Ten-year trends of syphilis in sero-surveillance of pregnant women in Rwanda and correlates of syphilis-HIV co-infection

Abstract

Syphilis can be transmitted by pregnant women to their children and is a public health problem in Africa. A cross-sectional survey was conducted in 24 antenatal clinics from 2002 to 2003 and increased to 30 sites from 2005 to 2011. Participants were tested for syphilis and HIV. Multi-variate logistic regression was performed to identify risks associated with syphilis and its co-infection with HIV. Results showed that syphilis decreased from 3.8% in 2002 to 2.0% in 2011. Syphilis in the HIV-infected participants increased from 6.0% in 2002 to 10.8% in 2011, but decreased from 3.7% to 1.7% in the HIV-negative participants. In 2011, syphilis in urban participants was 2.7% and 1.4% in rural ones. HIV-infected participants screened positive for syphilis more frequently in both rural (aOR=3.64 [95% CI: 1.56%–8.51%]) and urban areas (aOR=7.26 [95% CI: 5.04%–10.46%]). Older participants (25–49 years) residing in urban areas (aOR=0.43[95% CI: 0.32%–0.58%]) and women with secondary or high education (aOR=0.35[95% CI: 0.20%–0.62%]) were less likely to screen positive for syphilis. HIV-syphilis co-infection was more likely in women residing in urban areas (aOR=8.32[95% CI: 3.54%–19.56%]), but less likely in women with secondary/high education (aOR=0.11[95% CI: 0.01%–0.77%]). In conclusion, syphilis increased in HIV-positive pregnant women, but decreased in HIV-negative women. Positive HIV status and young age were associated risks for syphilis. HIV-syphilis co-infection was associated with a lower level of education and urban residence.

HIV/AIDS and Syphilis Sero-prevalence Among Pregnant Women Attending Antenatal Care Center in Rwanda

“…It was previously reported that 215000 infants are at increased risk of dying from prematurity, low-birth-weight or congenital disease due to HIV/Syphilis co-infection in pregnant women especially in low-income countries [8]. Given the consequences of HIV/Syphilis co-infection in pregnant women in addition to being high-risk group [9,10], the continued surveillance of this co-infection is of paramount to establish the status of the diseases and increase the awareness.…”

Prevalence and predictors of HIV-syphilis co-infection among HIV-infected pregnant women in China, 2011-2018

“…A similar trend of epidemics was found in Asia; the prevalence of syphilis was found at 1.6% in HIV infected women in India [21], at 3.6% in a female sex worker in Karnataka, India [22]. Even though the observed prevalence of syphilis in HIVpositive pregnant women was much lower than those reported by Sub-Sahara countries such as Rwanda, Tanzania, Ethiopia, Uganda and Zambia [13][14] [27] [28], extra attention should be given to those are experiencing HIV-syphilis co-infection, as it was associated with poorer maternal outcomes and higher risk of MTCT of both HIV and Syphilis [34] [35].…”

“…However, without any interventions from gestation, infants who infected congenitally will grow up with pathogens, especially HBV and HIV [3] [4] [9], and transmit those to others at some stage of their lives. Infection of HIV and syphilis in infants often occur simultaneously due to the similar pathways of transmission (i.e., from the placenta) [10] [11] [12] [13] [14] [15]. Maternal co-infection with HIV and syphilis is dangerous.…”

“…HIVsyphilis co-infection is very prevalent in the developing countries that are suffering from poverty and under-serviced health care because fewer resources and fundings are pointed to healthcare systems in these places [23]. Sub-Saharan countries such as Rwanda, Tanzania, Ethiopia, Uganda, Zambia, and Nigeria are coming across a greater problem of maternal HIV-syphilis co-infection than any other part of the world [24][25] [26]. In Congo, it was reported that the HIV-syphilis co-infection occurred at the rate of 0.73% among pregnant women attending antenatal clinics.…”

“…In Congo, it was reported that the HIV-syphilis co-infection occurred at the rate of 0.73% among pregnant women attending antenatal clinics. The syphilis-infection in HIV-positive pregnant women increased from 6.0-10.8% from 2002 to 2011 in Rwanda [14]. Another few cross-sectional studies in Tanzania indicated a co-infection rate was found at around 0.7-1.4% in pregnant women [13][27] [28].…”