Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes.
Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant women was recruited in Tanzania. Birth outcomes were compared among women treated for high-titer (n=133; rapid plasma reagin [RPR] titer > or = 1:8 and Treponema pallidum hemagglutination assay [TPHA]/fluorescent treponemal antibody [FTA] positive) and low-titer (n=249; RPR titer <1:8 and TPHA/FTA positive) active syphilis and 950 uninfected women. Stillbirth or low-birth-weight live births were observed in 2.3% and 6.3%, respectively, of women treated for high-titer active syphilis and in 2.5% and 9.2%, respectively, of seronegative women. There was no increased risk for adverse pregnancy outcome for women treated for high-titer active syphilis (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.4-1.4) or low-titer active syphilis (OR, 0.95; 95% CI, 0.6-1.5), compared with seronegative women. Single-dose treatment is effective in preventing adverse pregnancy outcomes attributable to maternal syphilis.
Watson-Jones
Deborah
D
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. deborah.watson-jones@lshtm.ac.uk
Gumodoka
Balthazar
B
Weiss
Helen
H
Changalucha
John
J
Todd
James
J
Mugeye
Kokungoza
K
Buvé
Anne
A
Kanga
Zephrine
Z
Ndeki
Leonard
L
Rusizoka
Mary
M
Ross
David
D
Marealle
Janeth
J
Balira
Rebecca
R
Mabey
David
D
Hayes
Richard
R
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007273:Injections, Intramuscular; D016017:Odds Ratio; D010401:Penicillin G Benzathine / Q000008:administration & dosage / Q000627:therapeutic use*; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011446:Prospective Studies; D013587:Syphilis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D013588:Syphilis Serodiagnosis; D013636:Tanzania / Q000453:epidemiology; D014210:Treponema pallidum
D010406:Penicillins; D010401:Penicillin G Benzathine