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This article is part of the supplement: Technical inputs, enhancements and applications of the Lives Saved Tool (LiST)

Open Access Review

Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality

Hannah Blencowe1*, Simon Cousens1, Mary Kamb4, Stuart Berman4 and Joy E Lawn23

Author Affiliations

1 London School of Hygiene and Tropical Medicine, London, UK

2 Saving Newborn Lives/Save the Children-USA, South Africa

3 Health Systems Strengthening Unit, Medical Research Council, South Africa

4 Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, USA

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BMC Public Health 2011, 11(Suppl 3):S9  doi:10.1186/1471-2458-11-S3-S9

Published: 13 April 2011

Abstract

Background

Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity.

Objectives

This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality.

Methods

We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken.

Results

Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 – 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 – 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong.

Conclusion

Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.