title: Syphilis in pregnancy in Tuscany, description of a case series from a global health perspective.
abstract: OBJECTIVE
  To estimate the epidemiological impact of syphilis in pregnancy and congenital syphilis in Tuscany and to better delineate their determinants in this region.
  
  
  METHODS
  Features of pregnant women with syphilis attending the Tuscany Reference Center for Infectious Diseases in Pregnancy between 2000 and 2010 and their infants were retrospectively reviewed.
  
  
  RESULTS
  One hundred and eighty-seven pregnancies were observed. The number of pregnancies evaluated increased steadily from 24 in 2000-2002 to 70 in 2009-2010. The majority of women were Italian (20.32%) and East European (44.39%). Eight cases of congenital syphilis were diagnosed (5.60% of pregnancies with known outcome). Italian women had more often an early stage of syphilis (11.76 vs. 1.34%; p = 0.016), an rapid plasma regain (RPR) title ≥ 1:8 (15.79 vs. 5.37%; p = 0.041) and a partner with positive test (60.00 vs. 21.69%; p < 0.001) compared with migrant women. Migrant women received treatment after the first trimester more often compared with Italian ones (40.94 vs. 18.42%; p = 0.013).
  
  
  CONCLUSIONS
  Syphilis in pregnancy is emerging in Tuscany. Italian and migrant women with syphilis show two different "risk patterns" of vertical transmission. An additional screening test for syphilis in the third trimester and educational campaigns about maternal and sexual health could be effective in combating congenital syphilis in Italy.
authors: Department of Critical Care Medicine and Surgery, Infectious Diseases Unit, University of Florence, Florence, Italy. lorenzo.zammarchi@unifi.it
authors: Lorenzo
authors: L
authors: Zammarchi
authors: Beatrice
authors: B
authors: Borchi
authors: Elena
authors: E
authors: Chiappini
authors: Luisa
authors: L
authors: Galli
authors: Michela
authors: M
authors: Brogi
authors: Gaetana
authors: G
authors: Sterrantino
authors: Michele
authors: M
authors: Trotta
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D016022:Case-Control Studies; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013587:Syphilis / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D013590:Syphilis, Congenital / Q000453:epidemiology*; D055815:Young Adult