The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review

Abstract

Background Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10–15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. Methods Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. Results Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. Conclusion Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.

Factores Asociados Al Crecimiento De Hijos De Madres Con Agravamiento De Transmisión Vertical

“…A sífilis deveria ser uma doença facilmente eliminada, visto que sua triagem ainda no período pré-natal é simples e barata. Somado a isso, têmse que com a descoberta da penicilina, os índices de cura se aproximam a 100%, evitando a transmissão vertical (21) . Infelizmente, ao observar dados epidemiológicos nota-se que os casos de bebês acometidos pela sífilis congênita ainda são elevados, o que demostra uma falha importante dentro da assistência à gestante no âmbito da saúde pública (22) .…”

“…Em relação aos resultados do índice de massa corporal e da antropometria de crianças, filhas de mães diagnosticadas com sífilis durante o período gestacional, chama a atenção o fato de que a exposição à sífilis não influenciou negativamente no crescimento de crianças até 18 meses (21,24) , o que ratifica o declínio dos percentis fora da normalidade até a sexta consulta conforme encontrado em nosso estudo.…”

Limited syphilis testing for key populations in Zimbabwe: A silent public health threat

“…For example, the non-treponemal tests and treponemal combined POCTs have been employed in antenatal care POC testing in low-income countries resulting in higher testing and treatment rates. 33 This will be crucial to addressing the problem of significant overtreatment in KP, particularly in settings where the prevalence of syphilis is high if relying on treponemal POC tests alone.…”

Maternal HIV and syphilis are not syndemic in Brazil: Hot spot analysis of the two epidemics

“…Further, improved communication between institutions within the treatment cascade may increase detection and treatment. The broad adoption of rapid, point-of-care (POC) testing may also contribute to efforts to control syphilis MTCT [34,35]. While rapid POC syphilis testing is encouraged in the prenatal setting [33], VDRL is still commonly used throughout the country [36][37][38].…”