RotchforK, et al, 2000(1717 Rotchfor K, Lombard C, Zuma KK. Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial. Trop Med Int Health. 2000;5(11):800-4. https://doi.org/10.1046/j.1365-3156.2000.00636.x
https://doi.org/10.1046/j.1365-3156.2000...
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Complete treatment of syphilis: three doses of penicillin at weekly intervals; appropriate treatment of syphilis: at least two doses of penicillin at weekly intervals. |
Inadequate treatment: one dose or less of penicillin received. |
158 positive tests, with the prevalence of syphilis estimated at 9%. |
The mean age was 25 years. The mean gestational age at the first antenatal visit was 24 weeks, and a history of previous perinatal death was reported by eight (7%) of 115 previously pregnant women. |
30 (19%) received no treatment for syphilis, 20 (13%) received one dose of penicillin, 12 (7%) received two doses, and 96 (61%) received the recommended three doses. Thus, 50 (32%) women were considered inadequately treated. The average number of doses received was 2.1. The average delay of diagnosis until the first dose of penicillin was 20 days, for the second dose, it was 27 days, and among those who completed treatment, the mean time to completion was 34 days. Partner treatment: 78 (86%) reported receiving a contact card. Of these, 70 (77%) reported informing their partners about the need for treatment, but only 24 (26%) reported being sure that they had received it |
Among inadequately treated pregnant women, the mean gestational age at the first prenatal visit was 27 weeks versus 23.6 for those who were adequately treated (p < 0.0001). The mean number of penicillin doses received was 0.4 versus 2.9 (p < 0.0001), respectively. the median delay to the first dose of penicillin was 31 days versus 18 (p < 0.0001), respectively. The median gestational age at the first dose of penicillin was 31 weeks versus 26 (p 0.0003), respectively. The number of perinatal deaths was 11 deaths versus 4 (p<0.0001). |
Mullick S, 2005(1818 Mullick S, Beksinksa M., Msomi S. Treatment for syphilis in antenatal care: compliance with the three doses standard treatment regimen. Sexually Transmitted Infections. Sex Transm Infect. 2005;(3):220-2. https://doi.org/10.1136/sti.2004.011999
https://doi.org/10.1136/sti.2004.011999...
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Three doses of penicillin |
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188 women were considered positive for syphilis, a prevalence rate of 1.03%. |
The mean age of pregnancy at the first prenatal visit was 26 weeks, with 17% presenting at 30 weeks or later. Few women attended consultation before 20 weeks of gestation (10.7%). |
Of 186 (2 missing), 64.8% of women received all three doses, 5.8% received two doses, 13.2% received one dose, and 15.9% of women received no treatment. The mean time elapsed from the test to receiving the first dose of treatment was 34 days. The majority (81%) were treated for the first time after 14 days and almost a fifth (18%) waited at least 2 months for the test to start treatment. |
The number of treatment doses was significantly associated with gestational age at the first visit (p = 0.029). Women who presented later in prenatal care were less likely to receive all three doses. |
Brito ESV, et al, 2009(1919 Brito ESV, Jesus SB, Silva MRF. Sífilis congênita como indicador de avaliação da assistência ao pré-natal no município de Olinda (PE), Brasil. Rev APS [Internet]. 2009 [cited 2021 Oct 07];12(1):62-71. Available from: https://periodicos.ufjf.br/index.php/aps/article/view/14199/7684
https://periodicos.ufjf.br/index.php/aps...
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VDRL (Venereal Disease Research Laboratory), which should be performed in the first and third trimesters of pregnancy, and cure control for pregnant women and partners with a positive diagnosis. |
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A total of 234 cases of congenital syphilis were recorded. |
The highest proportion of congenital syphilis occurs among women over 20 years of age, with less than 8 years of education, and 83.25% of them underwent prenatal care. |
Both women (89.96%) and their partners (92.11%) were inadequately treated. Also, 36.9% of the group did not control the cure of VDRL positive pregnant women, and the majority (78.3%) had problems to carry out the treatment of partners of pregnant women. |
According to nurses, poverty and ignorance are the main barriers they face to perform adequate treatment of pregnant women and their partners, including laboratory tests (54.3%). The first is the main cause that prevents access to health services. As for the second, fear and lack of knowledge about sexually transmitted diseases motivate users to refuse treatment for infections, especially by their partners. |
Zhu L, et al, 2010(2020 Zhu L, Qin M, Du L, Xie R, Wong T, Wern SW. Maternal and congenital syphilis in Shanghai, China, 2002 to 2006. Int J Infect Dis. 2010;14(3):45-8. https://doi.org/10.1016/j.ijid.2009.09.009
https://doi.org/10.1016/j.ijid.2009.09.0...
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Primary, secondary and early latent syphilis: benzathine penicillin G (4.8 million units) intramuscularly in two doses (9.6 million units total) weekly. Late latent syphilis: benzathine penicillin G (2.4 million units) intramuscularly in three doses (7.2 million units total) weekly. |
Cases of maternal syphilis that did not complete a full course of treatment were considered treated incompletely |
A total of 1,471 cases of maternal syphilis (298.7 per 100,000 live births) were identified. The maternal syphilis rate was 156.2 per 100,000 live births in Shanghai residents and 371.7 per 100,000 live births in the migrant population. |
Among the identified cases of syphilis, the mean age was 27.2 years. The majority were unemployed (888) |
392 had incomplete treatment. |
They were associated with low compliance with treatment, lower maternal education, and in the incomplete treatment group, only 24% had completed high school or higher education versus 76% in the complete treatment group (p <0.05), lower paternal education, whereas, in the incomplete treatment group, 26% completed high school or higher versus 74% in the full treatment group (p < 0.05) and an abnormal reproductive history, which occurred in 35.9% of incomplete treatment cases versus 64.1% in the full treatment group (p <0.05). |
Chávarro MAS, et al, 2017(2121 Silva-Chávarro AM, Bois-Melli F. Factors associated with failure in the diagnosis and treatment of maternal syphilis. Study of cases and controls. Rev Mex Pediatr [Internet]. 2017 [cited 2021 Oct 07];84(2):54-60. Available from: https://www.medigraphic.com/pdfs/pediat/sp-2017/sp172c.pdf
https://www.medigraphic.com/pdfs/pediat/...
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Three doses of benzathine penicillin one week apart and receiving the last dose at least one month before childbirth. |
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There were 54 cases of congenital syphilis recorded with an incidence rate of congenital syphilis of 13.4 cases per 1,000 live births in 2014. In the following year, 55 cases of congenital syphilis were recorded, with an incidence of 15 cases per 1,000 live births. |
There were 106 cases of congenital syphilis. The mean maternal age in the group of congenital syphilis cases was 22 years, and 25 in the control group. 6% of mothers with syphilis did not complete elementary school, and in the control group, 2%. |
Of the 106 cases identified, 66 (62.3%) were born to women diagnosed in the postpartum period, indicating failure to diagnose, and 40 (37.7%) from women diagnosed during prenatal care, but who received treatment inappropriately. |
In the logistic regression model, the factors related to treatment failure were newborns of mothers with ≤ 5 prenatal visits were 2.85 times more likely to fail in treatment, compared to those with more than 5 visits (95% CI: 1.29-6.28). Mothers aged ≤ 18 years were 4.07 times more likely to fail treatment compared to those aged over 18 years (95% CI: 1.43-11.57). |
Hong F, et al, 2017(2222 Hong FC, Wu XB, Yang F, Lan LN, Guan Y, Zhang CL, et al. Risk of Congenital Syphilis (CS) Following Treatment of Maternal Syphilis: Results of a CS Control Program in China. Clin Infect Dis. 2017;65(4):588-94. https://doi.org/10.1093/cid/cix371
https://doi.org/10.1093/cid/cix371...
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Intramuscular benzathine penicillin G, regardless of disease stage, for at least 1 course (2.4 million units once a week for 3 consecutive weeks). Penicillin-allergic pregnant women were treated with erythromycin 500 mg orally 4 times a day for 15 days. Azithromycin should be given 500 mg orally once a day for 10 days. Ceftriaxone sodium injection of 1 g daily for 10 days should be administered. |
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162 babies were diagnosed with congenital syphilis, a general incidence of 3.41%. Among children born to women seropositive for syphilis and treated appropriately before pregnancy, the incidence was 0.22%. There were 159 cases of congenital syphilis in 3,519 babies born to women seropositive for syphilis during pregnancy, an incidence of 4.52%. |
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The results of the multivariate analysis showed that women with complete or incomplete primary education were 1.5 times more likely not to treat syphilis compared to those with high school and higher education. (95% CI: 1.17-1.92). Local residents were 1.38 times more likely not to treat syphilis compared to those who were not local residents (95% CI: 1.00-1.88). Those who consulted antenatal clinics in less developed areas were 1.62 times more likely to not be treated for syphilis compared to those who consulted antenatal clinics in more developed areas (95% CI: 1.38-1.91). Those who had their first prenatal visit at the 28th week of gestation or later were 21.47 times more likely not to treat syphilis compared to those who had consultation in less than 28 weeks (95% CI: 18.07-25.50). HIV-infected mothers were 4.01 times more likely not to treat syphilis compared to non-infected mothers (95% CI: 1.08-14.93), and women who treated syphilis before their current pregnancy were 1.65 times more likely not to treat syphilis compared to those who did not previously treat (95% CI: 1.36-2.02). |
Nunes, JT, et al, 2017(2323 Nunes JT, Marinho AV, Davim RMB, Silva GGO, Felix RSA, Martino MMF. Syphilis in gestation: perspectives and nurse conduct. Rev Enferm UFPE. 2017;11(12):4875-84. https://doi.org/10.5205/1981-8963-v11i12a23573p4875-4884-2017
https://doi.org/10.5205/1981-8963-v11i12...
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Benzathelin penicillin, completed 30 days before childbirth, with partner being treated concomitantly. |
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From the speeches, categories emerged: Actions of nurses in monitoring pregnant women with syphilis; Aspects that hinder the effectiveness in gestational syphilis treatment; Syphilis: notifiable disease; Temporary lack of medication necessary for treatment; Absence of a protocol to ensure that nurses provide care to pregnant women with syphilis; Low compliance of partners and pregnant women with treatment, reporting it to be quite painful. |
Kidd S, et al, 2018(2424 Kidd S, Bowen VB, Torrone EA, Bolan G. Use of National Syphilis Surveillance Data to Develop a Congenital Syphilis Prevention Cascade and Estimate the Number of Potential Congenital Syphilis Cases Averted. Sex Transm Dis. 2018;45(suppl 1):23-8. https://doi.org/10.1097/OLQ.0000000000000838
https://doi.org/10.1097/OLQ.000000000000...
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Receiving the appropriate penicillin regimen for the maternal stage of syphilis started at least 30 days before childbirth. |
Mothers without relevant documentation from any of services deemed appropriate were considered to have not received treatment. |
There were 628 reported cases of congenital syphilis in the United States in 2016. |
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Of the 2,508 pregnant women with syphilis, 2,208 (88%) received prenatal care at least 30 days before childbirth, 2,242 (89.4%) were tested for syphilis at least 30 days before childbirth, 1,928 (76.9%) received an adequate treatment regimen and started at least 30 days before childbirth, 48 (7.6%) mothers of reported cases of congenital syphilis received an appropriate treatment regimen for their syphilis stage and started at least 30 days before childbirth, and 580 (92.4%) did not. |
The most common reason for not receiving adequate treatment started at least 30 days before childbirth was the lack of tests at least 30 days before childbirth (n = 266; 45.9% of those not treated properly; 42.4% of all cases). Eighty-eight mothers (15.2% of those not properly treated; 14.0% of cases) were tested for syphilis at least 30 days before childbirth, tested positive, but did not receive treatment at least 30 days before childbirth. |
Anugulruengkitt S, et al, 2020(2525 Anugulruengkitt S, Yodkitudomying C, Sirisabya A, Chitsinchayakul T, Jantarabenjakul W, Chaithongwongwatthana S, et al. Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand. Pediatr Int. 2020;62(3):330-6. https://doi.org/10.1111/ped.14132
https://doi.org/10.1111/ped.14132...
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Untreated syphilis, undocumented therapy, use of antibiotics other than benzathine penicillin, insufficient dosing regimen, inadequate serologic response to treatment (<4-fold reduction in nontreponemal titers within 3 months), or therapy not taken within 1 month of childbirth. |
The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100,000 live births. |
The median maternal age was 21 years, and 12 (17%) had HIV co-infection. The median gestational age at the time of diagnosis of syphilis was 23 weeks, with 25 (36%) diagnosed during the third trimester, followed by 22 (32%) and 11 (16%) during the second and first trimesters. |
Of 69 pregnant women, there were 28 (41%) women with inadequate treatment. |
The most common cause of lack of treatment was delay or absence of prenatal care, 13 (19%). Six (8%) were not treated or had incomplete treatment due to recent infection near childbirth. Five (7%) did not receive adequate treatment due to failure to provide and follow up on treatment. For example, no system to call back for treatment despite positive test results, or loss of follow-up during referral or after starting treatment. Four (6%) had inappropriate treatment in terms of dosage and regimen. |
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