Treatment of maternal syphilis in rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss.
OBJECTIVE
Despite few data, the treatment of syphilis in pregnant women using a single dose of benzathine penicillin is the standard of care in many resource-poor settings. We examined the effect of various doses of benzathine penicillin on pregnancy loss among women with a positive Rapid Plasma Reagin (RPR) test result in a rural South African district.


METHODS
All pregnant women making their first antenatal care visit during pregnancy were screened for syphilis using the RPR test. Those testing positive were counselled to receive three weekly doses of benzathine penicillin, and received a partner notification card. Pregnancy outcomes were determined from facility records or home visits where necessary.


RESULTS
Of 8917 women screened, 1043 (12%) had reactive syphilis serology; of those with titre data available, 30% had titres of 1:8 or greater. While 41% (n = 430) of women received all three doses as counselled, 30% (n = 312) received only one dose, and 20% (n = 207) did not return to the clinic to receive treatment. Among the 947 women with pregnancy outcome data available, there were 17 miscarriages and 48 perinatal deaths observed. There was a strong trend towards reduced risk of pregnancy loss among women receiving multiple doses of penicillin (adjusted OR for perinatal mortality for each additional dose received, 0.63; 95% CI, 0.48-0.84).


CONCLUSIONS
While this association requires further investigation, these results suggest that there may be substantial benefit to providing multiple doses of benzathine penicillin to treat maternal syphilis in this setting.
Myer
Landon
L
School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. lmyer@cormack.uct.ac.za
Abdool Karim
Salim S
SS
Lombard
Carl
C
Wilkinson
David
D
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D009035:Mothers; D010401:Penicillin G Benzathine / Q000008:administration & dosage*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D011295:Prenatal Care / Q000379:methods; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology; D013587:Syphilis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine