Syphilis in pregnancy: an ongoing public health threat

Eppes, Catherine; Stafford, Irene; Rac, Martha

doi:10.1016/j.ajog.2022.07.041

Cited by 22 publications

(17 citation statements)

References 61 publications

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“…Efforts are increasing to establish ongoing provider education about syphilis and public awareness of the national public health crisis. Additionally, experts have called for national clinical and public health networks to serve as resources for generalist obstetricians and gynecologists to contact for management questions, as well as to facilitate communication across state lines regarding historical treatment when faced with questions of treatment adequacy in pregnancy [36].…”

Section: Challenges To Fighting the Syphilis Pandemicmentioning

confidence: 99%

Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem

Adhikari

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review While the clinical disease of syphilis, its consequences in pregnancy, and its sensitivity to penicillin treatment have remained relatively unchanged for a century or more, new technologies and basic discoveries in syphilis research have translated into tangible advances in clinical diagnosis, treatment, and prevention. The purpose of this review is to help the reader understand some of the recent relevant scientific publications on syphilis and its causative organism in a clinical obstetric context. Recent findings Rates of adult and congenital syphilis have risen dramatically in the last decade despite public health efforts. Penicillin shortages and lack of screening or adequate treatment have all contributed to global disease burden. Advances in genomic and microbiological characterization of this spirochete have led to new developments in serologic and molecular diagnosis as well as evaluation of potential vaccine candidates. Until a syphilis vaccine is available, substance use disorders and lack of screening in pregnancy are associated with increased congenital syphilis, and these challenges will require novel solutions to fully address this public health crisis. Summary Addressing the burden of congenital syphilis demands that obstetricians stay well informed of new tools and resources for diagnosis, treatment, and prevention of syphilis now and in the future.

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Section: Challenges To Fighting the Syphilis Pandemicmentioning

confidence: 99%

Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem

Adhikari

2024

Current Opinion in Obstetrics &Amp; Gynecology

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“…Syphilis during pregnancy is the second leading cause of stillbirths globally, and also contributes to preterm birth, low birth weight, neonatal death, and infections in newborns, amongst other conditions [4]. Congenital syphilis (CS) is the condition where syphilis is transmitted from an infected mother to her baby during pregnancy or delivery; it can lead to severe sequelae including stillbirth, neonatal death, low-birth weight and prematurity, sepsis, neonatal conjunctivitis and congenital deformities [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Predicting congenital syphilis: Using machine learning to enhance disease management and control

da Silva Rocha,

de Morais,

Teixeira

et al. 2024

Preprint

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Objective: Sexually Transmitted Infections (STIs) present significant challenges to global public health, affecting physical and mental well-being and straining healthcare systems and economies. This study aims to enhance the predictive performance of models for congenital syphilis prediction by incorporating additional information obtained during gestational follow-up. Building upon the work of Teixeira et al. [1], which utilizes clinical and sociodemographic data, our model was enriched with results from venereal disease research laboratory (VDRL) and rapid tests for congenital syphilis conducted on pregnant women. Method: The dataset utilized in this study comprised 47,604 records spanning the period from 2013 to 2022, with 27 attributes collected from pregnant women enrolled in the Mãe Coruja Pernambucana Program in Pernambuco, Brazil. Among these attributes, we included clinical and sociodemographic factors, as well as results from venereal disease research laboratory (VDRL) and rapid tests for congenital syphilis. Results: Our proposed model surpassed Teixeira's models exhibiting higher specificity (94.74\%) and a slight increase in sensitivity (70.37\%). Conclusions: Our study highlights the value of incorporating additional information from VDRL and rapid tests into models for predicting congenital syphilis. The combined approach involving both clinical, sociodemographic, and test result data enhances the accuracy of predictions thereby facilitating better informed healthcare decisions at different stages of pregnancy. This approach also holds significant potential in combating and managing congenital syphilis by providing assistance to health system decision makers and public policymakers. As a result, it can ultimately enhance the overall outcomes of maternal and child health and contribute to disease control.

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“…CS is preventable with maternal screening and timely and adequate treatment during pregnancy [1]. Despite global initiatives to eliminate mother-to-child transmission of syphilis and CS, analyses of national data from several countries, including the United States of America, Canada, and Brazil, have shown an alarming rise in the number of CS cases [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

et al. 2023

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Background Congenital syphilis (CS) is a major and avoidable cause of neonatal death worldwide. In this study, we aimed to estimate excess all-cause mortality in children under 5 years with CS compared to those without CS. Methods and findings In this population-based cohort study, we used linked, routinely collected data from Brazil from January 2011 to December 2017. Cox survival models were adjusted for maternal region of residence, maternal age, education, material status, self-declared race and newborn sex, and year of birth and stratified according to maternal treatment status, non-treponemal titers and presence of signs and symptoms at birth. Over 7 years, a total of 20 057 013 live-born children followed up (through linkage) to 5 years of age, 93 525 were registered with CS, and 2 476 died. The all-cause mortality rate in the CS group was 7·84/1 000 person-years compared with 2·92/1 000 person-years in children without CS, crude hazard ratio (HR) = 2·41 (95% CI 2·31 to 2·50). In the fully adjusted model, the highest under-five mortality risk was observed among children with CS from untreated mothers HR = 2·82 (95% CI 2·63 to 3·02), infants with non-treponemal titer higher than 1:64 HR = 8·87 (95% CI 7·70 to 10·22), and children with signs and symptoms at birth HR = 7·10 (95% CI 6·60 to 7·63). Among children registered with CS, CS was recorded as the underlying cause of death in 33% (495/1 496) of neonatal, 11% (85/770) of postneonatal, and 2·9% (6/210) of children 1 year of age. The main limitations of this study were the use of a secondary database without additional clinical information and the potential misclassification of exposure status. Conclusions This study showed an increased mortality risk among children with CS that goes beyond the first year of life. It also reinforces the importance of maternal treatment that infant non-treponemal titers and the presence of signs and symptoms of CS at birth are strongly associated with subsequent mortality. Trial registration Observational study.

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Syphilis in pregnancy: an ongoing public health threat

Cited by 22 publications

References 61 publications

Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem

Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem

Predicting congenital syphilis: Using machine learning to enhance disease management and control

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

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