1166. Reverse Syphilis Screening and Adherence to The Congenital Syphilis Guidelines: Institutional Experience

Background This study is analysis the consequences of the reverse syphilis screening on the management of newborns exposed to maternal syphilis, and pediatric physicians’ adherence to the existing guidelines. Methods We conducted a 5-year retrospective review of the maternal population and their newborns diagnosed with syphilis. Women with positive results (TT+/NTT+) and discordant (TT+/NTT-/TT+) and their newborns were included in the analysis. Results Per American Academy of Pediatrics (AAP), the 202 newborns were divided in two groups: proved or highly probable and possible congenital syphilis (Group A, n=102) and less likely and unlikely congenital syphilis (Group B, n=100). Except for the RPR, none of the other laboratory tests showed higher odds for predicting congenital syphilis. The RPR titers above 1:16 were only identified among newborns belonging to the Group A (5%); 32 patients (31%) in the Group A and 19 (9%) in the Group B had an RPR titer equal to or below 1:8. An RPR titer equal to or above 1:4 was almost three times more likely to be identified in patients from Group A (OR 2.91; CI 1.51- 5.59, p< 0.05). The newborns with non-reactive RPRs represented 64% of the patients in the Group A and 47% of them were born to mother with non-reactive RPR also (mothers with discordant results). Among the Group B, 82% of the neonates had a non-reactive RPR and 54% were delivered to mother with non-reactive RPRs. Babies in Group B had additional work-up performed 69% (n=37) of the time; 15% of these babies were treated with intramuscular penicillin which does not follow established AAP guidelines. Statistical analysis of the laboratory tests used for the congenital syphilis work-up Result table comparing the two groups of newborns Conclusion The reverse syphilis screening and non-adherence to the guidelines led to additional screening to half of the newborns in both groups. This study highlights the need for a comprehensive maternal history at the time of delivery that is effectively communicated between the providers. This might lead to greater congruence with the established AAP guidelines. Disclosures All Authors: No reported disclosures

Epidemiological characterization of congenital syphilis in a health region of the northern zone in the state of Ceará, Brazil

The study sought to investigate the epidemiological profile of congenital syphilis in a health region in the State of Ceará, in the period from 2015 to 2019. This is a descriptive epidemiological study, with a quantitative approach, with secondary data collected through the Health System. Information on Notifiable Diseases and Live Birth Information System. There were a total of 248 cases: 65 cases in 2015, 50 in 2016, 45 in 2017, 51 in 2018 and 37 in 2019. The incidence of congenital syphilis was: 8.1 (2015), 6.1 (2016), 5.1 (2017), 5.3 (2018) and 3.9 (2019). In 62.9% of cases from all the years, women were between 20 and 34 years old and in 45.5% of cases they had less than eight years of educational instruction. 57.2% never had a miscarriage, 63.3% had vaginal deliveries and 59.2% had full-term deliveries. Most women received prenatal care (95.9%). In 49.5% of cases, the diagnosis of maternal syphilis occurred during prenatal care. Only 67 (27%) of the pregnant women were treated properly and only 52 (29%) had their partners treated. The study shows a flaw in prenatal care with low effectiveness of the prevention actions, determining factors in the control of congenital syphilis.

Congenital syphilis: Need for intensification of antenatal screening and clinician awareness

Congenital syphilis occurs due to trans-placental transmission of Treponema pallidum or rarely, intrapartum contact with infectious lesions. Even though preventable, congenital syphilis occurs sporadically in India, owing to lack of antenatal screening as well as the lack of awareness among clinicians about the burden of syphilis in the community. Since a significant overlap of clinical manifestations exists with many systemic diseases, awareness among clinicians is crucial for an early diagnosis. Renomegaly, nephrotic syndrome and nephritis can all be the signs of renal involvement in congenital syphilis, which can provide clues of the diagnosis. Direct invasion by spirochetes, hypersensitivity reactions and immune complex deposition in glomeruli contribute to the pathogenesis. We report a case of congenital syphilis characterised by delayed diagnosis with renal as well as cutaneous manifestations from missed maternal syphilis during the antenatal period and owing to the lack of antenatal screening.

Maternal HIV and syphilis are not syndemic in Brazil: Hot spot analysis of the two epidemics

While the annual incidence of HIV diagnosis in pregnancy in Brazil remains relatively stable, rates of maternal syphilis increased over six-fold in the past decade. We hypothesized that maternal HIV and syphilis are two distinct epidemics. Data on all cases of maternal HIV or syphilis detected in pregnancy between January 1, 2010 to December 31, 2018 were requested from the Brazilian Ministry of Health. In order to evaluate how the epidemics evolved over the time period, ArcGIS software was used to generate spatiotemporal maps of annual rates of detection of maternal HIV and syphilis in 2010 and 2018. We utilized Euclidean-distance hot spot analysis to identify state-specific clusters in 2010 and 2018. From 2010 to 2018, there were 66,631 cases of maternal HIV, 225,451 cases of maternal syphilis, and 150,414 cases of congenital syphilis in Brazil. The state of Rio Grande do Sul had the highest rate of maternal HIV detection in both 2010 and 2018. Hot spots of maternal HIV were identified in the three most Southern states in both 2010 and 2018 (99% confidence, z-score >2.58, p <0.01). While syphilis incidence >30 per 1,000 live births in 2018 in four states, only the two coastal states of Rio de Janeiro and Espirito Santo in Southeastern Brazil were significant hot spots (90% confidence, z-score 1.65–1.95, p <0.10). Contrary to the general assumption, HIV and syphilis epidemics in Brazil are not syndemic in pregnant women. There is a spatial cluster of maternal HIV in the South, while syphilis is increasing throughout the country, more recently on the coast. Focusing on maternal HIV hot spots in the Southern states is insufficient to curtail the maternal and congenital syphilis epidemics throughout the country. New strategies, including ongoing hot spot analysis, are urgently needed to monitor, identify and treat maternal syphilis.

Congenital Syphilis Case Surveillance in South Africa 2017–19: Experience, Challenges and Opportunities

Background Untreated or inadequately treated maternal syphilis infection may be transmitted from mother to child resulting in congenital syphilis (CS) infection. In South Africa (SA), CS is a notifiable medical condition (NMC). The NMC surveillance system (NMCSS) was improved by introducing an electronic notification application, a new case notification form and training resources in July 2017. We describe CS surveillance in SA and report on experiences from implementing an improved NMCSS from August 2017 to December 2019. Methods We present the CS case definition, data collected by the CS case investigation and notification forms and data flow through the NMCSS. Descriptive statistics were used to analyse CS notifications received from August 2017 to December 2019. Qualitative inductive analysis of the stakeholder communications diary was conducted to identify CS surveillance challenges. Results There were 418 CS notifications submitted from 80 facilities in 35 out of 52 districts. Of the notified cases, 194 (46.8%) were male and the median age at notification was 7 days (interquartile range: 3–16 days). The majority were diagnosed in hospital (98.6%). KwaZulu–Natal Province notified the most cases (52.9%) followed by Gauteng (28.0%). Challenges in CS surveillance included the lack of awareness of the CS case definition, completed paper-based notifications not reaching the NMCSS and the limited ability of the system to distinguish improved notifications from increase in disease burden. Conclusion Improved CS surveillance through NMCSS was implemented in SA. Training, support and mentoring on CS and the notification system will be needed to inform elimination efforts.

Secondary Syphilis During Pregnancy: The Importance of Screening and Clinical Management

Background: Syphilis is one of the most serious sexually transmitted diseases worldwide, and has tremendous consequences for the mother and her developing fetus if left untreated. The burden of morbidity and mortality due to congenital syphilis is high. Purpose: Screening and prompt to know the importance of treatment of syphilis during pregnancy. Case: A 32-year-old multigravida in 5 months of pregnancy presented with multiple raised lesions over her labia. It was accompanied by fluor and smelly fishy odor. There was no history of genital ulcers in either spouse and no history of sexual promiscuity. History of antenatal care in public health showed non-reactive status of HIV, syphilis and hepatitis B. Clinical examination revealed multiple flat, moist warts over her labia mayora and minora, and multiple roseola syphilitica on the plantar pedis sinistra. Darkfield microscopic examination presence spirochete, venereal disease research laboratory (VDRL) titer was 1:16 and T. pallidum particle agglutination assay (TPHA) titer was 1:2560. Obstetric ultrasonography examination was suggestive no mayor congenital abnormalities. Both of serology VDRL and TPHA were non-reactive in her husband. Significant of lesion improvement and decrease a fourfold titer serologic in VDRL (1:4) and TPHA (1:320) as follow-up 3 months after being treated with single intra-muscular injections of benzathine penicillin 2.4 million units. Discussion: Coordinated prenatal care and treatment are vital. It’s implemented before the fourth month of pregnancy to reduce vertical transmission and all associated side effects of congenital syphilis. Penicillin is highly efficacious in maternal syphilis and prevention of congenital syphilis. Conclusion: Universal screening and adequate pregnancy care must be a priority.

Sífilis congênita no estado de Pernambuco: uma análise de tendência e das respostas governamentais 2008-2017

<p><span class="fontstyle0">This article sought to describe the profile of congenital syphilis (CS) cases in Pernambuco and to evaluate government responses from 2008 to 2017. This is a cross-sectional study, with data obtained from the Department of Chronic Conditions and Sexually Transmitted Infections / MS. A trend analysis was conducted with the Joinpoint program and the following variables were adopted: maternal age group, maternal race / color, maternal education, moment of diagnosis of maternal syphilis, maternal treatment scheme, treatment of the mother’s partner and performance of prenatal. From 2008 to 2017, 9866 cases of congenital syphilis were registered in the state of Pernambuco, the numbers of cases showed an increasing trend over the time line. Out of the total, 75% (n = 7405) of women with a notified outcome of CS performed prenatal care. But only 36.9% (n = 3642) of cases of syphilis during pregnancy were diagnosed. As for the treatment performed, 57% (n = 6551) were done inappropriately. The data reflect the need for adjustments in prenatal care in Pernambuco, as well as the strengthening of actions aimed at controlling this indicator</span> <br /><br /></p>

SYPHILIS IN PREGNANCY, FACTORS ASSOCIATED WITH CONGENITAL SYPHILIS AND NEWBORN CONDITIONS AT BIRTH

ABSTRACT Objectives: to investigate factors associated with the occurrence of congenital syphilis in pregnant women with syphilis and to describe the cases of this disease regarding the justification for notification and aspects related to the newborn. Method: cohort study, with data collection between July and September 2017 which included 158 pregnant women diagnosed with syphilis during pregnancy, reported between 2013 and 2015. The characteristics of pregnant women and newborns are presented descriptively. The outcome under study was the occurrence or not of congenital syphilis. Sociodemographic exposure variables related to prenatal care and the adequacy of maternal syphilis treatment were analyzed by the stepwise selection criteria, and those that presented p<0.20, included in adjusted analysis, when critical p <0.05 was adopted. Results: most pregnant women with syphilis were white, had nine or more years of schooling and did not work. Among the participants, 74 (46.8%) had a newborn with congenital syphilis. Independently, the number of prenatal consultations was the only factor associated with congenital syphilis: as the number of consultations increased, the occurrence decreased (p=0.013, OR=0.87, 95%CI=0.79-0.97). The non-treatment of the mother and partner were the most frequent justifications for defining the case of congenital syphilis, and 33 newborns with syphilis presented complications at birth. Conclusion: considering the association with the number of prenatal consultations, in order to reduce cases of congenital syphilis, the municipality should modify the follow-up in this period, offering consultations, developing health education actions, implementing diagnostic investigation and appropriate treatment for pregnant women, and partnership when necessary.