Congenital Syphilis: An Overlooked Cause of Prematurity

By: Nanthalile Mugala, Zambia Country Program Leader, PATH

Today is World Prematurity Day, and I would like to raise the issue of congenital syphilis. You may be wondering—why? What does syphilis have to do with prematurity?

A lurking killer

Syphilis is well known as a sexually transmitted infection (STI) affecting adults, but few are aware of its potential effects on newborns. Similar to HIV, syphilis infection can be spread from mother to child during pregnancy or at birth and can cause a variety of complications. Health risks include premature birth, low birth weight, birth defects, stillbirth, and even newborn death. Together, these outcomes of syphilis infection in pregnancy are often referred to as “congenital syphilis.”

Despite its simple prevention and treatment, congenital syphilis remains a major public health burden. The World Health Organization estimates that, in 2012, nearly one million pregnant women worldwide had active syphilis infections, accounting for 1 percent of all pregnancies. This resulted in 150,000 early fetal deaths or stillbirths, 50,000 preterm or low-birthweight infants, 60,000 neonatal deaths, and 110,000 infants with congenital syphilis infection—in other words, thousands of lives lost, many babies born too soon, and others prevented from living up to their full potential. While the majority of these complications occur in low-income countries, this is a problem in the United States, too.

In my country, Zambia, recent data show that approximately 9,100 pregnant women had syphilis infections in 2012, resulting in nearly 3,000 potential complications. Under current health policies and available interventions in Zambia, only about a third of these complications could be prevented. With the right policies and practices, we could do so much more to improve health outcomes.

We have to change this situation.

Simple tools at hand

Syphilis is not a new or mysterious infection; it has been around for a very long time. We know how to prevent it, detect it, treat it, and stop it from being spread from mother to baby. And we have the tools to do so. New rapid syphilis tests (RSTs) are low-cost, easy to use, and can produce accurate results within minutes in health facilities—even those without laboratory services. Penicillin, a low-cost antibiotic that is on Zambia’s Essential Drug List and is readily available at most health facilities around the country, can be given to an infected pregnant woman to treat her and to effectively prevent transmission to her baby.

Caption: Rapid syphilis tests such as this one are a simple, low-cost way to diagnose syphilis within minutes. Photo: PATH

We can tackle congenital syphilis. So why is it still happening?

Zambia made a commitment to eliminate congenital syphilis by 2015 and has guidelines in place for testing and treating syphilis in pregnant women. However, many women are still not tested for syphilis during their antenatal care visits due in large part to stockouts of RSTs. Without the tests, infections go undetected and untreated, and many women remain unaware of their syphilis infection status—even when they deliver.

Policy solutions to eliminate congenital syphilis

One critical way to address the frequent test kit stockouts is to ensure a strong policy and financing environment for procurement and distribution of RSTs. PATH and partners are currently compiling evidence on supply and logistics management for RSTs and innovative testing approaches—such as combination tests for syphilis and HIV—as well as advocating with the government to ensure adequate resources to purchase and distribute the test kits.

But our work doesn’t stop there. To truly eliminate mother-to-child transmission of syphilis, the issue needs to be recognized in broader national policies, strategies, and guidelines related to reproductive health, maternal health, newborn health, and other STIs, so that no woman or baby slips through the cracks.

Syphilis testing must become a routine part of antenatal care, and health workers must have the knowledge and skills for effective testing and treatment. We also need to continue to improve use of antenatal care in Zambia so that all women and their babies can get the full spectrum of testing, treatment, prevention, and educational health services they need.

Don’t forget about syphilis!

Transmission of syphilis from mother to baby can cause preterm birth and other health complications for newborns. Fortunately, we know how to stop it. Photo: PATH/Gabe Bienczycki

As we mark World Prematurity Day, don’t forget about syphilis.

While there are many complex causes of prematurity and other health issues surrounding birth, congenital syphilis is a straightforward one. It is one that we know how to address—one that we can do something about right now.

Lives are at stake in Zambia and around the world. As long as the diverse health communities with a stake in the issue work together, we can eliminate mother-to-child transmission of syphilis.


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