Full length article| Volume 228, P274-278, September 2018

Download started.


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



      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Schmid G.P.
        • Stoner B.P.
        • Hawkes S.
        • Broutet N.
        The need and plan for global elimination of congenital syphilis.
        Sex Transm Dis. 2007; 34: S5-10
        • Simms I.
        • Broutet N.
        Congenital syphilis re-emerging.
        J Dtsch Dermatol Ges. 2008; 6 (Epub 2008 Feb 11): 269-272
        • European Centre for Disease Prevention and Control
        Antenatal screening for HIV, hepatitis B, syphilis and rubella susceptibility in the EU/EEA.
        ECDC, Stockholm2016
        • Centers for Disease Control and Prevention
        Sexually transmitted disease treatment guidelines, 2015.
        MMWR recomm rep. vol. 64. 2015: 3
        • Janier M.
        • Hegyi V.
        • Dupin N.
        • Unemo M.
        • Tiplica G.S.
        • Potočnik M.
        • et al.
        2014 European guideline on the management of syphilis.
        J Eur Acad Dermatol Venereol. 2014; 28 (Epub 2014 Oct 27. Erratum in: J Eur Acad Dermatol Venereol. 2015): 1581-1593
        • Schmid G.
        Economic and programmatic aspects of congenital syphilis prevention.
        Bull World Health Organ. 2004; 82: 402-409
        • Zammarchi L.
        • Borchi B.
        • Chiappini E.
        • Galli L.
        • Brogi M.
        • Sterrantino G.
        • et al.
        Syphilis in pregnancy in Tuscany, description of a case series from a global health perspective.
        J Matern Fetal Neonatal Med. 2012; 25 (Epub 2012 Aug 13): 2601-2605
        • Rac M.W.
        • Revell P.A.
        • Eppes C.S.
        Syphilis during pregnancy: a preventable threat to maternal-fetal health.
        Am J Obstet Gynecol. 2017; 216 (Epub 2016 Dec 9): 352-363
        • Newman L.
        • Kamb M.
        • Hawkes S.
        • Gomez G.
        • Say L.
        • Seuc A.
        • et al.
        Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data.
        PLoS Med. 2013; 10 (Epub 2013 Feb 26)e1001396
        • Hawkes S.J.
        • Gomez G.B.
        • Broutet N.
        Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis.
        PLoS ONE. 2013; 8 (Epub 2013 Feb 28)e56713
        • Kamb M.L.
        • Newman L.M.
        • Riley P.L.
        • Mark J.
        • Hawkes S.J.
        • Malik T.
        • et al.
        A road map for the global elimination of congenital syphilis.
        Obstet Gynecol Int. 2010; 2010 (pii: 312798, Epub 2010 Jul 14)
      1. The global elimination of congenital syphilis: rationale and strategy for action.
        World Health Organization, Geneva2007 (accessed 21 December 2015)
      2. Report on global sexually transmitted infection surveillance.
        1.Sexually transmitted diseases – epidemiology. 2. Epidemiological monitoring. 3. Epidemiologic methods. I. World Health Organization, 2015 (ISBN 978 92 4 156530 1)
        • Wijesooriya N.S.
        • Rochat R.W.
        • Kamb M.L.
        • Turlapati P.
        • Temmerman M.
        • Broutet N.
        • et al.
        Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study.
        Lancet Glob Health. 2016; 4: 525-533
        • European Centre for Disease Prevention and Control
        Sexually transmitted infections in Europe 2013.
        ECDC, Stockholm2015
        • Tridapalli E.
        • Capretti M.G.
        • Reggiani M.L.
        • Stronati M.
        • Faldella G.
        Italian neonatal task force of congenital syphilis for The Italian Society of Neonatology – Collaborative Group. Congenital syphilis in Italy: a multicentre study.
        Arch Dis Child Fetal Neonatal Ed. 2012; 97: F211-213
        • Tsankova G.
        • Todorova T.T.
        • Kostadinova T.
        • Ivanova L.
        • Ermenlieva N.
        Seroprevalence of syphilis among pregnant women in the Varna region (Bulgaria).
        Acta Dermatovenerol Croat. 2016; 24: 288-290
        • Lutomski J.E.
        • Shiely F.
        • Molloy E.J.
        The prevalence of syphilis at childbirth in Ireland: a six-year review.
        J Matern Fetal Neonatal Med. 2014; 27 (Epub 2014 Jan 13): 1823-1825
        • Hook 3rd, E.W.
        Lancet. 2017; 389 (Epub 2016 Dec 18. Review): 1550-1557
        • O’Connor M.
        • Kleinman S.
        • Goff M.
        Syphilis in pregnancy.
        J Midwifery Womens Health. 2008; 53: e17-21
        • Mandelbrot L.
        • Marcollet A.
        Syphilis and pregnancy.
        Rev Prat. 2004; 54: 392-395
        • Morshed M.G.
        • Singh A.E.
        Recent trends in the serologic diagnosis of syphilis.
        Clin Vaccine Immunol. 2015; 22 (Epub 2014 Nov 26): 137-147
        • Rac M.W.
        • Revell P.A.
        • Eppes C.S.
        Syphilis during pregnancy: a preventable threat to maternal-fetal health.
        Am J Obstet Gynecol. 2017; 216 (Epub 2016 Dec 9): 352-363
        • Berman S.M.
        Maternal syphilis: pathophysiology and treatment.
        Bull World Health Organ. 2004; 82 (PMCID: PMC2622860 PMID: 15356936): 433-438
        • Gomez G.B.
        • Kamb M.L.
        • Newman L.M.
        • Mark J.
        • Broutet N.
        • Hawkes S.J.
        Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis.
        Bull World Health Organ. 2013; 91: 217-226
        • Donders G.G.
        • Desmyter J.
        • Hooft P.
        • Dewet G.H.
        Apparent failure of one injection of benzathine penicillin G for syphilis during pregnancy in human immunodeficiency virus-seronegative African women.
        Sex Transm Dis. 1997; 24: 94-101
        • Townsend C.L.
        • Francis K.
        • Peckham C.S.
        • Tookey P.A.
        Syphilis screening in pregnancy in the United Kingdom, 2010-2011: a national surveillance study.
        BJOG. 2017; 124 (Epub 2016 May 24): 79-86
        • Simms I.
        • Tookey P.A.
        • Goh B.T.
        • Lyall H.
        • Evans B.
        • Townsend C.L.
        • et al.
        The incidence of congenital syphilis in the United Kingdom: February 2010 to January 2015.
        BJOG. 2017; 124 (Epub 2016 Mar 2): 72-77

        • Stray-Pedersen B.
        Cost-benefit analysis of a prenatal preventive programme against congenital syphilis.
        NIPH Ann. 1980; 3: 57-66