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Testing for syphilis during pregnancy
Editorial
On March 1, 2012, the Global Congenital Syphilis Partnership, with members including the Bill and Melinda Gates Foundation, Save the Children, WHO, and the US Centers for Disease Control and Prevention, was launched in London. The spur for the launch was a 3 year research project headed by Rosanna Peeling and David Mabey from the London School of Hygiene and Tropical Medicine. The study, to be published soon, screened 150 000 people in Brazil, China, Haiti, Peru, Tanzania, Uganda, and Zambia, and showed the costeffectiveness and practicability of different strategies for the introduction of rapid syphilis testing. The research shows that the number of women and men who come for antenatal check-ups increases if the test and the treatment are offered on the same day. The test costs less than £1 and can provide a result in under 15 minutes. It could be offered to women at their first antenatal check-up along with interventions for prevention of mother-to-child-transmission of HIV, since women with syphilis have an increased risk of acquiring and transmitting HIV infection. Today syphilis, a sexually transmitted disease caused by the bacterium Treponema pallidum, is largely forgotten in developed countries, but elsewhere the disease remains common especially among expectant mothers, who can pass on the disease to their unborn babies. As a result of congenital infection, babies can be stillborn, born early or with low weight, or affected by blindness, deafness, facial deformation, and nervous system problems. In Africa alone, syphilis causes almost 400 000 stillbirths and newborn deaths every year. WHO estimates that worldwide, 2 million pregnant women are infected with syphilis each year and almost 1 million babies are born with congenital syphilis. Given that syphilis is a preventable disease, which if detected before the end of the second trimester is easily treated with penicillin, why is it still such a potent threat in developing countries? Although reliable and simple diagnostic tests for syphilis are available, and screening of pregnant women is an effective health intervention, currently only 30% of women with syphilis are screened and treated. Most countries have policies in place for antenatal syphilis screening, but implementation of these policies in developing countries has often been poor. Lack of www.thelancet.com/infection Vol 12 April 2012
access to laboratories and clinics is an important impediment to screening: for example, many women live in rural areas and have to travel long distances before reaching health facilities that offer screening services. Treatment of sexual partners throughout pregnancy to prevent reinfection after treatment is also essential to prevent transmission of syphilis from mothers to unborn babies, but this is often neglected. Lack of knowledge about the disease among expectant mothers is another important barrier to the uptake of antenatal screening. Because the disease is hard to detect in its early stages and can be asymptomatic for long periods of infection, many women do not know that they are infected and that their babies might be at risk. Stigma in certain communities can also contribute to the lack of demand for services. In the September, 2011, issue of The Lancet Infectious Diseases, Sarah Hawkes and colleagues showed that a simple blood test for pregnant women and same-day treatment of those infected could reduce the incidence of perinatal death and stillbirth attributable to syphilis by about 50%. Greater awareness of the prevalence and dangers of congenital syphilis among populations at risk and their health-care providers is urgently needed to ensure that the basic methods of testing and treatment reach the vast numbers of people in need. The Global Congenital Syphilis Partnership aims to build a broad coalition to invest in the fight against syphilis by providing technical support and looking at new technologies that would help in the screening of both syphilis and HIV. Many countries have progressed toward the fourth Millennium Development Goal (MDG4) of reducing mortality in children younger than 5 years by two-thirds. Between 1960 and 1990, the risk of dying in the first 5 years of life halved. However, neonatal mortality remains high: of the 130 million babies born every year, about 4 million die in the first 4 weeks of life. Given the burden of congenital syphilis, effective control strategies and screening among pregnant women in developing countries will contribute greatly to reducing infant mortality. Syphilis is a major cause of death in newborn babies but it is entirely preventable and curable disease. Test it and you will find it. ■ The Lancet Infectious Diseases
Biomedical Imaging Unit, Southampton General Hospital/SPL
Testing for syphilis during pregnancy
See Correspondence page 269 For Hawkes and colleagues study on syphilis screening see Articles Lancet Infectious Diseases 2011; 11: 684–91 For estimates of neonatal deaths see Articles Lancet 2005; 365: 891–900. For more on congenital syphilis see http://www.ukcds.org.uk/ feature-Congenital_Syphilis___ the_silent_killer-1283.html
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On March 1, 2012, the Global Congenital Syphilis Partnership, with members including the Bill and Melinda Gates Foundation, Save the Children, WHO, and the US Centers for Disease Control and Prevention, was launched in London. The spur for the launch was a 3 year research project headed by Rosanna Peeling and David Mabey from the London School of Hygiene and Tropical Medicine. The study, to be published soon, screened 150 000 people in Brazil, China, Haiti, Peru, Tanzania, Uganda, and Zambia, and showed the costeffectiveness and practicability of different strategies for the introduction of rapid syphilis testing. The research shows that the number of women and men who come for antenatal check-ups increases if the test and the treatment are offered on the same day. The test costs less than £1 and can provide a result in under 15 minutes. It could be offered to women at their first antenatal check-up along with interventions for prevention of mother-to-child-transmission of HIV, since women with syphilis have an increased risk of acquiring and transmitting HIV infection. Today syphilis, a sexually transmitted disease caused by the bacterium Treponema pallidum, is largely forgotten in developed countries, but elsewhere the disease remains common especially among expectant mothers, who can pass on the disease to their unborn babies. As a result of congenital infection, babies can be stillborn, born early or with low weight, or affected by blindness, deafness, facial deformation, and nervous system problems. In Africa alone, syphilis causes almost 400 000 stillbirths and newborn deaths every year. WHO estimates that worldwide, 2 million pregnant women are infected with syphilis each year and almost 1 million babies are born with congenital syphilis. Given that syphilis is a preventable disease, which if detected before the end of the second trimester is easily treated with penicillin, why is it still such a potent threat in developing countries? Although reliable and simple diagnostic tests for syphilis are available, and screening of pregnant women is an effective health intervention, currently only 30% of women with syphilis are screened and treated. Most countries have policies in place for antenatal syphilis screening, but implementation of these policies in developing countries has often been poor. Lack of www.thelancet.com/infection Vol 12 April 2012
access to laboratories and clinics is an important impediment to screening: for example, many women live in rural areas and have to travel long distances before reaching health facilities that offer screening services. Treatment of sexual partners throughout pregnancy to prevent reinfection after treatment is also essential to prevent transmission of syphilis from mothers to unborn babies, but this is often neglected. Lack of knowledge about the disease among expectant mothers is another important barrier to the uptake of antenatal screening. Because the disease is hard to detect in its early stages and can be asymptomatic for long periods of infection, many women do not know that they are infected and that their babies might be at risk. Stigma in certain communities can also contribute to the lack of demand for services. In the September, 2011, issue of The Lancet Infectious Diseases, Sarah Hawkes and colleagues showed that a simple blood test for pregnant women and same-day treatment of those infected could reduce the incidence of perinatal death and stillbirth attributable to syphilis by about 50%. Greater awareness of the prevalence and dangers of congenital syphilis among populations at risk and their health-care providers is urgently needed to ensure that the basic methods of testing and treatment reach the vast numbers of people in need. The Global Congenital Syphilis Partnership aims to build a broad coalition to invest in the fight against syphilis by providing technical support and looking at new technologies that would help in the screening of both syphilis and HIV. Many countries have progressed toward the fourth Millennium Development Goal (MDG4) of reducing mortality in children younger than 5 years by two-thirds. Between 1960 and 1990, the risk of dying in the first 5 years of life halved. However, neonatal mortality remains high: of the 130 million babies born every year, about 4 million die in the first 4 weeks of life. Given the burden of congenital syphilis, effective control strategies and screening among pregnant women in developing countries will contribute greatly to reducing infant mortality. Syphilis is a major cause of death in newborn babies but it is entirely preventable and curable disease. Test it and you will find it. ■ The Lancet Infectious Diseases
Biomedical Imaging Unit, Southampton General Hospital/SPL
Testing for syphilis during pregnancy
See Correspondence page 269 For Hawkes and colleagues study on syphilis screening see Articles Lancet Infectious Diseases 2011; 11: 684–91 For estimates of neonatal deaths see Articles Lancet 2005; 365: 891–900. For more on congenital syphilis see http://www.ukcds.org.uk/ feature-Congenital_Syphilis___ the_silent_killer-1283.html
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