Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand

Abstract

Background The World Health Organization has set a goal to eliminate mother‐to‐child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention. Methods A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria. Results From 2013 to 2017, 69 syphilis‐infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78–164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18–32) years and 12 (17%) women had human immunodeficiency virus co‐infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non‐reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non‐reactive rapid plasma reagin at the age of 7 months. Conclusions Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care.

Fatores associados ao tratamento inadequado da sífilis na gestação: revisão integrativa

“…A partir dos achados, nota-se que os artigos (17)(18)(21)(22)25) trazem como fatores associados ao tratamento inadequado da sífilis na gestação variáveis clínicas relacionadas à gestante, como o tratamento de sífilis antes da gravidez atual e infecção pelo HIV. Os artigos (19)(20)(21)(22) apontam os aspectos sociodemográficos, como a baixa escolaridade, renda e idade materna, que implicam por vezes no desconhecimento acerca da doença e, por conseguinte, o tratamento inadequado.…”

Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review

“…S, et al, 2020 (25) The number of treatment doses was significantly associated with gestational age at the first visit (p = 0.029). Women who presented later in prenatal care were less likely to receive all three doses.…”

“…Based on the findings, it is noted that articles (17)(18)(21)(22)25) bring as factors associated with inadequate treatment of syphilis during pregnancy clinical variables related to pregnant women, such as syphilis treatment before the current pregnancy and HIV infection. Articles (19)(20)(21)(22) point out sociodemographic aspects, such as low education, income and maternal age, which sometimes imply ignorance about the disease and, consequently, inadequate treatment.…”

“…Additionally, other studies (17,(23)(24)(25) indicate the issues of dispensing the drug, prescription and follow-up of treatment, such as temporary lack of medication, failures in prenatal care, including delay or absence of it, delay in receiving the 1 st dose of penicillin, lack of tests or treatment performed less than 30 days before childbirth/ miscarriage and inappropriate prescribing, in terms of dosage and regimen. Partners' low treatment compliance, including the report of being painful, was pointed out in two articles (19,23) .…”

Vaccines for Perinatal and Congenital Infections—How Close Are We?

“…Meanwhile, in low-and middle-income countries syphilis remains at endemic levels due to lack of access to antenatal care visits, missed screening at these visits, and increase in prevalence among key populations such as men who have sex with men and female sex workers (1,258,259). Additionally, there are global drug shortages of benzathine benzylpenicillin, the treatment for syphilis which has been placed on the essential medicines list by the WHO.…”