Syphilis in pregnancy widespread but preventable

Syphilis is still a widespread problem among pregnant women worldwide, despite tests and treatment being inexpensive and readily available, show study findings.

"This analysis indicates that syphilis continues to be an important cause of adverse outcomes of pregnancy, including substantial numbers of perinatal deaths and disabilities," say Lori Newman (World Health Organization [WHO], Geneva, Switzerland) and colleagues in PLoS Medicine.

They add: "Primary prevention of syphilis in people of reproductive age is an important first step towards reducing these deaths."

Using WHO databases, Newman and team analyzed national syphilis seropositivity data from 97 countries and antenatal care (ANC) coverage for women with syphilis from 147 countries for 2008.

They found that approximately 1.36 million pregnant women had probable active syphilis, of whom 80% had attended appropriate ANC.

The researchers estimated that the number of adverse pregnancy outcomes caused by maternal syphilis worldwide in 2008 was approximately 520,905. This number included approximately 212,327 stillbirths (>28 weeks of gestation) or early fetal deaths (22-28 weeks of gestation), 91,764 neonatal deaths, 65,267 preterm or low birth weight infants, and 151,547 infected newborns.

Although Newman and co-authors estimate that 26% of the adverse outcomes were likely to have been averted in 2008 by the intervention of clinical services, around 66% of the adverse outcomes seen in women attending ANC were in those who were not tested or treated for syphilis.

Important data regarding syphilis seropositivity was missing for many countries in Europe, the Mediterranean, and North America, note the researchers, who say this influenced their findings. However, it is clear from the survey results that significantly improved syphilis testing and treatment of pregnant women is needed in many places, they add.

"In 2007, WHO launched its Initiative for the Global Elimination of Congenital Syphilis, with the goal that by 2015 at least 90% of pregnant women are tested for syphilis and at least 90% of seropositive pregnant women receive adequate treatment," explain the researchers, adding that in order to reach this goal more work is needed.

They suggest that "efforts are needed to ensure universal access to early antenatal care, as well as improved quality of antenatal care so that all pregnant women receive an essential package of services that includes routine and early access to point-of-care testing and adequate treatment for syphilis if seropositive."

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