Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health 2011 11 (Suppl 3):S9.
- Maternal syphilis causes between 730,000 and 1.5 million adverse pregnancy outcomes annually. (1,2)
- Risk of syphilis to the fetus is dependent upon the stage of maternal infection and on the stage of pregnancy at fetal exposure.
- Fetal involvement is most consistent in pregnant women with “active” infections (RPR titre > 1:4), reflecting inadequately treated infections acquired in the five years preceding pregnancy.
- CDC and WHO recommend a single dose of long acting penicillin (e.g. benzathine penicillin) to treat early syphilis, and three doses at weekly intervals for infections of > 1 year (or unknown) duration for infected adults (including pregnant women). (3)
Detection and treatment of active syphilis in pregnancy with > 2.4 MU benzathine penicillin on incidence of clinical congenital syphilis
97% (95% ci: 93-98%) reduction in incidence of clinical congenital syphilis
Moderate quality of evidence – upgraded from low because of large and consistent effect size from 3 observational studies and the fact that confounding is unlikely
Detection and treatment of active syphilis in pregnancy with > 2.4 MU benzathine penicillin on stillbirths
Detection and treatment of active syphilis in pregnancy with > 2.4 MU benzathine penicillin on preterm delivery
- 64% reduction (95% ci: 53-73%) in preterm delivery
- Low quality of evidence – based on large and consistent effect size from 7 observational studies
Detection and treatment of active syphilis in pregnancy with > 2.4 MU benzathine penicillin on neonatal deaths
- 80% reduction (95% ci: 68-87%) in all-cause neonatal deaths
- Low quality of evidence – based on large and consistent effect size from 5 observational studies
Intervention Recommendation: STRONG
- Large and consistent observed effects across studies
- Clear biological mechanism for effectiveness
References from Blencowe Paper Cited Here
- Schmid GP, et al. The need and plan for global elimination of congenital syphilis. Sexually Transmitted Diseases 2007, 34(7 Suppl):S5-10.
- World Health Organization and Department of Reproductive Health and Research. Investment Case for Eliminating Congenital Syphilis: Promoting Better Maternal and Child Health Outcomes and Stronger Health Systems. WHO Geneva Switzerland; 2010.
- Centers for Disease, C: STD Treatment Guidelines 2006. http://www.cdc.gov/std/treatment/2006/congenital-syphilis.htm