Syphilis in HIV-infected Mothers and Infants

Abstract

Background Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common. Methods We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.

Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015

“…1–9 Furthermore, recent studies have suggested the possibility of increased mother-to-child transmission of human immunodeficiency virus (HIV) among mothers with bacterial STIs. 3,10,11 …”

Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected Pregnant Women and Adverse Infant Outcomes

“…Those findings were also not explained by high rates of untreated maternal syphilis (10%), as they persisted in a second analysis controlling for this variable. (34)…”

Screening for Sexually Transmitted Infections in Antenatal Care Is Especially Important Among HIV-Infected Women

“…5 Serological evidence of syphilis without documented treatment was noted in 10.3% (n=171) of 1664 HIV-infected pregnant women. Fully 1.4% of their 1684 infants (n=24) were dually HIV and syphilis infected.…”

“…1 Along with the previously reported syphilis prevalence of 10.3%, one can speculate that over 20% of women in the HPTN 040 study had a treatable bacterial STI (the number of women co-infected with syphilis and either CT or NG or both was not specified). 1,5 Both CT and NG were detected in 2.5% of women. The overall rate of HIV MTCT was 8.5%.…”

“…Of 6 VDRL-positive newborns with symptomatic syphilis, 2 died and 2 more were HIV-infected. 5 Complementing this analysis, Adachi et al have now provided multivariable assessment of potential contributions of CT and NG bacterial co-infections on the risk of MTCT from the same HPTN 040 study. 1 …”