Syphilis management in pregnancy: a review of guideline recommendations from countries around the world

Abstract

Guidelines can help healthcare practitioners manage syphilis in pregnancy and prevent perinatal death or disability. We conducted systematic reviews to locate guidance documents describing management of syphilis in pregnancy, 2003-2017. We compared country and regional guidelines with current World Health Organization (WHO) guidelines. We found 64 guidelines with recommendations on management of syphilis in pregnancy representing 128 of the 195 WHO member countries, including the two WHO guidelines published in 2016 and 2017. Of the 62 guidelines, 16 were for countries in Africa, 21 for the Americas, two for Eastern Mediterranean, six for Europe and 17 for Asia or the Pacific. Fifty-seven (92%) guidelines recommended universal syphilis screening in pregnancy, of which 46 (81%) recommended testing at the first antenatal care visit. Also, 46 (81%) recommended repeat testing including 21 guidelines recommended this during the third pregnancy trimester and/or at delivery. Fifty-nine (95%) guidelines recommended benzathine penicillin G (BPG) as the first-line therapy for syphilis in pregnancy, consistent with WHO guidelines. Alternative regimens to BPG were listed in 42 (68%) guidelines, primarily from Africa and Asia; only 20 specified that non-penicillin regimens are not proven-effective in treating the fetus. We identified guidance recommending use of injectable penicillin in exposed infants for 112 countries. Most guidelines recommended universal syphilis testing for pregnant women, repeat testing for high-risk women and treatment of infected women with BPG; but several did not. Updating guidance on syphilis testing and treatment in pregnancy to reflect global norms could prevent congenital syphilis and save newborn lives.

Early limb paralysis in infants: do not forget about congenital syphilis

“…[2][3][4][6][7][8] This case highlights the need for a major awareness of this disease and supports the opportunity of a second screening in high-risk groups of women. 7,8 It is fundamental to diagnose all cases of congenital syphilis and to notify them to public health for epidemiological purposes. Finally, national observational studies are needed to identify mothers' risk factors for congenital syphilis, in order to tailor the second screening accurately.…”

“…Screening of syphilis during the first trimester of pregnancy is strongly recommended by most countries 2,3,7 . A second screening later in pregnancy is offered only by countries with high rates of congenital syphilis, such as those in Eastern Europe.…”

“…2,3,6,7 In other countries, a second test is offered to women at risk, such as migrant women and women engaging in highrisk behaviors (drug addiction, multiple sex partners, and HIV infection). [2][3][4][6][7][8] Clinicians have a crucial role in the detection of risk factors during pregnancy and in prevention strategies. In countries where only first trimester screening is recommended, it is very important that women are given advice about safe sex in pregnancy.…”

“…A second screening later in pregnancy is offered only by countries with high rates of congenital syphilis, such as those in Eastern Europe. 2,3,6,7…”

Tendência temporal e distribuição espacial da sífilis gestacional e congênita em Goiás, 2007-2017: um estudo ecológico

“…A review which analyzed guidelines for management of syphilis in pregnancy in World Health Organization (WHO) member countries found 64 guidelines with recommendations on management of syphilis in pregnant women published over a 15-year period. 6 Following the same global perspective of the fight against syphilis and other maternal and infant health conditions, the Stork Network (Rede Cegonha) was set up in Brazil in 2011 to provide actions and services with the aim of offering humanized health care during pregnancy, childbirth and the postpartum period and ensuring the right to safe childbirth and healthy child growth and development. Implementation of Rede Cegonha led to expansion of prenatal screening for syphilis, by means of decentralizing rapid tests to Primary Health Care services so as to increase detection capacity.…”