Towards the elimination of mother to child transmission of syphilis 2015–2020: practice and progress in Zhejiang province, eastern China

Abstract

Objectives To estimate the progress towards elimination of mother-to-child transmission (EMTCT) of syphilis in Zhejiang province. Methods Data were obtained from Zhejiang provincial EMTCT network. Childbearing women infected with syphilis during 2015–2020 were recruited. Joinpoint mode was used to analyze changing trends in syphilis screening, treatment and adverse pregnancy outcomes (APOs). Changing trends were presented as the annual percentage of change (APC). Multivariate logistic regression mode was used to analyzerisk factors of APOs. Results Of 3,658,266 participants, an average maternal syphilis incidence was 0.38%. From 2015 to 2020, the coverage of syphilis screening in pregnancy (96.31% to 99.24%; P < 0.001) and coverage of antenatal health care (ANC) within 13 gestational weeks (55.27% to 77.82%; P = 0.002) were increased.The coverage of maternal syphilis treatment(88.30% to 98.25%; P = 0.001) and adequate treatment (66.92% to 83.37%; P = 0.001) were also increased. Over the years, the APC was -19.30% (95%CI:-24.33 ~ -13.92, P = 0.001) in perinatal death,-26.55% in congenital syphilis(95%CI:-38.75 ~ -11.92, P = 0.009), and -14.67% in other neonatal complications (95%CI:-23.96 ~ -4.24, P = 0.019).In 2020, 11.58% of women had APOs. The rate of syphilis infection during pregnancy increased among women aged (< 20 years) or (≥ 35 years), multiparous, and with pregnancy complications (all P < 0.05).APOs risk increased in women with higher maternal RPR/TRUST titers while it decreased in women who had (adequate) therapy, early ANC, and aged in 21–34 years (all P < 0.001). Conclusions Despite steady progress towards the goal of EMTCT in implementing universal screening and treatment, syphilis continuously affects a large number of pregnant women. Increasing vulnerable women, small proportions of inadequately treated and delay in early ANC should be noticed.

Predicting adverse pregnancy outcomes of pregnant mothers with syphilis based on a logistic regression model: a retrospective study

“…The Chinese government provides comprehensive syphilis intervention services for all pregnant women free of charge. These services included syphilis counseling and testing at the first antenatal care, treatment for positive cases during pregnancy, follow-up service for exposed infants until they were diagnosed or excluded CS, which described in detail in Li and Wang ( 13 , 20 ). This study was approved by the Ethics committee of The Affiliated Infectious Diseases Hospital of Soochow University (No.…”

“…These services included syphilis counseling and testing at the first antenatal care, treatment for positive cases during pregnancy, follow-up service for exposed infants until they were Abbreviations: APO, adverse pregnancy outcomes; CS, congenital syphilis; TPPA, treponema pallidum particle agglutination; AUC, area under the curve; DCA, decision curve analysis. diagnosed or excluded CS, which described in detail in Li and Wang (13,20). This study was approved by the Ethics committee of The Affiliated Infectious Diseases Hospital of Soochow University (No.…”

“…A Portuguese study indicated that sociodemographic, behavioral, and health care factors are determinant factors for gestational syphilis ( 12 ). In addition, a study from Zhejiang Province, China, demonstrated its progress in eliminating mother-to-child transmission from 2015 to 2020: there was a significant increase in both screening coverage and treatment coverage, yet the overall incidence of APOs did not decrease significantly ( 13 ). Studies have used prediction tools to predict HIV risk in pregnant women and to prioritize pregnant women for preexposure prophylaxis ( 14 ).…”

Congenital Syphilis—An Illustrative Review

“…In China, following the development of a national plan to prevent maternal-to-child transmission of syphilis in 2011 that was promoted in 2015, there was a reduction in the incidence of congenital syphilis from 91.6 cases per 100,000 livebirths in 2011 to 11.9 cases per 100,000 livebirths in 2019 [ 4 , 29 ]. In spite of this decrease nationally, due to existing economic (migrant workers), cultural, and ethnic differences in a vast country, there are variations in disease distribution between regions [ 30 , 31 ]. In a prospective cohort study from Shenzen, South China, maternal education, history of syphilis, paternal age, and education were negatively associated with congenital syphilis [ 32 ].…”

Factors associated with adverse pregnancy outcomes of maternal syphilis in Henan, China, 2016–2022

“…Maternal syphilis can cause severe harm to pregnant women, foetuses, and infants. It not only severely affects the quality of life of pregnant women [ 1 ] but also may lead to adverse pregnancy outcomes (APOs), such as preterm birth, stillbirth, and congenital syphilis [ 2 , 3 ]. Studies showed that the incidence of APOs in pregnant women infected with syphilis was significantly higher than that in pregnant women without syphilis [ 4 , 5 ].…”