Syphilis in Pregnancy in Tanzania. II. The Effectiveness of Antenatal Syphilis Screening and Single‐Dose Benzathine Penicillin Treatment for the Prevention of Adverse Pregnancy Outcomes

Abstract

Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant women was recruited in Tanzania. Birth outcomes were compared among women treated for high-titer (n=133; rapid plasma reagin [RPR] titer > or = 1:8 and Treponema pallidum hemagglutination assay [TPHA]/fluorescent treponemal antibody [FTA] positive) and low-titer (n=249; RPR titer <1:8 and TPHA/FTA positive) active syphilis and 950 uninfected women. Stillbirth or low-birth-weight live births were observed in 2.3% and 6.3%, respectively, of women treated for high-titer active syphilis and in 2.5% and 9.2%, respectively, of seronegative women. There was no increased risk for adverse pregnancy outcome for women treated for high-titer active syphilis (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.4-1.4) or low-titer active syphilis (OR, 0.95; 95% CI, 0.6-1.5), compared with seronegative women. Single-dose treatment is effective in preventing adverse pregnancy outcomes attributable to maternal syphilis.

The need for further integration of services to prevent mother‐to‐child transmission of HIV and syphilis in Mwanza City, Tanzania

“…A previous study in Mwanza, Tanzania, published in 2002, showed that 51% of stillbirths and 24% of pre-term live births could be attributed to syphilis [19,20]. These adverse outcomes can be prevented with a single dose of penicillin given before 28 weeks of pregnancy [19], with this being one of the most cost-effective healthcare interventions available [21].…”

“…These adverse outcomes can be prevented with a single dose of penicillin given before 28 weeks of pregnancy [19], with this being one of the most cost-effective healthcare interventions available [21]. Screening of pregnant women for syphilis is national policy in most countries; yet, in 2001, it was estimated that less than 40% of pregnant women were screened for syphilis in Sub-Saharan Africa [22].…”

Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

“…21 This study allowed the concomitant measurement of the ims s portance and impact of other maternal factors in this population.…”

“…21 In summary, a prospective cohort of 1688 women ats s tending an antenatal clinic (ANC) was recruited from the main ANC in Mwans s za city from 1997 to 2000 to examine the effectiveness of antenatal screening and treatment of syphilis. Women were screened at the ANC for syphilis by the rapid plasma reagin assay (RPR).…”

“…24 As previously described, trichomoniasis was diagnosed using wet preparations and culture, Neisseria gonorrhoeae by culture and C. trachomatis by an enzyme immus s noassay antigen detection test to allow early treatment of infected women. 21 Firstsvoid urine samples (the first few mls of urine passed when voiding the bladder) were tested by the polymerase chain reaction (PCR) for C. trachomatis and N. gonorrhoeae. Anonymous tests s ing for human immunodeficiency virus (HIV) using screening (Vironostika HIV UnisForm II, Organon Teknika, Boxtel, the Netherlands) and confirmas s tory ELISA (Enzygnost® AntisHIV 1/2 Plus, Behring, Marburg, Germany) was performed on stored maternal serum collected at delivery.…”