the diagnosis of syphilis was not considered. This case shows that even if early syphilis screening of pregnant women is negative, they may still get infected with T. pallidum later on in pregnancy. Therefore, in patients presenting with a rash without an obvious cause, T. pallidum infection should be excluded. The health status of patients' spouses should be assessed during pregnancy. Additionally, perinatal health education is necessary for women and their spouses during pregnancy. The abovementioned factors could reduce the probability of T. pallidum infection in pregnant women and their infants.
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Affiliation(s)
- Lei-Wen Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yu-Jie Gao
- Department of Laboratory Medicine, Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, China
| | - Ya-li Cui
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Laboratory Medicine, Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, China
| | - Huang Xu
- Department of Laboratory Medicine, Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, China
| | - Zheng-Xiang Gao
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Dantas JDC, Marinho CDSR, Pinheiro YT, da Silva RAR. Temporal Trend of Gestational Syphilis between 2008 and 2018 in Brazil: Association with Socioeconomic and Health Care Factors. Int J Environ Res Public Health 2022; 19:16456. [PMID: 36554342 PMCID: PMC9778377 DOI: 10.3390/ijerph192416456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
The increased number of cases in recent years has turned syphilis into a global public health problem. In 2020, 115,371 cases of acquired syphilis were reported (detection rate of 54.5 cases/100,000 inhabitants) in Brazil. In that same period, the country notified 61,441 cases of gestational syphilis (detection rate of 21.6 per 1000 live births). The number of syphilis cases points to the need to reinforce surveillance, prevention, and infection control actions, which is a worrying scenario for government organizations. This study aims to describe the temporal trend of gestational syphilis from 2008 to 2018 in Brazilian regions and to associate its detection rate with socioeconomic and health care indicators. We conducted an ecological study of temporal trends using secondary data from the Department of Informatics of the Unified Health System. The temporal trend was analyzed using the Joinpoint Regression program. The annual percent change (APC) and 95% confidence intervals (95%CI) were estimated and tested; statistical significance was assessed using the Monte Carlo permutation test. Correlations were assessed using Pearson's correlation coefficient, and statistical significance was calculated using Pearson's product-moment correlation. The gestational syphilis detection rate increased between 2008 and 2018. The South region showed the greatest trend, whereas the Midwest region presented the lowest trend. The following variables were significantly correlated with the gestational syphilis detection rate: Municipal Human Development Index, illiteracy rate, percentage of primary health care coverage, and proportion of doctors, nurses, and basic health units per inhabitant. Health policies are needed to mitigate social vulnerabilities and strengthen primary health care.
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Affiliation(s)
- Janmilli da Costa Dantas
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
| | | | - Yago Tavares Pinheiro
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
| | - Richardson Augusto Rosendo da Silva
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
- Center of Health Sciences, Department of Nursing, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
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Tuddenham S, Ghanem KG. The Critical Need to Modernize Syphilis Screening. JAMA 2022; 328:1209-1211. [PMID: 36166050 DOI: 10.1001/jama.2022.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Matthias J, Spencer EC, Bowen VB, Peterman TA. Exploring changes in maternal and congenital syphilis epidemiology to identify factors contributing to increases in congenital syphilis in Florida: a two time-period observational study (2013-2014 vs 2018-2019). BMJ Open 2022; 12:e065348. [PMID: 36008067 PMCID: PMC9422834 DOI: 10.1136/bmjopen-2022-065348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES As, cases of congenital syphilis (CS) and infectious syphilis among women more than doubled in Florida and across the nation during 2013-2019, we sought to understand what may be contributing to these increases in Florida. DESIGN A two time-period observational study. SETTING Pregnant women with reported syphilis infections and their pregnancy outcomes (2013-2014 and 2018-2019) in Florida. PARTICIPANTS 1213 pregnant women with reported syphilis infections living in Florida and 341 infants meeting the CS case definition. OUTCOME MEASURES We assessed what proportion of the increase in CS was from increases in maternal syphilis infections. We examined maternal demographics, infection characteristics and timing of diagnoses that could explain the increase in CS. Finally, we reviewed if changes in presentation or severity of CS cases occurred. RESULTS During 2013-2014, 83 (21%) of 404 pregnant women with syphilis delivered babies with CS. During 2018-2019, 258 (32%) of 809 pregnant women with syphilis delivered babies with CS. Comparing CS prevention rates, it was determined that 65% of the increase in CS was due to the increases in maternal syphilis infections. The proportion of maternal cases staged as primary or secondary increased over time (7%-13%) (p<0.01) and reports of drug use became slightly more common (6%-10%) (p=0.02). During 2018-2019, women delivering CS infants were more likely to be reinfected during the same pregnancy (27 (10%) vs 5 (6%) p=0.23) and more had negative third trimester screening tests (43 (17%) vs 7 (8% p=0.07)). The percentage of infants with CS who had ≥1 sign or symptom increased from 35% to 40%, and the combined total of stillbirths and infant deaths increased from 5 to 26. CONCLUSIONS Recently, more pregnant women are being infected with syphilis and a higher per cent are not being treated to prevent CS. The reasons for this finding are unclear.
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Affiliation(s)
- James Matthias
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA
| | - Emma C Spencer
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA
| | - Virginia B Bowen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas A Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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de Brito Pinto TK, da Cunha-Oliveira ACGDP, Sales-Moioli AIL, Dantas JF, da Costa RMM, Silva Moura JP, Gómez-Cantarino S, Valentim RADM. Clinical Protocols and Treatment Guidelines for the Management of Maternal and Congenital Syphilis in Brazil and Portugal: Analysis and Comparisons: A Narrative Review. Int J Environ Res Public Health 2022; 19:10513. [PMID: 36078229 PMCID: PMC9518460 DOI: 10.3390/ijerph191710513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 05/18/2023]
Abstract
(1) Background: Maternal syphilis (MS) and congenital syphilis (CS) are serious public health problems worldwide due to their high morbidity and mortality rates. (2) Objective: Evaluating the applicability of Clinical Protocols and Treatment Guidelines on case incidence trends in Brazil and Portugal. (3) Methods: The review was done through bibliographic research in two public databases and government websites from both countries, published between 2007 and 2022. All guidelines that contained CS and MS were selected. (4) Results and discussion: After evaluation, we found that Brazil and Portugal have adequate protocols for screening and treating congenital and maternal syphilis. (5) Conclusion: The results suggest that CS and MS incidence are notably higher in Brazil than in Portugal due to economic, cultural, and social disparities and the differences in territory size. Therefore, these demographic and socioeconomic factors could strongly influence efforts to fight against syphilis and thus control the infection.
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Affiliation(s)
- Talita Katiane de Brito Pinto
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3001-901 Coimbra, Portugal
| | - Aliete Cristina Gomes Dias Pedrosa da Cunha-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3001-901 Coimbra, Portugal
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
| | | | - Jane Francinete Dantas
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
| | - Rosângela Maria Morais da Costa
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
- Municipal Health Department, Natal City Hall, Natal 59014-030, Brazil
| | - José Paulo Silva Moura
- Doctor Daniel de Matos Maternity, Coimbra Hospital and University Center, 3000-157 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
| | - Sagrario Gómez-Cantarino
- Faculty of Physiotherapy and Nursing, Toledo Campus, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Ricardo Alexsandro de Medeiros Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
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Round JM, Plitt SS, Eisenbeis L, Smyczek P, Gratrix J, Charlton C, Fathima S, O'Brien A. Examination of Care Milestones for Preventing Congenital Syphilis Transmission Among Syphilis-Infected Pregnant Women in Alberta, Canada: 2017-2019. Sex Transm Dis 2022; 49:477-483. [PMID: 35470347 DOI: 10.1097/olq.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND An infectious syphilis outbreak in Alberta has resulted in increased congenital syphilis (CS) cases. To shed light on potential risk factors, we used administrative data sets to examine care milestones for the prevention of CS among pregnant women diagnosed with syphilis, as well as correlates of women giving birth to infants with CS. METHODS Provincial administrative databases were used to identify and describe pregnant women diagnosed with any stage of infectious or noninfectious syphilis who gave birth in Alberta between January 1, 2017, and December 31, 2019. Data on prenatal care, syphilis screening, and syphilis medication dispensation were used to evaluate the care milestones. Clinical care and maternal demographics were assessed using logistic and linear regression analyses to determine correlates for missed care milestones or a newborn outcome of CS. RESULTS Of 182 syphilis-infected pregnant women, 63 (34.6%) delivered a newborn with CS. Overall, in the first trimester, 136 (75.1%) women had a health care visit, 72 (39.6%) had a prenatal care visit, 71 (39.0%) were screened for syphilis, and 44 (24.2%) were treated. Gestational time to treatment initiation (adjusted odds ratio, 1.04; 95% confidence interval, 1.02-1.06) and older maternal age at diagnosis (adjusted odds ratio: 1.28, 95% confidence interval, 1.08-1.50) were independently associated with CS outcomes. No variables were found to be independently associated with a health care visit, prenatal screening, or initiation of treatment. CONCLUSIONS Although nearly two-thirds of CS cases were prevented, there remained missed opportunities in the prevention of CS. Early treatment, which relies on timely access to prenatal care and screening, was the most important for the prevention of CS.
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Clement AC, Fay KE, Yee LM. Disparities in state-mandated third-trimester testing for syphilis. Am J Obstet Gynecol MFM 2022; 4:100595. [PMID: 35176505 PMCID: PMC9081215 DOI: 10.1016/j.ajogmf.2022.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since 1999, Illinois has had a legal statute mandating both first-visit and third-trimester syphilis testing in all pregnancies. However, the incidence of syphilis infection is increasing at the national and state level, including among individuals of reproductive age, conferring risk of congenital syphilis. Although state-mandated infectious disease screening is purported to be a strategy to improve equity and quality of care, adherence to such mandates and disparities in adherence are unknown. OBJECTIVE We sought to evaluate compliance with state-mandated third-trimester syphilis testing at a single tertiary hospital in Illinois and to identify disparities in testing. STUDY DESIGN This is a retrospective cohort study of all pregnant individuals who delivered between January 1, 2015 and February 28, 2018 at a large-volume academic center. Patients who delivered after 28 weeks of gestation were included. Frequency of state-mandated first-visit (<28 weeks) and third-trimester (≥28 weeks) syphilis screening was evaluated over the study period. The primary outcome was completion of any third-trimester screening (ie, performed as an initial or repeat test in the third trimester) in accordance with state law. Demographic and clinical factors associated with the primary outcome and with completion of both first-visit and third-trimester screening were evaluated with multivariable logistic regression. RESULTS Of the 9048 eligible deliveries, 96.9% (N=8766) of patients had first-visit syphilis screening, whereas only 27.3% (N=2469) had third-trimester screening. Performance of third-trimester syphilis testing increased over time from an average of 5.8% of deliveries during the first 6 months of the study period to 59.8% over the last 6 months of the study period. Non-Hispanic Black or Hispanic race or ethnicity, non-English primary language, public insurance, age <25, multiparity, and greater body mass index were independently associated with increased odds of third-trimester screening. CONCLUSION Despite a decades-old state mandate for third-trimester syphilis screening in this high-prevalence region, third-trimester screening performance was suboptimal. Several demographic characteristics were associated with adherence to screening, suggesting inequity and bias exist in testing practices. It is important to acknowledge that legal statutes do not fully eliminate bias and health disparities.
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Affiliation(s)
- Amelia C Clement
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clement, Fay, and Yee); Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT (Dr Clement).
| | - Kathryn E Fay
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clement, Fay, and Yee); Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA (Dr Fay)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clement, Fay, and Yee)
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Drame FN, Urban MA, Inscho RR, Mendoza MD, Hiltunen K, Owens JM, Stone C, Hart-Malloy R. Best Practices Implementation: Congenital Syphilis Prevention Efforts in Monroe County, New York, 2018. Sex Transm Dis 2022; 49:310-312. [PMID: 34873114 DOI: 10.1097/olq.0000000000001588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Fanta Nani Drame
- From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - John M Owens
- Monroe County Department of Public Health, Monroe County
| | - Cord Stone
- Office of Sexual Health & Epidemiology, AIDS Institute, New York State Department of Health, Albany
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da Rocha MA, dos Santos MM, Fontes RS, de Melo ASP, Cunha-Oliveira A, Miranda AE, de Oliveira CAP, Oliveira HG, Gusmão CMG, Lima TGFMS, Pinto R, Barros DMS, Valentim RADM. The Text Mining Technique Applied to the Analysis of Health Interventions to Combat Congenital Syphilis in Brazil: The Case of the "Syphilis No!" Project. Front Public Health 2022; 10:855680. [PMID: 35433567 PMCID: PMC9005801 DOI: 10.3389/fpubh.2022.855680] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Congenital syphilis (CS) remains a threat to public health worldwide, especially in developing countries. To mitigate the impacts of the CS epidemic, the Brazilian government has developed a national intervention project called "Syphilis No." Thus, among its range of actions is the production of thousands of writings featuring the experiences of research and intervention supporters (RIS) of the project, called field researchers. In addition, this large volume of base data was subjected to analysis through data mining, which may contribute to better strategies for combating syphilis. Natural language processing is a form of knowledge extraction. First, the database extracted from the "LUES Platform" with 4,874 documents between 2018 and 2020 was employed. This was followed by text preprocessing, selecting texts referring to the field researchers' reports for analysis. Finally, for analyzing the documents, N-grams extraction (N = 2,3,4) was performed. The combination of the TF-IDF metric with the BoW algorithm was applied to assess terms' importance and frequency and text clustering. In total, 1019 field activity reports were mined. Word extraction from the text mining method set out the following guiding axioms from the bigrams: "confronting syphilis in primary health care;" "investigation committee for congenital syphilis in the territory;" "municipal plan for monitoring and investigating syphilis cases through health surveillance;" "women's healthcare networks for syphilis in pregnant;" "diagnosis and treatment with a focus on rapid testing." Text mining may serve public health research subjects when used in parallel with the conventional content analysis method. The computational method extracted intervention activities from field researchers, also providing inferences on how the strategies of the "Syphilis No" Project influenced the decrease in congenital syphilis cases in the territory.
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Affiliation(s)
- Marcella A. da Rocha
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Marquiony M. dos Santos
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Raphael S. Fontes
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Andréa S. P. de Melo
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Aliete Cunha-Oliveira
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Angélica E. Miranda
- Postgraduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitoria, Brazil
| | - Carlos A. P. de Oliveira
- Multidisciplinary Department of Human Development With Technologies, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hugo Gonçalo Oliveira
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, Coimbra, Portugal
| | - Cristine M. G. Gusmão
- Department of Biomedical Engineering, Federal University of Pernambuco (UFPE), Recife, Brazil
| | | | - Rafael Pinto
- 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
| | - Ricardo A. de M. Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
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Cuffe KM, Torrone EA, Hong J, Leichliter JS, Gift TL, Thorpe PG, Bernstein KT. Identification of United States Counties at Elevated Risk for Congenital Syphilis Using Predictive Modeling and a Risk Scoring System, 2018. Sex Transm Dis 2022; 49:184-189. [PMID: 34561374 DOI: 10.1097/olq.0000000000001561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The persistence of congenital syphilis (CS) remains an important concern in the United States. We use the 2018 data to refine a previous predictive model that identifies US counties at elevated risk for CS in 2018. METHODS Using county-level socioeconomic and health-related data from various sources, we developed a logistic regression predictive model to identify county-level factors associated with a county having had 1 or more CS case reported to the National Notifiable Diseases Surveillance System in 2018. We developed a risk scoring algorithm, identified the optimal risk score cutpoint to identify counties at elevated risk, and calculated the live birth to CS case ratio for counties by predicted risk level to compare counties at elevated risk with counties not at elevated risk. RESULTS We identified several county-level factors associated with a county having 1 or more CS case in 2018 (area under the curve, 88.6%; Bayesian information criterion, 1551.1). Using a risk score cutoff of 8 or higher (sensitivity, 83.2%; specificity, 79.4%), this model captured 94.7% (n = 1,253) of CS cases born in 2018 and identified 850 (27%) counties as being at elevated risk for CS. The live birth to CS case ratio was lower in counties identified as at elevated risk (2,482) compared with counties categorized as not at elevated risk (10,621). CONCLUSIONS Identifying which counties are at highest risk for CS can help target prevention efforts and interventions. The relatively low live birth to CS case ratio in elevated risk counties suggests that implementing routine 28-week screening among pregnant women in these counties may be an efficient way to target CS prevention efforts.
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Affiliation(s)
- Kendra M Cuffe
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Morgan J, Mathew T, Azariah S. Eliminating congenital syphilis from Aotearoa New Zealand. N Z Med J 2021; 134:8-12. [PMID: 34695089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jane Morgan
- Hamilton Sexual Health Service, Waikato District Health Board, Hamilton, New Zealand
| | - Teena Mathew
- MidCentral DHB Sexual Health Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sunita Azariah
- Auckland Regional Sexual Health Service, Auckland District Health Board, Auckland, New Zealand
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Machefsky AM, Loosier PS, Cramer R, Bowen VB, Kersh EN, Tao G, Gift TL, Hogben M, Carry M, Ludovic JA, Thorpe P, Bachmann LH. A New Call to Action to Combat an Old Nemesis: Addressing Rising Congenital Syphilis Rates in the United States. J Womens Health (Larchmt) 2021; 30:920-926. [PMID: 34254848 DOI: 10.1089/jwh.2021.0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Congenital syphilis (CS) is on the rise in the United States and is a growing public health concern. CS is an infection with Treponema pallidum in an infant or fetus, acquired via transplacental transmission when a pregnant woman has untreated or inadequately treated syphilis. Pregnant women with untreated syphilis are more likely to experience pregnancies complicated by stillbirth, prematurity, low birth weight, and early infant death, while their children can develop clinical manifestations of CS such as hepatosplenomegaly, bone abnormalities, developmental delays, and hearing loss. One of the ways CS can be prevented is by identifying and treating infected women during pregnancy with a benzathine penicillin G regimen that is both appropriate for the maternal stage of syphilis and initiated at least 30 days prior to delivery. In this article we discuss many of the challenges faced by both public health and healthcare systems with regards to this preventable infection, summarize missed opportunities for CS prevention, and provide practical solutions for future CS prevention strategies.
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Affiliation(s)
- Aliza M Machefsky
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Gilstrap Fellowship, CDC Foundation, Atlanta, Georgia, USA
| | - Penny S Loosier
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan Cramer
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Virginia B Bowen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Guoyu Tao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monique Carry
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer A Ludovic
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phoebe Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura H Bachmann
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Chan EYL, Smullin C, Clavijo S, Papp-Green M, Park E, Nelson M, Giarratano G, Wagman JA. A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California. PLoS One 2021; 16:e0249419. [PMID: 33793630 PMCID: PMC8016223 DOI: 10.1371/journal.pone.0249419] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients' social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.
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Affiliation(s)
- Elaine Y. L. Chan
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Carolyn Smullin
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Stephanie Clavijo
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
- Charles R Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Melissa Papp-Green
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Eunhee Park
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Marlene Nelson
- School of Social Sciences and Education, California State University-Bakersfield, Bakersfield, California, United States of America
| | - Gloria Giarratano
- School of Nursing, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jennifer A. Wagman
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
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Sukwa N, Simuyandi M, Chirwa M, Kumwimba YM, Chilyabanyama ON, Laban N, Koyuncu A, Chilengi R. Clinical presentation of congenital syphilis in a rotavirus vaccine cohort study in Lusaka: a case series. J Med Case Rep 2021; 15:149. [PMID: 33789741 PMCID: PMC8015191 DOI: 10.1186/s13256-021-02745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 02/17/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite an otherwise robust national antenatal clinic program, maternal and congenital syphilis remains an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with congenital syphilis in Lusaka, Zambia. CASE PRESENTATIONS The cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using rapid plasma reagin test. From a cohort of 214 mother-infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, four (3.5%) reported to have tested positive; and only two received treatment. Seven out of 57 (26.6%) children meeting the screening criteria had a positive rapid plasma reagin test result. The mean age at diagnosis was 4.5 months (1.3 months standard deviation), and the common presenting features included coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and underweight (5/7). Three of the seven infants were exposed to human immunodeficiency virus. Following diagnosis, all seven cases received standard treatment according to national treatment guidelines. That is, 6/7 cases received inpatient care with benzylpenicillin for 10 days, while 1/7 was treated as an outpatient and received daily procaine penicillin for 10 days. CONCLUSION These findings suggest that, though screening for syphilis is part of the standard antenatal care in Zambia, it is not offered optimally. There is urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms, regardless of the mother's human immunodeficiency virus status.
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Affiliation(s)
- Nsofwa Sukwa
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Michelo Simuyandi
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Masuzyo Chirwa
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Yvonne Mutombo Kumwimba
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Obvious N. Chilyabanyama
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Natasha Laban
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Aybüke Koyuncu
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Roma Chilengi
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Lin KW. Closing Primary and Prenatal Care Gaps to Prevent Congenital Syphilis. Am Fam Physician 2020; 102:78-79. [PMID: 32667163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kenneth W Lin
- Georgetown University Medical Center, Washington, DC, USA
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Ricco J, Westby A. Syphilis: Far from Ancient History. Am Fam Physician 2020; 102:91-98. [PMID: 32667172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rates of primary, secondary, and congenital syphilis are increasing in the United States, and reversing this trend requires renewed vigilance on the part of family physicians to assist public health agencies in the early detection of outbreaks. Prompt diagnosis of syphilis can be challenging, and not all infected patients have common manifestations, such as a genital chancre or exanthem. The U.S. Preventive Services Task Force recommends screening for syphilis in all patients at increased risk, particularly those who reside in high-prevalence areas, sexually active people with HIV infection, and men who have sex with men. Other groups at increased risk include males 29 years or younger and people with a history of incarceration or sex work. All pregnant women should be screened for syphilis at the first prenatal visit, and those at increased risk should be screened throughout the pregnancy. The Centers for Disease Control and Prevention recommends the traditional screening algorithm for most U.S. populations. Penicillin is the preferred treatment across all stages of syphilis, although limited research suggests a possible role for other antibiotics in penicillin-allergic patients with primary or secondary syphilis. Pregnant women with syphilis who are allergic to penicillin should undergo penicillin desensitization before treatment.
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Affiliation(s)
- Jason Ricco
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Andrea Westby
- University of Minnesota Medical School, Minneapolis, MN, USA
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Kimball A, Torrone E, Miele K, Bachmann L, Thorpe P, Weinstock H, Bowen V. Missed Opportunities for Prevention of Congenital Syphilis - United States, 2018. MMWR Morb Mortal Wkly Rep 2020; 69:661-665. [PMID: 32497029 PMCID: PMC7272112 DOI: 10.15585/mmwr.mm6922a1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
| | - Pablo J Sánchez
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Barbara J Stoll
- McGovern Medical School at the University of Texas Health Science Center at Houston
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Screening for Syphilis In Pregnant Women: Recommendation Statement. Am Fam Physician 2019; 99:Online. [PMID: 30990298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiané SG, Ishikawa N, Le LV, Newman-Owiredu M, Nagelkerke N, Newman L, Kamb M, Broutet N, Taylor MM. Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLoS One 2019; 14:e0211720. [PMID: 30811406 PMCID: PMC6392238 DOI: 10.1371/journal.pone.0211720] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/26/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. METHODS Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. RESULTS The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57-0.81%) resulting in a global CS rate of 473 (385-561) per 100,000 live births and 661,000 (538,000-784,000) total CS cases, including 355,000 (290,000-419,000) adverse birth outcomes (ABO) and 306,000 (249,000-363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs- 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63-0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000-432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. CONCLUSIONS Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.
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Affiliation(s)
| | - Jane Rowley
- Independent consultant, London, United Kingdom
| | - Monica Alonso
- Department of Communicable Diseases and Environmental Determinants of Health, Pan-American Health Organization, Washington DC, United States of America
| | - Maeve B. Mello
- Department of Communicable Diseases and Environmental Determinants of Health, Pan-American Health Organization, Washington DC, United States of America
| | | | - S. Guy Mahiané
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - Naoko Ishikawa
- World Health Organization, Regional Office for the Western Pacific, Manila, the Philippines
| | - Linh-Vi Le
- World Health Organization, Regional Office for the Western Pacific, Manila, the Philippines
| | - Morkor Newman-Owiredu
- World Health Organization, Sub-Saharan Africa Office, Brazzaville, Republic of Congo
| | | | - Lori Newman
- USA Centers for Disease Control and Prevention, Cambodia Country Office, Phnom Penh, Cambodia
| | - Mary Kamb
- USA Centers for Disease Control and Prevention, Cambodia Country Office, Phnom Penh, Cambodia
| | - Nathalie Broutet
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
| | - Melanie M. Taylor
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
- World Health Organization, Dept. of Reproductive Health and Research, Geneva, Switzerland
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Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Syphilis Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2018; 320:911-917. [PMID: 30193283 DOI: 10.1001/jama.2018.11785] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Untreated syphilis infection in pregnant women can be transmitted to the fetus (congenital syphilis) at any time during pregnancy or at birth. Congenital syphilis is associated with stillbirth, neonatal death, and significant morbidity in infants (eg, bone deformities and neurologic impairment). After a steady decline from 2008 to 2012, cases of congenital syphilis markedly increased from 2012 to 2106, from 8.4 to 15.7 cases per 100 000 live births (an increase of 87%). At the same time, national rates of syphilis increased among women of reproductive age. OBJECTIVE To update the US Preventive Services Task Force (USPSTF) 2009 recommendation on screening for syphilis infection in pregnant women. EVIDENCE REVIEW The USPSTF commissioned a reaffirmation evidence update to identify new and substantial evidence sufficient enough to change its prior recommendation. Given the established benefits and practice of screening for syphilis in pregnant women, the USPSTF targeted its evidence review on the direct benefits of screening on the prevention of congenital syphilis morbidity and mortality and the harms of screening for and treatment of syphilis infection in pregnant women. FINDINGS Using a reaffirmation process, the USPSTF found that accurate screening algorithms are available to identify syphilis infection. Effective treatment with antibiotics can prevent congenital syphilis and significantly decrease adverse pregnancy outcomes, with small associated harms, providing an overall substantial health benefit. Therefore, the USPSTF reaffirms its previous conclusion that there is convincing evidence that screening for syphilis infection in pregnant women provides substantial benefit. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends early screening for syphilis infection in all pregnant women. (A recommendation).
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Affiliation(s)
| | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
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Abstract
IMPORTANCE The incidence of syphilis and congenital syphilis in the United States has increased after reaching historic lows in the early 2000s. OBJECTIVE To systematically review literature on the effectiveness and harms of screening for syphilis in pregnancy and the harms of penicillin treatment in pregnancy to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant English-language literature, published from January 1, 2008, to June 2, 2017. Ongoing surveillance was conducted through November 22, 2017. STUDY SELECTION Studies conducted in countries categorized as "high" or "very high" on the Human Development Index that explicitly addressed 1 of 3 a priori-defined key questions. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Data from included studies were narratively synthesized without pooling data. MAIN OUTCOMES AND MEASURES Incidence of congenital syphilis; any harms of screening or penicillin treatment in pregnancy. RESULTS Seven studies in 8 publications were included. One observational study evaluated the implementation of syphilis screening in pregnancy in 2 441 237 women in China. From 2002 to 2012, screening for syphilis in all pregnant women increased from 89.8% to 97.2%, and the incidence of congenital syphilis decreased from 109.3 to 9.4 cases per 100 000 live births. Five studies (n = 21 795) evaluated the false-positive findings of treponemal tests and 1 study (n = 318) evaluated the false-negative findings of nontreponemal tests. These studies found that false-positives with treponemal-specific enzyme or chemiluminescent immunoassays were common (46.5%-88.2%), therefore warranting reflexive (automatic confirmatory) testing for all positive test findings. One study (n = 318) found no false-negatives with treponemal tests, and 1 study (n = 139) demonstrated the prozone phenomenon (false-negative response from high antibody titer) with rapid plasma reagin screening using undiluted samples (2.9%). No studies were identified for harms of penicillin in pregnancy. CONCLUSIONS AND RELEVANCE Screening for syphilis infection in pregnant women is associated with reduced incidence of congenital syphilis, and available evidence supports the need for reflexive testing for positive test results.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle L Eder
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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