Almost A Million Cases of Maternal Syphilis Globally Per year Interview with:

N. Saman Wijesooriya Public Health Advisor/Technical Advisor Centers for Disease Control and Prevention

N. Saman Wijesooriya

N. Saman Wijesooriya
Public Health Advisor/Technical Advisor
Centers for Disease Control and Prevention What is the background for this study? What are the main findings?

Response: The article Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modeling study by Wijesooriya, et al published in the August 2016 issue of The Lancet Global Health (Open source – estimates the incidence and prevalence of maternal and congenital syphilis for both time periods and identifies gaps antenatal care access and syphilis testing and treatment services to assess progress in the global elimination of congenital syphilis, or mother-to-child transmission of syphilis, as a public health problem.

Untreated maternal syphilis is understood to be transmitted from mother-to-child in utero in 50% of cases resulting in tragic adverse pregnancy outcomes, or congenital syphilis infections, including early fetal death, stillbirth, preterm birth, low birthweight, neonatal death, and congenital infections in infants. Since most maternal syphilis infections are asymptomatic, it is recommended that screening for syphilis use a combination of serological tests for pregnant women and treatment of syphilis seropositive women with at least 2.4 million units of benzathine penicillin intramuscularly early in pregnancy to prevent most congenital syphilis infections.

In 2007, the World Health Organization responded to estimates indicating 2 million maternal and 1.5 congenital syphilis infections would occur annually without treatment and launched the global initiative for the Elimination of Congenital Syphilis (ECS). The strategy includes reducing the prevalence of syphilis in pregnant women and mother-to-child transmission of syphilis. The objective is for countries to achieve high performing antenatal care systems providing access to antenatal care to more than 95% of pregnant women, syphilis testing for more than 95% of pregnant women, and treatment for more than 95% of seropositive women to attain a congenital syphilis rate of 50 or fewer cases per 100,000 live births.

In 2008, countries began reporting on three core indicators: syphilis testing, seropositivity, and treatment. Baseline global and regional estimates found 1.4 million maternal and 520,000 congenital syphilis cases. To assess progress, we updated the 2008 estimates and estimated the 2012 global burden of maternal and congenital syphilis.

For 2012, we estimated that 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes including 143,000 early fetal deaths and stillbirths, 62,000 neonatal deaths, 44,000 preterm or low weight births, and 102,000 infected infants worldwide. Sixty-five percent of all adverse pregnancy outcomes occurred because the mother was not tested for syphilis in antenatal care. Africans suffered 64.0% of adverse pregnancy outcomes. Furthermore, our results suggest declines in maternal syphilis infections from 2008 to 2012 by 38% from 1.5 million to 927,000 cases and congenital syphilis infections by 39% from 576,000 to 350,000 cases. Since India represented 65% of the decrease, we excluded India from the analysis and still found an 18% decrease in maternal and congenital syphilis cases globally. What should readers take away from your report?

Response: Despite progress from 2008 to 2012, untreated maternal syphilis still caused substantial preventable perinatal morbidity and mortality. We must improve access to and the quality of early antenatal care by increasing syphilis testing and ensuring adequate and prompt treatment for infected women and their partners, and expanding programmes focused on high-risk groups. What recommendations do you have for future research as a result of this study?

Response: Nationally representative data on the three core indicators — syphilis testing, seropositivity, and treatment — is needed to improve monitoring and evaluation of global, regional, and country-level progress to eliminate congenital syphilis. Is there anything else you would like to add?

Response: The supplementary appendix includes country-level numbers that can be considered by Ministries of Health and international partners to improve congenital syphilis elimination programming. Thank you for your contribution to the community.


Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study
Wijesooriya, N Saman et al.
The Lancet Global Health , Volume 4 , Issue 8 , e525 – e533

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Last Updated on July 29, 2016 by Marie Benz MD FAAD