Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia

Abstract

a b s t r a c t a r t i c l e i n f oKeywords: Antenatal care Congenital syphilis Penicillin Rapid syphilis tests Objective: To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. Methods: In March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6 months prior to RST introduction), midline (0-6 months after RST introduction), and endline (7-12 months after RST introduction). Results: Data collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P b 0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P = 0.199) RST introduction with low treatment rates throughout. Conclusion: With RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis. © 2015 World Health Organization; licensee Elsevier. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). BackgroundGlobally, it is estimated that approximately 1.4 million annual cases of syphilis occur during pregnancy [1]. A recent meta-analysis demonstrated that, among asymptomatic, untreated pregnant women with syphilis, fetal loss and stillbirth, neonatal deaths, and prematurity/low birth weight were 21%, 9.3%, and 5.8%, respectively, more frequent when compared with women without syphilis [2]. Treatment of syphilis-seroreactive pregnant women with 1 dose of intramuscular penicillin at least 30 days prior to delivery reduces the risk of adverse pregnancy outcomes to that of a non-infected mother, although full treatment of latent maternal syphilis requires three doses of intramuscular penicillin [3][4][5]. However, modeling data suggest that less than 10% of women with syphilis during pregnancy are screened and appropriately treated [1], despite the 2007 World Health Organization's Global Elimination of Congenital Syphilis initiative goals of testing more than 90% of pregnant women and of treating more than 90% of those who are seroreactive by 2015 [6].Recently-developed rapid syphilis tests (RST; BIOLINE, Korea) have a high sensitivity (85.7% to 100%) and specificity (96% to 100%), and do not require the traditional laboratory infrastructure used for rapid plasma reagin (RPR) tests [7][8][9]. Previous studies have suggested increased syphilis screening post-RST implementation, but longerterm evaluation of screening rates after initial training is needed [10]. In March 2012, the Elizabeth Glaser Pediat...

Assessment of Two Rapid Assays for Diagnostic Capability to Accurately Identify Infection by Treponema pallidum

“…There are a large number of reports in the literature describing rapid, point-of-care syphilis tests that detect antibodies to T and a lesser number for NT. A number of studies, including a metaanalysis describing 18 tests (10), have been published that describe the performance of rapid and point-ofcare syphilis tests to detect antibodies to T (2,5,6,7,9,(11)(12)(13)(14)(15)(16) and with multiplex tests that detect antibodies to T and to HIV simultaneously (16, 20-24, 28, 29). However, there is variation in the reported performance of these rapid tests, with sensitivities and specificities between 84% and 98%, and 94% and 98%, respectively; sensitivities when using whole blood samples are lower (7,10,15).…”

“…The purpose of this study was to validate the manufacturers' claims by evaluating 2 commercial rapid assays that detect infection by T. pallidum by assessing antibody reactivity to T and, for 1 assay, additionally to NT. There have been a number of studies that assess syphilis assays (2,5,6,7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), but none have evaluated these 2 tests using the same panel of samples under the same laboratory conditions. These tests represent 2 of the several major rapid tests to detect specific antibodies to T. pallidum that are available in the world market.…”

A study on usefulness of a set of known risk factors in predicting maternal syphilis infections in three districts of Western Province, Zambia

“…The sensitivity of this study's assessment criteria however, with its inherent limitations was inferior to the widely recommended on-site rapid syphilis screening tests such as treponemal-based immuno-chromatographic strips (ICS). The latter have been reported to have field sensitivities ranging from 85 to 95% [ 28 , 29 ]. The possible sources of bias included information bias as it is unclear whether there were any risk factors relevant to the local study population omitted from the assessment criteria.…”

Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis

“…They are usually carried out in finger-stick blood samples, are simple to perform, and their results are easy to interpret, being available in approximately 20 minutes. These tests have good sensitivity and specificity, comparable to those of conventional NTT and TT [ 10 , 35 , 37 - 38 ].…”

“…As penicillin has a high efficacy against Treponema pallidum infection in pregnancy, MTCT of syphilis could virtually be eliminated. Several strategies have been proposed to achieve this goal, which is, however, far from being attained in most populations; syphilis in pregnancy continues to be a major global problem in the second decade of the 21st century [ 1 - 10 ]. More women have syphilis than HIV infection and, taking into account only untreated pregnant women, MTCT of syphilis (nearly 100%) is higher than that of HIV (around 30%).…”