Syphilis screening in pregnancy in the United Kingdom, 2010-2011: a national surveillance study

BJOG. 2017 Jan;124(1):79-86. doi: 10.1111/1471-0528.14053. Epub 2016 May 24.

Abstract

Objective: To evaluate the national antenatal syphilis screening programme and provide evidence for improving screening and management strategies.

Design: National population-based surveillance.

Setting: United Kingdom (UK).

Population: All pregnant women screening positive for syphilis, 2010-2011.

Methods: Demographic, laboratory and treatment details for each pregnancy were collected from UK antenatal units (~210), along with follow-up information on all infants born to women requiring syphilis treatment in pregnancy.

Main outcome measures: Proportion of women with newly or previously diagnosed syphilis among those with positive screening tests in pregnancy; proportion requiring treatment.

Results: Overall, 77% (1425/1840) of reported pregnancies were confirmed syphilis screen-positive. Of these, 71% (1010/1425) were in women with previously diagnosed syphilis (155 requiring treatment), 26% (374/1425) with newly diagnosed syphilis (all requiring treatment) and 3% (41/1425) required treatment but the reason for treatment was unclear. Thus 40% (570/1425) required treatment overall; of these, 96% (516/537) were treated (missing data: 33/570), although for 18% (83/456), this was not until the third trimester (missing data: 60/537). Follow up of infants born to treated women was poor, with at least a third not followed. Six infants were diagnosed with congenital syphilis; two mothers were untreated, three had delayed treatment and one had incomplete treatment (first trimester).

Conclusion: Over 2 years, among pregnant women with confirmed positive syphilis screening results in the UK, a quarter had newly diagnosed infections and 40% required treatment. Despite high uptake of treatment, antenatal syphilis management could be improved by earlier detection, earlier treatment, and stronger links between healthcare teams.

Tweetable abstract: 25% of pregnant women screening positive for syphilis in the UK were newly diagnosed and 40% needed treatment.

Keywords: Congenital infection; epidemiology; pregnancy; surveillance; syphilis.

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Mass Screening
  • Population Surveillance
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Pregnancy Complications, Infectious / prevention & control
  • Prenatal Care / statistics & numerical data*
  • Prenatal Diagnosis / statistics & numerical data*
  • Retrospective Studies
  • Syphilis / diagnosis*
  • Syphilis / drug therapy
  • Syphilis / epidemiology*
  • Syphilis, Congenital / diagnosis
  • Syphilis, Congenital / epidemiology
  • United Kingdom / epidemiology