In a survey of 283 deliveries in Swaziland, active syphilis (positive results in the Treponema pallidum haemagglutination assay (TPHA) and the rapid plasma reagin (RPR) test) was found in 37 (13.1%) and possibly active infection (positive TPHA but negative RPR test results) in a further 87 (30.7%). The perinatal mortality of untreated mothers with active disease was 21.9% (7/32). The RPR test carried out antenatally by nurses had a sensitivity of 36% (13/36) and predictive accuracy of 48% (13/27). Awareness of this incidence of syphilis led to improved antenatal clinic measures and the prophylactic treatment of all newborn infants. More comprehensive serology is discussed and the prophylactic treatment of mothers considered. The need for health education aiming at safer sexual practices is of paramount importance in a society facing the arrival of the human immunodeficiency virus.
PIP: The prevalence of syphilis is at least 10% in several African countries, and untreated maternal syphilis has been associated with high rates of perinatal mortality. This study assessed the syphilis status of mothers delivering at Swaziland's Mbabane Hospital in July-November 1986. Conclusive evidence of syphilis (positive results on both the Treponema pallidum hemagglutination assay (TPHA) and the rapid plasma reagin (RPR) test) was found in 37 (13%) of the 283 mothers tested and possible evidence of syphilis (positive TPHA and negative RPR test results) was recorded for another 87 (31%). The prenatal RPR test had a sensitivity of 36% and a predictive accuracy of 48%. 12 of the 172 women with negative prenatal results were found to be actively infected with syphilis, suggesting either late seroconversion or false negative prenatal test results; there were 4 infant deaths among these 12 women. Untreated active syphilis was a risk factor in 24 deliveries that resulted in 7 perinatal losses, for a mortality of 29%. Mortality was 5% in women with possibly active syphilis and 3% in those with negative prenatal test results. Since 65% of mothers with active syphilis were missed and sexual partners were not treated, screening reduced the 3.5% expected perinatal mortality rate due to syphilis to only 2.3%. In areas of Africa with high rates of sexually transmitted diseases, a prophylactic regimen of penicillin at booking at prenatal clinics may be a more cost-effective means of reducing syphilis-associated perinatal mortality than mass screening.