Congenital Syphilis in Honiara, Solomon Islands

Abstract

Introduction Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis. Methodology All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated. Results Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy. Conclusions In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.

Incidence and causes of stillbirth in the only tertiary referral hospital in the Solomon Islands: a hospital-based retrospective cohort study

“…2 3 24 There is limited evidence regarding population prevalence of syphilis, however a recent study in the Solomon Islands 1:210 liveborn babies had evidence of congenital syphilis. 25 Routine antenatal testing is, thus, recommended as part of antenatal care. [26][27][28] A deficiency in testing of syphilis was evident in our cohort, with 53% (10 babies) of the 19 antenatal stillbirths associated with infection showing overt signs of congenital syphilis infection, however only one-third of the women were tested.…”

“…Syphilis remains a major cause of stillbirth globally 2 3 24. There is limited evidence regarding population prevalence of syphilis, however a recent study in the Solomon Islands 1:210 liveborn babies had evidence of congenital syphilis 25. Routine antenatal testing is, thus, recommended as part of antenatal care 26–28.…”

Chlamydial and gonorrheal neglected sexually transmitted diseases among Pacific Islanders of the Western Pacific Region—A narrative review and call to action

“…From early 2000 to 2019, four research studies from Vanuatu, Samoa, PNG, and the Solomon Islands investigated syphilis in pregnant women and neonates. While most followed WHO recommendations, in PNG, only 84% of neonates were treated; 8% died and 8% were not treated because results were not provided before labor or available prior to discharge [31,32,77,78].…”

Effect of treatment with benzathine penicillin combined with ceftriaxone in elderly patients with latent syphilis

“…Syphilis is a chronic infectious disease caused by Treponema pallidum, and its main route of transmission is through the genitals. It may also be transmitted as neonatal congenital syphilis (mother-to-child transmission) [1,2]. Some patients with syphilis do not show positive signs or symptoms after infection, thereby resulting in these patients not being diagnosed early and causing great inconvenience in the prevention and control of syphilis [3].…”