title: Serological follow-up of infants born to mothers with positive syphilis serology - real-world experiences.
abstract: The 2008 UK syphilis guideline recommends infants born to women with any positive syphilis serology be followed up until both treponemal and nontreponemal tests are negative to exclude congenital syphilis, whereas Centers for Disease Control and Prevention guidelines recommend using only nontreponemal tests. Historically, we had low infant follow-up rates with no coherent pathways. We initiated a change in multidisciplinary team practice of infant testing for syphilis in 2011 and evaluated the results before and after by retrospective review of testing of infants born to women with positive syphilis serology between 2005 and 2012. A total of 28 infants' mothers were treated in pregnancy (termed 'high risk'); 26 had adequate treatment prior to pregnancy (termed 'low risk'). There was a significant increase in serological testing after 2011 compared with before (83% versus 48%; OR 5.07 [95% CI 1.22-22.77] p = 0.01) but mainly in low risk infants with no significant improvement in high risk infants who are the priority group. Using nontreponemal tests only in the infants would have reduced the tests required by at least 50%, allowing health resources to be concentrated on achieving adequate follow-up for those infants most at risk.
authors.affiliation: Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, UK.
authors.forename: Harriet E
authors.initials: HE
authors.lastname: Wallace
authors.affiliation: University of Leeds Medical School, Leeds, UK.
authors.forename: Harriet M
authors.initials: HM
authors.lastname: Broomhall
authors.affiliation: University of Leeds Medical School, Leeds, UK.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Isitt
authors.affiliation: Department of Neonatology, Leeds Teaching Hospitals NHS Trust, UK.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Miall
authors.affiliation: Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, UK janet-d.wilson@nhs.net.
authors.forename: Janet D
authors.initials: JD
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D012189:Retrospective Studies; D012698:Serologic Tests; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy; D013588:Syphilis Serodiagnosis / Q000379:methods; D013590:Syphilis, Congenital / Q000517:prevention & control*; D016896:Treatment Outcome; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Syphilis; Treponema pallidum; congenital syphilis; diagnosis; infants