Features of syphilis seropositive pregnant women raising alarms in Hungary, 2013-2016

Objectives: The incidence of syphilis has been on the rise in Hungary over the last decades. We aimed to assess the syphilis seroprevalence in pregnant women during 2013-2016. The secondary aims were to describe seropositivity by age and gestational age, to estimate infectivity rates in different age groups, and to compare the efficacy of mandatory prenatal screening versus individual venereological testing in revealing syphilis. Study Design: During the above mentioned period the reactive serum samples (N = 527) of 49,965 pregnant women undergoing routine screening were submitted for syphilis verification to the Bacterial STI Reference Laboratory, National Center for Epidemiology, Budapest, Hungary. The confirmation process included titrated RPR and TPHA tests performed simultaneously. The tested women were considered seronegative if both tests gave negative results. When any of these tests proved indeterminate or positive, anti-Treponema pallidum IgG and IgM ELISA tests were performed. Patients confirmed for the presence for specific IgG were judged seropositive. Further evaluation of potential infectivity of seropositive patients was carried out on RPR reactivity. Results: Syphilis seropositivity was detected in overall 2.9%. (N = 148) of the cases. RPR-negative cases, i.e. past infections were confirmed in 36% (53/148); weak-reactive RPR (titres <= 8) cases, i.e. past/early acute infections in 37% (55/148); strong-reactive RPR (titres>8) cases suggesting recent syphilis in 27% (40/148). Half of the infectious syphilis cases (20/40) belonged to the 15-24 age group. The gestational age at screening was available of 123 seropositive women, out of whom 27 (22%) were diagnosed late, in the third trimester. Nineteen (13%) out of all seropositives were detected via individual venereological testing before/instead of general prenatal screening. Conclusions: The majority of infected pregnants may remain undetected due to the lack of mandatory general prenatal screening. The seropositivity for syphilis in pregnancy of 2.9/1000, of which one quarter were recent and infectious, the late diagnosis of syphilis in one in five, and the low pick-up rate of individualised instead of generalized screening are alarming signals and call for more effective prevention strategies, focusing on the most vulnerable adolescents, as well as on the first trimester of pregnancy. (C) 2018 Elsevier B.V. All rights reserved.

Jaar van publicatie:2018

Trefwoorden:A1 Journal article

BOF-keylabel:ja

BOF-publication weight:1

CSS-citation score:1

Auteurs:International

Authors from:Higher Education

Toegankelijkheid:Closed