Simple and cheap Syphilis test could save the lives of millions of babies

By Dr. Ananya Mandal, MDJun 16 2011

Syphilis, a sexually transmitted disease that has been a taboo for decades, kills an estimated one million newborn and stillborn babies every year. However a simple test for every pregnant woman followed by antibiotics for those infected would stop the deaths.

Even in the developing world, many public health experts apparently think syphilis is a disease of the past. Yet it is a massive killer of newborn babies. In a report published in Lancet Infectious Diseases, it was revealed that around two million pregnant women are infected with it every year. The outcomes for their babies are dire. In up to 69% of women, the pregnancy will have a tragic outcome - either the baby is stillborn, very tiny and thus vulnerable or disabled.

The Lancet study, led by Sarah Hawkes from University College London, looked at what could be done for pregnant women, reviewing ten studies that had tested interventions in the field. They found that offering women a syphilis test, followed by same-day antibiotic treatment for those infected, more than halved the deaths. It also reduced the numbers of babies born disabled because of congenital syphilis. So just a simple test and a course of antibiotics, costing less than £1 (around $1.60) in total per child, could dramatically reduce the number of newborn deaths and stillbirths.

Hawkes said, “It's incredibly cheap, you can do it with a simple blood test -- and women often have blood tests during antenatal care anyway…But we need to get all women who are pregnant to come to antenatal care early enough to be able to make a difference.”

In a study known as a meta-analysis, Hawkes' team reviewed the evidence for ways of increasing syphilis testing and treatment rates and improving pregnancy outcomes. Their review included 10 studies and more than 41,000 women and showed offering women same-day testing and treatment could cut perinatal deaths - which include stillbirths and miscarriages - by 54 percent. Looking at stillbirths alone, the deaths could be reduced by 58 percent, they found. “What this review shows is that screening is extremely effective at bringing down death rates and illness rates, but unfortunately the majority of pregnant women in the world are still not screened for syphilis,” Hawkes said.

David Mabey and Rosanna Peeling from the London School of Hygiene and Tropical Medicine wrote in an accompanying commentary in the journal that “the perception among many public health experts, programme managers and policy makers that syphilis has disappeared has probably been the greatest barrier to preventing syphilis deaths in babies.”

Funded by the Bill and Melinda Gates Foundation, Mabey and colleagues have been running feasibility projects in seven countries. Two of them, Brazil and Peru, are already embarking on national programs to try to eradicate syphilis as a killer of babies.

The World Health Organization estimates that 12 million new cases of syphilis occur every year. In developing countries, between 3 and 15 percent of women of child-bearing age have it.

In a comment on the study's findings, Peter Piot, director of London School of Hygiene and Tropical Medicine, said it was a reminder that syphilis is not a disease of the past, but a major cause of death for hundreds of thousands of newborn babies. “We can so easily stop this…Syphilis is invisible: if you don't test for it you don't find it,” he said.