You are viewing the site in preview mode

Skip to main content

Advertisement

Table 11 Impact of syphilis testing and treatment on stillbirth and perinatal mortality

From: Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy

Source Location and Type of Study Intervention Stillbirths/Perinatal Outcomes
Reviews and meta-analyses
Walker et al. 2001 [124] None. Meta-analysis (Cochrane). 29 RCTs and quasi-RCTs reviewed, 0 studies included. Assessed the impact of antibiotic treatment for syphilis during pregnancy. No data, 0 eligible studies.
Intervention studies
Bique et al. 2000 [130] Mozambique, ANC clinics. Case-control study. 4 suburban ANC clinics (2 intervention clinics, 2 control clinics). Pregnant women (N = 929; N = 453 intervention, N = 476 controls) with positive RPR. Compared the impact of an intervention offering RPR testing with immediate on-site treatment of seropositive cases with 2.4 million IU benzathine penicillin by specially trained nurse-midwives. The study offered to treat partners of intervention group as well. Controls were offered routine syphilis screening protocol requiring testing at a separate lab, return visits, and payment for treatment (< 50% compliance), with no partner treatment option. PMR: 13/1000 vs 34/1000 in intervention vs. control groups, respectively (P = 0.03). Fetal death (miscarriage+SB): 13/1000 vs. 26/1000 (P = 0.159) [NS]
Donders et al. 1997 [128] South Africa (Pretoria), hospital-based. Prospective cohort study. HIV-, RPR+ black urban pregnant women (N = 212; N = 135 received ≥ 1 injection) Assessed dosage impact of 0–3 weekly IM injections of benzathine penicillin G on perinatal outcomes. PMR secondary to congenital syphilis: RR = 20.5 (95% CI: 2.3–184, P = 0.0015). [0 injections: 7/55 (13%) 1 injection: 2/19 (11%) 2 injections: 1/24 (4.2%) 3 injections: 2/82 (2.4%)] Adjusted when Treponemicidal coverage was < 3 wks
Myer et al. 2003 [123] South Africa (Hlabisa district, rural KwaZulu Natal), PHC clinics. Cluster RCT. 7 pairs of clinics. Pregnant women (N = 549). Compared the impact of on-site syphilis testing complemented by laboratory confirmation vs. laboratory testing alone. PMR: adj. RD: -0.9%; 95% CI: (-) 4.4-2.7, P = 0.31) [NS] [33/1000 (18/549) vs. 51/1000 (8/157) in intervention clinics vs. control clinics, respectively.]
Rotchford et al. 2000 [129] South Africa (Hlabisa district, rural KwaZulu Natal), ANC clinics. Cluster RCT. 12 clinics. Pregnant women (N = 1783) screened for syphilis (N = 158 RPR+; 9% prevalence) at first ANC visit (mean: 24 wks); RPR+ women followed for pregnancy outcome (data available for N = 142 (90%); N = 30 had no treatment; N = 96 had all 3 doses penicillin) Assessed impact on PMR of inadequate maternal syphilis treatment in presence of adequate screening. PMR: 15/142 [0 or 1 dose penicillin: 11/43 (260/1000) ≥ 2 doses penicillin: 4/99 (40/1000)] Dose-response relationship observed. (P = 0.0001) PMR risk reduction: 1 dose: 41% reduction 2 doses: 65% reduction 3 doses: 79% reduction
Watson Jones et al. 2002 [127] Tanzania (Mwanza), ANC clinic. Case-control study. Pregnant women (N = 1688; N = 133 high-titre [RPR titre ≥ 1:8, TPHA/FTA+]; N = 249 low-titre [RPR titre < 1:8, TPHA/FTA+], N = 950 seronegative controls). To examine the effectiveness of treatment for maternal syphilis with single-dose IM benzathine penicillin (2.4 million units). Birth outcomes were compared SBR: 23/1000 vs. 25/1000 in treated high-titer women vs. seronegative women. LBW: 6.3% vs. 9.2% in treated high-titer women vs. seronegative women. Adverse pregnancy outcome (combined SBR+LBW): OR = 0.76 (95% CI: 0.4–1.4) [NS].
Observational studies
Delport et al. 1993 [199] South Africa (Pretoria), ANC clinic. Descriptive study. Kalafong Hospital. Pregnant women (N = 1237) attending ANC. Assessed the sensitivity, specificity, negative and positive predictive values of the RPR test at ANC compared with gold-standard laboratory Treponema pallidum haemagglutination test. RPR test: Sensitivity: 92.8% Specificity: 96.3% Negative predictive value: 99.5% Positive predictive value: 64.7%.
Guinness et al. 1988 [125] Swaziland (Mbabane), Public health unit Prospective cohort study. Pregnant women (N = 283) tested at ANC enrollment: N = 37 (13.1%) TPHA+ and RPR+; N = 87 (30.7%) TPHA+ and RPR-. Assessed the impact of antenatal screening on perinatal mortality attributable to syphilis. Mothers were tested prenatally and again at delivery; prenatal test found to have sensitivity = 36% and predictive accuracy = 48%. PMR (untreated active syphilis): 219/1000 (7/32). 12/172 seronegative women had active syphilis (late seroconversion or false negative prenatal test results): 4/12 experienced perinatal death. PMR: 46/1000 (4/87) vs. 28/1000 (4/415) in TPHA+/RPR- vs. syphilis-seronegative women. Screening reduced expected syphilis-attributable PMR from 3.5% to 2.3% (65% of mothers with active syphilis missed treatment; sexual partners were not treated).
Temmerman et al. 2000 [126] Kenya (Nairobi), maternity hospital. Prospective case control study. Women (N = 12414) delivering at Pumwani Hospital were RPR tested (3%, N = 377 were RPR-positive). TPHA testing confirmed syphilis infection (N = 296). Equal numbers of seronegative women also enrolled; records examined for syphilis testing and treatment during pregnancy. Assessed the impact of an antenatal syphilis control programme on pregnancy outcome. Adverse obstetric outcome (LBW or SB): OR = 4.1 (95% CI: 2.3–7.5, P < 0.001). [22.5% vs. 6.6% in untreated syphilis-positive vs. uninfected mothers, respectively.] LBW: OR = 4.0 (P < 0.0001) in untreated syphilis-seropositive mothers vs. uninfected mothers, respectively. SBR: OR = 3.3 (P = 0.028) in untreated syphilis-seropositive mothers vs. uninfected mothers, respectively. OR = 2.5 in treated syphilis-seropositive mothers vs. uninfected mothers, respectively (P < 0.05).