Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China
The purpose of this investigation was to assess the effectiveness of an intervention program on mother-to-child transmission (MTCT) of syphilis and investigate determinants of congenital syphilis (CS) and adverse pregnancy outcomes (APOs). The Shenzhen local government initiated an intervention program of MTCT of syphilis in 2001. Based on this program, maternal and paternal factors associated with CS and APOs among syphilitic women were investigated from 2007 to 2012 by a prospective cohort study. From 2002 to 2012, 2,441,237 pregnant women were screened and screening coverage reached 97.2 % in 2012. In the background of continuing growth of CS in China, CS in Shenzhen significantly decreased from 109.3 cases in 2002 to 9.9 cases in 2012 per 100,000 live births. Maternal education (adjusted odds ratio [aOR]CS = 0.65; aORAPOs = 0.79) and history of syphilis (aORCS = 0.28; aORAPOs = 0.61), as well as paternal age (aORCS = 0.62; aORAPOs = 0.86) and education (aORCS = 0.66; aORAPOs = 0.86) were negatively associated with CS and APOs, but maternal unmarried status (aORCS = 1.95; aORAPOs = 2.61), inadequate antenatal care (ANC) (aORCS = 3.61; aORAPOs = 1.79), more sexual partners (aORCS = 1.51; aORAPOs = 1.39), every week of delay in treatment (aORCS = 2.82; aORAPOs = 1.27), higher baseline titers of nontreponemal antibodies (aORCS = 5.65; aORAPOs = 1.47), early syphilis (aORCS = 23.24; aORAPOs = 26.95), and non-penicillin treatment (aORCS = 3.00; aORAPOs = 2.16), as well as paternal history of cocaine use (aORCS = 2.70; aORAPOs = 2.44) and positive (aORCS = 4.14; aORAPOs = 1.50) or unknown (aORCS = 2.37; aORAPOs = 2.06) status of syphilis increased the risk of CS and APOs. Condom use (aOR = 0.70) decreased MTCT of syphilis. A ten-year program consisting of screening and treatment, early ANC, health education, partners tracking, detection, and treatment, follow-up visits, and information management is an effective means to block MTCT of syphilis. Maternal and paternal factors constituted two separate profiles associated with MTCT of syphilis.
KeywordsPregnant Woman Sexual Partner Syphilis Sexually Transmitted Disease Congenital Syphilis
This study was supported by the program of prevention of mother-to-child transmission of syphilis in Shenzhen. The authors would like to thank the local governments for their financial and technical support, and thank the staff who worked in the study sites for recruiting the participants, collecting the specimens, and conducting the interviews. We are also very grateful to all the participants of this study for their cooperation. The authors also thank the editors and reviewers for their suggestions.
Conflict of interest
All authors declare that they have no conflicts of interest relevant to the subject of this manuscript.
This work was supported by the program of prevention of mother-to-child transmission of syphilis in Shenzhen, South China. The local government provides financial support. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Ethical clearance was obtained from the research ethics review committee of the Shenzhen Center for Chronic Disease Control and Prevention (SCCDC). Informed consent was obtained from all participants, who signed or fingerprinted the consent form after the aims of the study had been explained to them.
Conceived and designed the experiments: T-J Feng, F-C Hong, J-B Qin. Data collection: J-B Qin, L-N Lan, C-L Zhang, X-L Liu, Y-Z Yang. Analyzed the data: J-B Qin, T-B Yang. Manuscript preparation: J-B Qin, T-J Feng, T-B Yang, S-Y Xiao, H-Z Tan. Provided strategic advice throughout the study: J-B Qin, T-B Yang, T-J Feng, S-Y Xiao, H-Z Tan, X-L Liu, Y-Z Yang. All authors had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.
- 10.Hossain M, Broutet N, Hawkes S (2007) The elimination of congenital syphilis: a comparison of the proposed World Health Organization action plan for the elimination of congenital syphilis with existing national maternal and congenital syphilis policies. Sex Transm Dis 34(7 Suppl):S22–S30CrossRefPubMedGoogle Scholar
- 11.Kamb M (2009) Health systems strengthening: antenatal syphilis testing and treatment challenges. In: Proceedings of the 11th World Congress of the International Union against Sexually Transmitted Infections (IUSTI), Cape Town, South Africa, November 9–12, 2009Google Scholar
- 13.Chen XS, Yin YP, Wang QQ, Wang BX (2013) Historical perspective of syphilis in the past 60 years in China: eliminated, forgotten, on the return. Chin Med J (Engl) 126(14):2774–2779Google Scholar
- 18.The MOP Counselling Committee on Sexually Transmitted Diseases (2000) Guidelines for the diagnosis and control of congenital syphilis. BeijingGoogle Scholar
- 19.Centers for Disease Control and Prevention (CDC) (2002) Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep 51:1–78Google Scholar
- 21.World Health Organization (WHO) (2007) The global elimination of congenital syphilis: rationale and strategy for action. WHO, GenevaGoogle Scholar
- 22.China Ministry of Health: Notice of the Ministry of Health on Issuing National Program for Prevention and Control of Syphilis in China (2010–2020). Available online at: http://www.gov.cn/gzdt/2010-06/21/content_1632301.htm. Accessed 7 Oct 2012
- 27.World Health Organization (WHO). Global health observatory: antenatal care: situation. Available online at: http://www.who.int/gho/maternal_health/reproductive_health/antenatal_care_text/en/index.html. Accessed 17 Jan 2013
- 28.Kamb ML, Newman LM, Riley PL, Mark J, Hawkes SJ, Malik T et al (2010) A road map for the global elimination of congenital syphilis. Obstet Gynecol Int 2010. pii: 312798Google Scholar