Prevention of Congenital Syphilis Through Antenatal Screenings in Lusaka, Zambia: A Systematic Review

Abstract

Congenital syphilis is one of the preventable diseases caused by the gram-negative bacteria Treponema pallidum; yet, it imposes a serious global health and economic burden, with more than half of the cases resulting in serious adverse outcomes, including infant mortality. Mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million adjusted life years (DALYs) and around $309 million in medical costs. In 2006, an estimated 9.7 million children of age less than five years died in developing countries; almost four million were neonatal deaths. There were 3.2 million stillbirths globally, among whom 95% were in the developing countries. In sub-Saharan Africa, there is an estimated 2.7% (0.1%-10.3%) of pregnant women infected with syphilis, representing more than 900,000 pregnancies at risk each year. There were many non-specific and specific diagnostic tests used in the past, which required laboratory equipment and electricity, but there are many newer tests available now that provide rapid results with high sensitivity and specificity, e.g., the immunochromatographic strip (ICS) and rapid syphilis tests (RST). Early syphilis can be completely eliminated with a single injection of penicillin, which is readily available, cheap, and highly effective, and treating pregnant women with penicillin is 98% effective at preventing congenital syphilis. Targeting women at a high risk of having syphilis makes universal screening in antenatal programs the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a program to prevent congenital syphilis in the perinatal, neonatal, and postnatal periods is evident. While considering resource allocation to child survival programs in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system. In countries like Zambia and other resource-limited settings, a same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis. Eliminating MTCT of syphilis through screening and treatment in antenatal care (ANC) is highly cost-effective in a wide range of settings, especially in countries with a high prevalence.

Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

“…Early screening and treatment of HIV and syphilis help to prevent maternal to fetus transmission. Untreated mothers have a 70–100% chance of transmitting the infection to their fetus, one-third pregnancies results in stillbirth and of the infants of mothers with untreated syphilis, 15% of had clinical evidence of congenital syphilis [ 22 , 23 ]. Moreover, timely initiation of ANC is a good opportunity to discuss with pregnant mothers on birth preparedness and complication readiness plan and helps the mother to receive health promotion and disease prevention services such as immunization against tetanus, nutrition counseling, micro-nutrient supplements, prophylactic treatment of malaria and worms [ 9 , 14 , 21 , 24 ].…”

Case Report: A Delayed Diagnosis of Congenital Syphilis—Too Many Missed Opportunities

“…Several studies show that timely detection of syphilis in pregnant women and appropriate treatment with penicillin result in a reduction in the incidence of clinical congenital syphilis by 97% (11)(12)(13).…”

Impactos da sífilis para o binômio mãe-filho: uma revisão integrativa

“…O estudo 9 retratou a carga global dos casos de sífilis congênita, principalmente em países subdesenvolvidos que possuem pouco recurso, além disso uma das questões mais abordadas foi que a sífilis é uma infecção prevenível e tratável e que a triagem pré-natal se mostra como uma das melhores ferramentas para rastreamento e tratamento precoce a fim de prevenir piores prognósticos para a mãe e o feto. Um dos assuntos que é importante ser abordado é a conscientização das pessoas sobre a seriedade da triagem pré-natal da sífilis para diminuição dos desfechos adversos durante a gravidez (Akhtar & Rehman, 2018) Aliás, os estudos supracitados mostraram através de evidências a importância da captação e tratamento precoces do parceiro ou mais indivíduos que se relacionem com a gestante sexualmente. Pois o tratamento desses é crucial para a prevenção da SC, já que as chances de haver reinfecção da mulher devido ao não tratamento de seus afetos, seja por impossibilidade de rastreamento, não aceitação do tratamento e/ou abandono deste é potencialmente alta, colocando em risco a integridade física do Research, Society andDevelopment, v. 11, n. 10, e57111032308, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i10.32308 binômio mãe-filho.…”