The incidence of congenital syphilis in the United Kingdom: February 2010 to January 2015

Abstract

Objective To estimate the incidence of congenital syphilis in the UK. Design Prospective study. Setting and population United Kingdom. Methods Children born between February 2010 and January 2015 with a suspected diagnosis of congenital syphilis were reported through an active surveillance system. Main outcome measures Number of congenital syphilis cases and incidence. Results For all years, reported incidence was below the WHO threshold for elimination (<0.5/1000 live births). Seventeen cases (12 male, five female) were identified. About 50% of infants (8/17) were born preterm (<37 weeks' gestation): median birthweight 2000 g (865–3170 g). Clinical presentation varied from asymptomatic to acute disease, including severe anaemia, hepatosplenomegaly, rhinitis, thrombocytopaenia, skeletal damage, and neurosyphilis. One infant was deaf and blind. Median maternal age was 20 years (17–31) at delivery. Where maternal stage of infection was recorded, 6/10 had primary, 3/10 secondary and 1/10 early latent syphilis. Most mothers were white (13/16). Country of birth was recorded for 12 mothers: UK (n = 6), Eastern Europe (n = 3), Middle East (n = 1), and South East Asia (n = 2). The social circumstances of mothers varied and included drug use and sex work. Some experienced difficulty accessing health care. Conclusion The incidence of congenital syphilis is controlled and monitored by healthcare services and related surveillance systems, and is now below the WHO elimination threshold. However, reducing the public health impact of this preventable disease in the UK is highly dependent on the successful implementation of WHO elimination standards across Europe. Tweetable abstract Congenital syphilis incidence in the UK is at a very low level and well below the WHO elimination threshold.

Factors associated with four atypical cases of congenital syphilis in England, 2016 to 2017: an ecological analysis

“…No syphilis risk factors were identified by their physicians at the time of screening. For two cases, our investigations identified social vulnerabilities that had been highlighted in previous studies [ 3 ]. All four mothers were white and born in the United Kingdom (UK).…”

“…Since 2011, the rapid increase in sexually transmitted infectious syphilis (ST-syphilis) (primary, secondary and early latent) diagnoses among gay, bisexual or other men-who-have-sex-with-men (MSM) in England has contrasted with a low, relatively stable number among heterosexuals [ 1 , 2 ]. Congenital syphilis (CS) is rare in England with only 21 cases occurring between February 2011 and January 2017 (data not shown) and [ 3 ]. Cases have been associated with mothers who were socially marginalised and encountered barriers when accessing antenatal care.…”

Syphilis in Pregnancy: The Reality in a Public Hospital

“…1,2 Facts such as recent syphilis epidemics were reported around the world, including alarming increases in the infection rates in Brazil, meaning that improved care and the prevention of adverse effects are a substantial necessity. [3][4][5] Syphilis, a sexually transmitted disease (STD) caused by the spirochete Treponema pallidum, goes through distinct phases from the moment of infectionprimary, secondary, latent, and tertiary. During pregnancy, there is no alteration on the physical manifestations of any phase, and transmissibility is possible in any stage of the pregnancy.…”

Symptomatic congenital syphilis in a tertiary neonatal unit in Cape Town, South Africa: High morbidity and mortality in a preventable disease

“…[26] The study findings of HSM, petechiae, pallor and jaundice were common clinical signs in symptomatic groups of neonates in other study populations. [14,21,27] However, none of our patients had rhinitis or the 'syphilitic snuffles' , which is quoted to affect 4 -22% of neonates and may be the earliest presenting sign. [14,28] Radiological abnormalities, despite being noted in more than half of the neonates who had long-bone X-rays performed, were lower than rates of 75 -100% quoted in the literature.…”

“…The influence of social factors on maternal antenatal care has been noted in studies from both the developing and developed world, with incarceration, substance use and prostitution mentioned as possible contributors. [21,22] However, social factors may be more complex and multifaceted; for example, Almeida et al [17] identified married women with a single sexual partner and >8 years of education as having high rates of syphilis.…”