Syphilis sero-positivity among pregnant women attending public antenatal clinics: A five-year analysis from 15 public clinics in Gaborone, Botswana

Abstract

The prevalence of syphilis in pregnancy varies across the globe and among different age groups within the same country. In sub-Saharan Africa, syphilis prevalence among pregnant women has been found to range from 2.5 to 18% among antenatal clinic attendees, with the highest prevalence in the age group 35-49 years. Also, it is higher in the rural than urban clinics. Objectives: To determine trends in syphilis prevalence using the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) test among pregnant women attending the public antenatal clinics in Gaborone, Botswana (2004-2008). Study design: Cross-sectional study using routinely collected antenatal data. Results: The overall syphilis prevalence amongst pregnant women in Gaborone, Botswana decreased from 2.96% (95% CI, 2.55-3.37) in 2004 to 1.15% (95% CI, 0.89-1.41) in 2008 (p < 0.001). The age specific prevalence per total number of reactive VDRL/RPR was highest amongst pregnant women aged 26 to 30 years (p < 0.001) and lowest for those aged 16 to 20 years (p < 0.025) during the period 2004-2008. However, there were variations in syphilis prevalence rates within and between the clinics. Conclusion: Syphilis sero-positivity in pregnancy in Gaborone, Botswana has been declining for the last five years, but was more prevalent amongst pregnant women aged 26 to 30 years with the lowest prevalence among those aged 16 to 20 years during the period 2004 to 2008. This decline may be attributed to a number of factors and, in particular, the adoption of the syndromic approach for management of sexually transmitted infections in the country.

Using a dual antibody point-of-care test with visual and digital reads to diagnose syphilis among people living with HIV in Botswana

“… 12 The lower proportion of syphilis infection found in our study compared to the earlier study in the HIV clinic population may reflect a reduction in syphilis in the overall population, a general trend that has also been observed in Botswana’s ANC data between 2004 and 2008 and which is attributed to syndromic STI management. 23 However, it is also likely to represent differences in the study populations which were independently selected from the clinic. In the earlier study, all participants were ART-naïve, with a median CD4 cell count of 104 cell/μL and had a lower median age than our population of older, ART-experienced individuals, and no exclusion criteria were noted.…”