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NEW SCHEME AIMS TO ERADICATE CONGENITAL SYPHILIS IN THREE YEARS

Tuesday, 10th of April 2012

• NEW SCHEME AIMS TO ERADICATE CONGENITAL SYPHILIS IN THREE YEARS

BMJ 2012; 344 doi: 10.1136/bmj.e1616 (Published 2 March 2012)

Cite this as: BMJ 2012;344:e1616

See also http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70104-9/abstract

and http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(12)70069-5/fulltext#

London

A three year international initiative has been launched in London aiming to garner funding and support to eradicate congenital syphilis, which kills hundreds of thousands of babies every year.

The Global Congenital Syphilis Partnership will seek to distribute a simple prenatal blood test and same day antibiotic treatment to pregnant women in many more parts of the world.

Members of the partnership include the London School of Hygiene and Tropical Medicine, the Bill and Melinda Gates Foundation, Save the Children, the World Health Organization, and the US Centers for Disease Control and Prevention.

At the launch on 1 March, Peter Piot, the partnership’s chairman and director of the London School of Hygiene, said that tackling syphilis would be a major step towards reducing neonatal deaths by 2015, one of the United Nations’ millennium development goals that was proving hard to meet.

He said, “Congenital syphilis is one of the last taboos, because it is associated with sex and also ignorance. Syphilis is on the rise again, particularly in China. But it’s a problem with a solution. This partnership can really make a difference.”

An estimated two million pregnant women are infected with syphilis every year, and over half of these women pass the infection on to their unborn children.

If untreated during pregnancy syphilis can lead to miscarriage, stillbirth, premature delivery, low birth weight, and the death of newborns.

In Africa alone syphilis causes almost 400 000 stillbirths and newborn deaths every year.

Last year research published in Lancet Infectious Diseases (2011;11:684-91, doi:10.1016/S1473-3099(11)70104-9) showed that effective programmes for screening antenatal syphilis could halve the incidence of stillbirth and perinatal death attributable to syphilis.

In rapid testing for syphilis, pregnant women whose blood test is positive for syphilis receive a dose of penicillin within 20 minutes.

At the launch of the partnership Rosanna Peeling and David Mabey, professors at the London School of Hygiene, said that pilot studies in seven countries (Brazil, China, Haiti, Peru, Zambia, Uganda, and Tanzania) had shown that it was feasible and cost effective to introduce the rapid tests in very different settings. The research has yet to be published.

Professor Peeling said that all seven countries had now adopted the rapid tests in their screening programmes.

She said, “It is possible to introduce these tests in all healthcare settings; it’s easy to train people to do it. It costs less than £1 per woman screened.”

The London School of Hygiene has produced a toolkit to help countries introduce rapid syphilis tests.

Professor Piot said, “If all pregnant women were screened, and those who tested positive were treated with just one dose of penicillin before 28 weeks’ gestation, no stillbirths or neonatal deaths would be due to syphilis. It’s as simple as that.”

He said that the tests could be introduced all over the world, in settings as diverse as urban areas in China and remote villages in the Amazon.

Professor Mabey told the BMJ that the challenge now was to persuade more people to fund the widespread introduction of the tests and technical support.

He cited a WHO publication from 2010 stating that $13m (£8.2m; €10m) was needed over five years to scale up the prevention of congenital syphilis in 10 high burden countries.

Xiang-Shen Chen, deputy director of China’s national centre for sexually transmitted diseases, said that introducing rapid tests should be one of the most important strategies for the country.

Justin Forsyth, chief executive of Save the Children, said that there would be opportunities to integrate testing for syphilis with existing programmes of screening for HIV.

He said, “Syphilis is one of the major causes of deaths in children under 1 month old. This feels like a moment of opportunity. Now we have to galvanise the political will to make it happen.”