An intervention study to reduce adverse pregnancy outcomes as a result of syphilis in Mozambique

Abstract

Objectives: To create and evaluate an alternative screening approach among pregnant women in order to reduce adverse pregnancy outcome as a result of syphilis in Mozambique. Methods: Four suburban antenatal clinics, two "control" and two "intervention" clinics, were compared regarding syphilis screening and treatment. Pregnant women with positive rapid plasma reagin (RPR) test (n=929) were enrolled, 453 in the intervention and 476 in the control clinics. In control clinics the normal routine regarding syphilis screening was followed for 383 women remaining for follow up. In intervention clinics nurse midwives were trained to perform the RPR test. RPR seropositive cases were immediately treated on site by the nurse midwives and the partners were invited to come any afternoon for treatment. In the third trimester (around 30 weeks) a new RPR test was performed and all women with positive RPR test results were again treated and the partners were invited to come for treatment. Results: At delivery, the drop out rate was 15.7% in the intervention and 20.1% in the control group. The perinatal mortality was significantly higher in the control group than in the intervention group, 3.4% v 1.3% (p=0.030). At delivery the intervention group had significantly more negative RPR results-40.9% v 24.2% (p=0.000). Conclusion: More active training of nurse midwives in antenatal care to perform on site RPR tests, to give syphilis treatment, and to notify partners results in improved perinatal outcome and more seronegative parturient women.

Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera

“…25 Our results on the high proportion of BFP reactions of VDRL tests question the usefulness of employing non-treponemal test procedures for syphilis screening in low-prevalence populations. [26][27][28] If the VDRL test is used as a screening procedure, the proportion of BFPs might be even higher, as found here, because we did not assess the low-titre BFPs in our test protocol. VDRL endpoint titration was only performed for patients with a simultaneously positive TPHA.…”

Relação entre oferta de diagnóstico e tratamento da sífilis na atenção básica sobre a incidência de sífilis gestacional e congênita

“…Estudos controlados exploraram a notificação do parceiro como componente da triagem e tratamento em gestantes com sífilis, e evidenciaram que o tratamento de parceiros estava relacionado à redução de desfechos adversos da gestação em comparação com os grupos em que eles não foram notificados. Porém, esses não investigaram a associação entre a notificação do parceiro e a diminuição da incidência de sífilis congênita 25,26,27 . Considera-se que a notificação e tratamento dos parceiros seja uma estratégia global de redução da incidência geral de sífilis, atuando na redução da incidência de sífilis gestacional.…”

Treatment of maternal syphilis in rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss

“…To date, much of the focus on treatment of syphilis during pregnancy in resource-poor countries has been on the implementation of appropriate screening programmes during antenatal care, often in the form of a serological test conducted on-site by primary care service providers (Bique Osman et al 2000;Beksinska et al 2002). While these services represent a critical step towards reduced perinatal mortality, our findings suggest that there may still be appreciable preventable pregnancy loss in settings where syphilis testing is available but only a single dose of benzathine penicillin is provided as treatment.…”