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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

  • J.-B. Qin
  • T.-J. Feng
  • T.-B. Yang
  • F.-C. Hong
  • L.-N. Lan
  • C.-L. Zhang
  • X.-L. Liu
  • Y.-Z. Yang
  • S.-Y. Xiao
  • H.-Z. Tan
Article

Abstract

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.

Keywords

Pregnant Woman Sexual Partner Syphilis Sexually Transmitted Disease Congenital Syphilis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

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.

Funding

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

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.

Author contributions

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.

References

  1. 1.
    Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A et al (2013) Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med 10(2):e1001396CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Schmid G (2004) Economic and programmatic aspects of congenital syphilis prevention. Bull World Health Organ 82(6):402–409PubMedPubMedCentralGoogle Scholar
  3. 3.
    Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ (2013) Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ 91(3):217–226CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    McDermott J, Steketee R, Larsen S, Wirima J (1993) Syphilis-associated perinatal and infant mortality in rural Malawi. Bull World Health Organ 71:773–780PubMedPubMedCentralGoogle Scholar
  5. 5.
    Gloyd S, Chai S, Mercer MA (2001) Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction. Health Policy Plan 16(1):29–34CrossRefPubMedGoogle Scholar
  6. 6.
    Hawkes S, Matin N, Broutet N, Low N (2011) Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 11(9):684–691CrossRefPubMedGoogle Scholar
  7. 7.
    Kuznik A, Lamorde M, Nyabigambo A, Manabe YC (2013) Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis. PLoS Med 10(11):e1001545CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hawkes SJ, Gomez GB, Broutet N (2013) Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis. PLoS One 8(2):e56713CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Saloojee H, Velaphi S, Goga Y, Afadapa N, Steen R, Lincetto O (2004) The prevention and management of congenital syphilis: an overview and recommendations. Bull World Health Organ 82(6):424–430PubMedPubMedCentralGoogle Scholar
  10. 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. 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
  12. 12.
    Terris-Prestholt F, Watson-Jones D, Mugeye K, Kumaranayake L, Ndeki L, Weiss H et al (2003) Is antenatal syphilis screening still cost effective in sub-Saharan Africa. Sex Transm Infect 79(5):375–381CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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
  14. 14.
    Chen ZQ, Zhang GC, Gong XD, Lin C, Gao X, Liang GJ et al (2007) Syphilis in China: results of a national surveillance programme. Lancet 369(9556):132–138CrossRefPubMedGoogle Scholar
  15. 15.
    Zhou H, Chen XS, Hong FC, Pan P, Yang F, Cai YM et al (2007) Risk factors for syphilis infection among pregnant women: results of a case–control study in Shenzhen, China. Sex Transm Infect 83(6):476–480CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cheng JQ, Zhou H, Hong FC, Zhang D, Zhang YJ, Pan P et al (2007) Syphilis screening and intervention in 500,000 pregnant women in Shenzhen, the People’s Republic of China. Sex Transm Infect 83(5):347–350CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Qin JB, Feng TJ, Yang TB, Hong FC, Lan LN, Zhang CL (2014) Maternal and paternal factors associated with congenital syphilis in Shenzhen, China: a prospective cohort study. Eur J Clin Microbiol Infect Dis 33:221–232CrossRefPubMedGoogle Scholar
  18. 18.
    The MOP Counselling Committee on Sexually Transmitted Diseases (2000) Guidelines for the diagnosis and control of congenital syphilis. BeijingGoogle Scholar
  19. 19.
    Centers for Disease Control and Prevention (CDC) (2002) Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep 51:1–78Google Scholar
  20. 20.
    Walker DG, Walker GJ (2002) Forgotten but not gone: the continuing scourge of congenital syphilis. Lancet Infect Dis 2:432–436CrossRefPubMedGoogle Scholar
  21. 21.
    World Health Organization (WHO) (2007) The global elimination of congenital syphilis: rationale and strategy for action. WHO, GenevaGoogle Scholar
  22. 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
  23. 23.
    Rotchford K, Lombard C, Zuma K, Wilkinson D (2000) Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial. Trop Med Int Health 5:800–804CrossRefPubMedGoogle Scholar
  24. 24.
    Watson-Jones D, Changalucha J, Gumodoka B, Weiss H, Rusizoka M, Ndeki L et al (2002) Syphilis in pregnancy in Tanzania. I. impact of maternal syphilis on outcome of pregnancy. J Infect Dis 186:940–947CrossRefPubMedGoogle Scholar
  25. 25.
    Lago EG, Rodrigues LC, Fiori RM, Stein AT (2004) Congenital syphilis: identification of two distinct profiles of maternal characteristics associated with risk. Sex Transm Dis 31:33–37CrossRefPubMedGoogle Scholar
  26. 26.
    Southwick KL, Blanco S, Santander A, Estenssoro M, Torrico F, Seoane G et al (2001) Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors. Bull World Health Organ 79:33–42PubMedPubMedCentralGoogle Scholar
  27. 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. 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
  29. 29.
    Qin JB, Feng TJ, Yang TB, Hong FC, Lan LN, Zhang CL et al (2014) Risk factors for congenital syphilis and adverse pregnancy outcomes in offspring of women with syphilis in Shenzhen, China: a prospective nested case–control study. Sex Transm Dis 41(1):13–23CrossRefPubMedGoogle Scholar
  30. 30.
    Todd J, Munguti K, Grosskurth H, Mngara J, Changalucha J, Mayaud P et al (2001) Risk factors for active syphilis and TPHA seroconversion in a rural African population. Sex Transm Infect 77:37–45CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Greenberg MS, Singh T, Htoo M, Schultz S (1991) The association between congenital syphilis and cocaine/crack use in New York City: a case–control study. Am J Public Health 81:1316–1318CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lago EG, Vaccari A, Fiori RM (2013) Clinical features and follow-up of congenital syphilis. Sex Transm Dis 40:85–94PubMedGoogle Scholar
  33. 33.
    Blondel B, Marshall B (1998) Poor antenatal care in 20 French districts: risk factors and pregnancy outcome. J Epidemiol Community Health 52:501–506CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Mullick S, Watson-Jones D, Beksinska M, Mabey D (2005) Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm Infect 81:294–302CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Yang LG, Tucker JD, Liu FY, Ren XQ, Hong X, Wang C et al (2013) Syphilis screening among 27,150 pregnant women in South Chinese rural areas using point-of-care tests. PLoS One 8(8):e72149CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • J.-B. Qin
    • 1
  • T.-J. Feng
    • 2
  • T.-B. Yang
    • 1
  • F.-C. Hong
    • 2
  • L.-N. Lan
    • 2
  • C.-L. Zhang
    • 2
  • X.-L. Liu
    • 2
  • Y.-Z. Yang
    • 2
  • S.-Y. Xiao
    • 3
  • H.-Z. Tan
    • 1
  1. 1.Department of Epidemiology and Health Statistics, School of Public HealthCentral South UniversityChangshaChina
  2. 2.Department of Dermatology and Venereal DiseaseShenzhen Center for Chronic Disease Control and PreventionShenzhenChina
  3. 3.Department of Social Medicine, School of Public HealthCentral South UniversityChangshaChina

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