Abstract
Objectives
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: July 21, 2018
Accepted:
July 20,
2018
Received:
June 5,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
