|Year : 2015 | Volume
| Issue : 1 | Page : 1-2
Congenital syphilis: Marching toward elimination
Yogesh S Marfatia, Ipsa Pandya, Sheethal K Jose
Department of Skin and VD, Medical College Baroda, Vadodara, Gujarat, India
|Date of Web Publication||8-May-2015|
Dr. Yogesh S Marfatia
Department of Skin and VD, Medical College Baroda, Vadodara, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Marfatia YS, Pandya I, Jose SK. Congenital syphilis: Marching toward elimination. Indian J Sex Transm Dis 2015;36:1-2
|How to cite this URL:|
Marfatia YS, Pandya I, Jose SK. Congenital syphilis: Marching toward elimination. Indian J Sex Transm Dis [serial online] 2015 [cited 2019 Sep 16];36:1-2. Available from: http://www.ijstd.org/text.asp?2015/36/1/1/156674
Congenital syphilis is a serious but preventable disease that can be eliminated proactively through effective screening of all pregnant women for syphilis and treatment of those infected including their partner and newborn. In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes, including 143,000 early fetal deaths/stillbirths, 62,000 neonatal deaths, 44,000 preterm/low weight births, and 102,000 infected infants. Nearly 80% of adverse outcomes (274,000) occurred among ANC attendees. From updated 2008 to 2012 estimates, maternal and congenital syphilis decreased by 38% (560,000 and 226,000 cases respectively). India represented 65% of the decline.Despite these declines, maternal syphilis still causes substantial adverse pregnancy outcomes, even among women attending ANC. Improving access to quality ANC, including syphilis testing and treatment, and surveillance are key to achieve EPTCT of syphilis as a public health problem.
The syphilis seroprevalence among the pregnant women in India was reported as 0.38%, the annual burden of syphilis among pregnant women is about 103,960 out of which 53,187 show any adverse outcomes that include 21,488 early fetal loss/stillbirths, 9213 neonatal deaths, 6161 premature or low birth weight babies, 16,324 newborns showing clinical evidence of syphilis. In the Indian scenario, programme data from National AIDS Control Organization (NACO) shows a declining trend of seropositivity of syphilis (as defined as being rapid plasma reagin [RPR]/venereal disease research laboratory [VDRL] positive) among antenatal clinic (ANC) attendees at Designated STI/RTI clinics (DSRCs), from 1.7% in 2005-2006 to 0.8% since 2010-2011.
Global and regional strategies focus on four main pillars consisting of:
- Providing access to the essential ANC package to all pregnant women, preferably in the first trimester
- Early screening of all pregnant women for syphilis
- Treating all syphilis-reactive pregnant women and their partners
- Treating all newborn infants of syphilis-reactive pregnant women.
A national strategy for India "toward elimination of parent-to child transmission (E-PTCT) of syphilis" was launched in February 2015 by NACO under Ministry of Health and Family Welfare and World Health Organization (WHO). This strategy emphasizes the management of syphilis among pregnant women through a functional convergence approach.
The goal of the strategy is to eliminate parent to child transmission E-PTCT of syphilis by 2017. It targets to reduce the incidence of congenital syphilis to <0.3 cases/1000 live births by 2017.The program targets to achieve the above goal are: ANC coverage (pregnant women having at least one ANC visit) of ≥95%, covering of syphilis testing of ANC attendees of ≥95% and treatment of syphilis-reactive ANC attendees of ≥95%.
Screening of all pregnant women for syphilis during their first visit should be done, preferably in the first trimester. Make the results available promptly; testing and handing over of test results should preferably be done on the same day. For those who were not tested earlier, testing needs to be done at the time of delivery. Retest high-risk pregnant women during late pregnancy who had tested negative earlier as peroperational guidelines. Educate and counsel the women about the use of condom and treat the partner to prevent re-infection.
At health care points without laboratories, ANC attendees have to be screened using point-of-care (POC) test. At healthcare service points with laboratory support, ANC attendees can be screened using the RPR or VDRL test. For women coming directly in labor, a POC test will be used. If the screening test was a POC test that was positive, after immediate treatment with one dose of inj. Benzathine penicillin, a second test will be conducted to confirm active syphilis. When the screening test is an RPR/VDRL test, a Treponema pallidum magglutination assay may be conducted, if available, to confirm active syphilis.
National STI guidelines for the treatment of syphilis in pregnancy specify the following:
- In the early stage, a single intramuscular injection of 2.4 million IU benzathine benzyl penicillin
- In the late stage or if the duration is unknown, 3 weekly intramuscular injections of 2.4 million IU benzathine benzyl penicillin.
Alternative regimen for penicillin allergic pregnant patients includes:
- Early stage syphilis: Erythromycin, 500 mg orally, 4 times a day for 15 days
- Late stage syphilis: Erythromycin, 500 mg orally, 4 times a day for 30 days.
All newborns born to syphilis-reactive pregnant women should either receive a prophylactic treatment (regimen 1) or a curative treatment (regimen 2).
| Prophylactic Treatment (Regimen 1)|| |
All asymptomatic infants with no serological evidence of syphilis and born to mothers who were adequately treated for maternal syphilis during current pregnancy 4 weeks prior to delivery should be treated with a single dose of benzathine penicillin G 50,000 units/kg given as a single intramuscular injection.
| Curative Treatment (Regimen 2)|| |
It should be given to:
- All symptomatic infants
- All asymptomatic infants born to mothers who:
- Were treated with penicillin <4 weeks before delivery
- Were treated with nonpenicillin regimens
- Treatment status unknown
- All infants fulfilling anyone of the following criteria:
Whose RPR/VDRL titer is four-fold higher than that of the mother at delivery
- Born to mothers with clinical evidence of syphilis
- Born to mothers whose RPR/VDRL titer did not drop four-fold
- Having a rising RPR/VDRL titer.
Includes aqueous crystalline penicillin G 100,000-150,000 units/kg/day intravenously. It could be given as 50,000 units/kg/dose IV every 12 h during the first 7 days and thereafter every 8 h for next 3 days. Alternatively procaine penicillin 50,000 units/kg body weight can be given intramuscularly daily for 10 days.
Active participation of the members of Indian Association for the Study of Sexually Transmitted Diseases and AIDS will go a long way in achieving the goal of eliminating Congenital Syphilis from our country.
The National Strategy and Operational Guidelines towards Elimination of Congenital Syphilis, 2015 published by NACO under Ministry of Health and Family Welfare and WHO.