Evaluation of the management of pregnancies and infants at risk for congenital syphilis: La Réunion, 2008 to 2014

Abstract

Objective:

To evaluate the maternal–fetal management and follow-up of infants at risk for congenital syphilis.

Study Design:

Monocentric retrospective cohort study at the Félix Guyon Hospital, Saint-Denis, La Réunion between January 2008 and December 2014. Management of 38 pregnancies (35 women, 39 fetuses) with a positive syphilis serology was evaluated according to the Centers for Disease Control and Prevention (CDC) guidelines.

Results:

A total of 68% (n=26) of pregnancies were screened before 16 weeks of gestation, and 26% (n=10) had appropriate treatment. Adverse outcomes were noted in 45% of pregnancies. Neonatal serology was not performed in 7 live-born neonates (19%) and 33 infants were classifiable according to the four CDC scenarios. In the infants, adequate complementary evaluation and appropriate treatment were noted in 42% (n=13) and 55% (n=17) of cases, respectively. Rate of infant follow-up was 76% (n=16). No treatment failure was observed in infants.

Conclusion:

Reinforcement of public health policies and a better sensitization, training and collaboration among perinatal caregivers are warranted given the gaps revealed in our study.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1

References

  1. 1

    Centers for Disease Control and Prevention Centers for Disease Control and Prevention, Patton ME Centers for Disease Control and Prevention, Su JR Centers for Disease Control and Prevention, Nelson R Centers for Disease Control and Prevention, Weinstock H . Primary and secondary syphilis—United States, 2005-2013. MMWR Morb Mortal Wkly Rep 2014; 63 (18): 402–406.

    Google Scholar 

  2. 2

    European Centre for Disease Prevention and Control Sexually Transmitted Infections in Europe 2013. ECDC: Stockholm :2015.

  3. 3

    Bouyssou A, Janier M, Dupin N, Alcaraz I, Vernay-Vaisse C, Basselier B et al. La syphilis en France : analyse des données de surveillance sur 10 ans, 2000-2009. Bull Epidemiol Hebd 2011; (26-27-28: 295–298.

    Google Scholar 

  4. 4

    Bowen V, Su J, Torrone E, Kidd S, Weinstock H . Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep 2015; 64 (44): 1241–1245.

    Article  Google Scholar 

  5. 5

    Saloojee H, Velaphi S, Goga Y, Afadapa N, Steen R, Lincetto O . The prevention and management of congenital syphilis: an overview and recommendations. Bull World Health Organ 2004; 82 (6): 424–430.

    PubMed  PubMed Central  Google Scholar 

  6. 6

    Hawkes S, Matin N, Broutet N, Low N . Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 2011; 11 (9): 684–691.

    Article  Google Scholar 

  7. 7

    Renault P, Boidin E, D’Ortenzio E, Balleydier E, Filleul L . Recrudescence de la syphilis à La Réunion: résultats d’une enquête rétrospective 2004-2008. BVS 2010; 6: 2–7.

    Google Scholar 

  8. 8

    Ramiandrisoa J, Aubert L, Lespine EB, Alessandri JL, Robillard PY, Bertsch M et al. Congenital syphilis, Réunion Island, 2010. Emerg Infect Dis 2011; 17 (11): 2082–2083.

    Article  Google Scholar 

  9. 9

    Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Morb Mortal Wkly Rep 2006; 55 (11): 22–33.

    Google Scholar 

  10. 10

    HAS. Recommandations en santé publique. Evaluation a priori du dépistage de la syphilis en France, mai 2007. Available at http://www.has-sante.fr.

  11. 11

    Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ . Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ 2013; 91 (3): 217–226.

    Article  Google Scholar 

  12. 12

    Mise à jour des courbes de morphométrie néonatale. Available at http://www.audipog.net/courbes_morpho.php. Published 6 February 2008. Accessed 2 January 2016.

  13. 13

    Schmid G . Economic and programmatic aspects of congenital syphilis prevention. Bull World Health Organ 2004; 82 (6): 402–409.

    PubMed  PubMed Central  Google Scholar 

  14. 14

    Herremans T, Kortbeek L, Notermans DW . A review of diagnostic tests for congenital syphilis in newborns. Eur J Clin Microbiol Infect Dis 2010; 29 (5): 495–501.

    CAS  Article  Google Scholar 

  15. 15

    Giraudon I, Forde J, Maguire H, Arnold J, Permalloo N . Antenatal screening and prevalence of infection: surveillance in London, 2000-2007. Euro Surveill 2009; 14: 8–12.

    CAS  PubMed  Google Scholar 

  16. 16

    Tridapalli E, Capretti MG, Reggiani ML, Stronati M, Faldella G . Congenital syphilis in Italy: a multicentre study; Italian Neonatal Task Force of Congenital Syphilis for The Italian Society of Neonatology–Collaborative Group. Arch Dis Child Fetal Neonatal 2012; 97 (3): F211–F213.

    Article  Google Scholar 

  17. 17

    Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C et al. UK national guidelines on the management of syphilis. Int J STD AIDS 2015; 27 (6): 421–446.

    Article  Google Scholar 

  18. 18

    Shiber L, Todia WJ . Cost and clinical utility of repeated syphilis screening in the third trimester in a high-risk population. Am J Obstet Gynecol 2014; 210 (3): 267.e1–5.

    Article  Google Scholar 

  19. 19

    Kiss H, Widhalm A, Geusau A, Husslein P . Universal antenatal screening for syphilis: is it still justified economically? A 10-year retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2004; 112 (1): 24–28.

    Article  Google Scholar 

  20. 20

    Singh AE, Romanowski B . Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev 1999; 12 (2): 187–209.

    CAS  Article  Google Scholar 

  21. 21

    Goldenberg RL, Thompson C . The infectious origins of stillbirth. Am J Obstet Gynecol 2003; 189 (3): 861–873.

    Article  Google Scholar 

  22. 22

    Walker GJ, Walker DG . Congenital syphilis: a continuing but neglected problem. Semin Fetal Neonatal Med 2007; 12 (3): 198–206.

    Article  Google Scholar 

  23. 23

    Sothinathan U, Hannam S, Fowler A, Zuckerman M, Reeves I, Tenant-Flowers M . Detection and follow up of infants at risk of congenital syphilis. Arch Dis Child 2006; 91 (7): 620.

    CAS  Article  Google Scholar 

  24. 24

    Centers for Disease Control and Prevention. Congenital syphilis - United States, 2003-2008. MMWR Morb Mortal Wkly Rep 2010; 59 (14): 413–417.

    Google Scholar 

  25. 25

    Qin JB, Feng TJ, Yang TB, Hong FC, Lan LN, Zhang CL . Maternal and paternal factors associated with congenital syphilis in Shenzhen, China: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2014; 33 (2): 221–232.

    Article  Google Scholar 

  26. 26

    Cross A, Luck S, Patey R, Sharland M, Rice P, Chakraborty R . Syphilis in London circa 2004: new challenges from an old disease. Arch Dis Child 2005; 90 (10): 1045–1046.

    CAS  Article  Google Scholar 

  27. 27

    Hawkes SJ, Gomez GB, Broutet N . Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis. PLoS One 2013; 8 (2): e56713.

    CAS  Article  Google Scholar 

  28. 28

    Zhu L, Qin M, Du L, Xie RH, Wong T, Wen SW . Maternal and congenital syphilis in Shanghai, China, 2002 to 2006. Int J Infect Dis 2010; 14 (Suppl 3): e45–e48.

    Article  Google Scholar 

  29. 29

    Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD Jr . Fetal syphilis: clinical and laboratory characteristics. Obstet Gynecol 2001; 97 (6): 947–953.

    CAS  PubMed  Google Scholar 

  30. 30

    Rodríguez-Cerdeira C, Silami-Lopes VG . Congenital syphilis in the 21st century. Actas Dermosifiliogr 2012; 103 (8): 679–693.

    Article  Google Scholar 

  31. 31

    Sánchez PJ, Wendel GD, Norgard MV . IgM antibody to Treponema pallidum in cerebrospinal fluid of infants with congenital syphilis. Am J Dis Child 1992; 146 (10): 1171–1175.

    PubMed  Google Scholar 

  32. 32

    Beeram MR, Chopde N, Dawood Y, Siriboe S, Abedin M . Lumbar puncture in the evaluation of possible asymptomatic congenital syphilis in neonates. J Pediatr 1996; 128 (1): 125–129.

    CAS  Article  Google Scholar 

  33. 33

    Alexander JM, Sheffield JS, Sanchez PJ, Mayfield J, Wendel GD Jr . Efficacy of treatment for syphilis in pregnancy. Obstet Gynecol 1999; 93 (1): 5–8.

    CAS  PubMed  Google Scholar 

  34. 34

    Radcliffe M, Meyer M, Roditi D, Malan A . Single-dose benzathine penicillin in infants at risk of congenital syphilis—results of a randomised study. S Afr Med J 1997; 87 (1): 62–65.

    CAS  PubMed  Google Scholar 

  35. 35

    Paryani SG, Vaughn AJ, Crosby M, Lawrence S . Treatment of asymptomatic congenital syphilis: benzathine versus procaine penicillin G therapy. J Pediatr 1994; 125 (3): 471–475.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to D Ramful.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Le Chevalier de Préville, M., Alessandri, J., Traversier, N. et al. Evaluation of the management of pregnancies and infants at risk for congenital syphilis: La Réunion, 2008 to 2014. J Perinatol 37, 116–121 (2017). https://doi.org/10.1038/jp.2016.158

Download citation

Further reading

Search