Congenital Syphilis - the silent killer

The World Health Organisation (WHO) estimates that across the world, two million pregnant women each year are infected with syphilis. Approximately 1.2 million of these women transmit the infection to their baby, who may be stillborn, born early, born with a low weight or congenitally affected as a result.

Congenital syphilis is entirely preventable if syphilis in pregnancy is diagnosed and treated. Currently however, only 30% of pregnant women with syphilis are screened and treated, even though universal screening of pregnant women is recommended policy in many countries.

World Bank/Mellisa Thompson/ USAID

The major obstacle to screening is the lack of access to laboratories that can offer screening as women often have to travel long distances to reach a hospital or clinic with such services.

The research
Simple rapid tests are now commercially available; they can be used anywhere without equipment, are easy to use and give a result in 15 minutes.

A three year research project undertaken by the London School of Hygiene and Tropical Medicine (LSHTM) has sought to demonstrate the feasibility and cost effectiveness of using rapid tests to increase access to syphilis screening. The research has taken place across seven countries, where over 150,000 people have been screened and over 90% of those testing positive have received immediate treatment.

The research has shown that a simple test, plus a single dose of penicillin will prevent the adverse pregnancy outcomes caused by syphilis for less than £1 per unborn child. The World Development Report cites antenatal screening and treatment for syphilis as one of the most cost effective health interventions.

World Bank/Mellisa Thompson/ USAID

The study has also shown that it is beneficial to integrate antenatal syphilis screening with prenatal services and Prevention of Mother To Child Transmission programmes for HIV. There is evidence to suggest that syphilis enhances the sexual transmission of HIV, and some to suggest it enhances mother to child transmission of HIV; therefore screening and treatment for syphilis could help reduce the incidence of HIV. By providing access to syphilis screening and treatment, research has shown increased antenatal clinic attendance for both HIV and syphilis.

The most cost effective way to save lives
This three year study has led to many policy advances across the developing world. The WHO has indicated this research will be considered as a potential case study for the World Health Report 2012 for its innovative approach in ensuring the rapid translation of research into policy and practice.

Key facts

• Approximately 1.2 million pregnant women infected with syphilis globally transmit the infection to their baby
• Three year study to demonstrate the cost effectiveness and feasibility of using rapid tests to increase access to syphilis screening
• Study carried out across seven countries:China, Uganda, Tanzania, Zambia, Brazil,Peru and Haiti, with 150,000 people screened.
• Rapid tests shown to be easy and affordable, providing a result in 15 minutes at a cost of less than £1 per unborn child.
• Tackling congenital syphilis will have an impact on neonatal deaths, a target of Millennium Development Goal four.

Research funders
The Bill and Melinda Gates Foundation

Collaborating research organisations

• The London School of Hygiene and Tropical Medicine, London, UK
• TDR, a Special Programme for Research and Training in Tropical Diseases, WHO;
• Universidad Peruana Cayetano Heredia, Lima, Peru
• National Institute for Medical Research, Mwanza, Tanzania
• Alfredo da Matta Foundation, Manaus, Brazil
• National Centre for STD Control, China CDC, Nanjing, People’s Republic of China
• Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centre, Port-au-Prince, Haiti
• Elizabeth Glaser Pediatric AIDS Foundation,Kampala, Uganda and Lusaka, Zambia.

For further information, please contact  Beth Downe, London School of Hygiene and Tropical Medicine
Tel: +44 (0) 20 7927 2010