Is syphilis lurking behind many of the global preterm births and stillbirths?

Every once and a while we need to get back to basics. Yes, we need to focus on the day of birth because of the high incidence of maternal and newborn mortality that occurs on this critical day.

But what insidious factors are at play and underlie problems on the day of birth? What causes that day of birth to occur TOO EARLY IN THE PREGNANCY? What if a certain sexually transmitted disease was easy to detect and easy to treat?

According to the World Health Organization (WHO), each year more than 2 million pregnant women are diagnosed with active syphilis (Treponema pallidum), 65% of which result in adverse pregnancy outcomes: fetal death in early to late gestation (fetal death and stillbirth) or neonatal death soon after birth.

Surviving children diagnosed with congenital syphilis (mother to child transmission) are often born with low birth weight and develop serious problems, such as blindness, deafness, and cognitive impairment. Studies have shown that early intervention by testing and appropriate treatment with penicillin, can eradicate syphilis with a success rate of 98%.

Despite the threat of contracting syphilis in some countries being high, up to one third of the women attending antenatal care (ANC) clinics are not tested for syphilis during pregnancy check-ups. Research shows women who have access to antenatal care in the first two trimesters of their pregnancy and who receive the proper care and follow up, are more likely to have a healthy infant, compared to women screened and treated in the third trimester; making it imperative that effective intervention and care be available early in pregnancy.

Syphilis testing and treatment are relatively inexpensive even in low-resource settings, compared with other interventions, with tests typically costing less than $1 US, and treatment (often a single dose of penicillin) less than that. The magnitude of the congenital syphilis burden, globally, cannot be underestimated; it rivals that of HIV infection in neonates yet receives little attention.

It has been estimated that untreated syphilis in pregnancy can directly cause adverse outcomes in around 50% of cases. In comparison, HIV, if untreated, will result in in-utero transmission around 20%. Syphilis is an entirely treatable disease, however, left untreated, it puts an already at-risk population in even more uncertain circumstances. Paramount to the success of syphilis detection and treatment is the coordination of government policy with health care systems, building awareness, and their respective agencies, who provide screenings and treatment, so that proper antenatal care can lead to healthier mother and child outcomes.


Credit: The research for this post and the post were contributed by Isolde Maher, intern from Mt. Holyoke

1. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001396(Accessed 5/31/13)
2. ibid(Accessed 5/31/13)
3. http://www.cdc.gov/std/syphilis/STDFact-Syphilis-detailed.htm (Accessed 6/1/13)
4. http://www.who.int/bulletin/volumes/91/3/12-107623/en/index.html (Accessed 6/1/13)
5. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0056713 (Accessed 6/1/13)
6.http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001396#s4
7.http://journals.lww.com/stdjournal/Abstract/2007/07001/The_Need_and_Plan_for_Global_Elimination_of.3.aspx (Accessed 5/31/13)
8. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0056713(Accessed 6/1/13)