Intermittent preventive treatment of congenital syphilis in pregnancy: a Ugandan pilot study

BACKGROUND: Syphilis is an ubiquitous chronic sexually transmitted disease characterized by intermittent active and dormant stages. It is estimated that 50-80 % of untreated syphilis acquired during pregnancy lead to congenital syphilis. Children born with congenital infection are more prone to paediatric diseases and maintain lifelong deficiencies compared to their healthy counterparts. Thus, prevention and early treatment of the mother is overwhelmingly considered the best approach in protecting the newborn. AIM OF THE STUDY: The main goal of the study was to demonstrate the efficacy of intermittent preventive treatment of syphilis offered to pregnant women in reducing or eliminating the risk of congenital syphilis in their offspring. METHODS: 589 pregnant women attending their first antenatal care visit in a rural primary health center from southern Uganda were enrolled consecutively in the present study. All women received two injections of Benzathine penicillin G, three months apart, throughout their pregnancy. Upon delivery, diagnosis of congenital syphilis was performed with the treponemal serological test (FTAAbs) from a specialized laboratory. STATISTICS: In Uganda, congenital syphilis is prevalent in about 3% of pregnancies. We hypothesized that an intermittent preventive treatment was able to lower this prevalence to 0,5% pregnancies. Analysis were undertaken on per protocol basis. The binomial and Chi-square tests were employed to assess the number of congenital syphilis and other syphilis-related pregnancy complications, respectively. Wilcoxon signed rank test was employed to assess antenatal care attendance during the study. RESULTS: Only 2 out of 589 samples tested positive for congenital syphilis and the result was found statistically very significant. Even after summarizing all other syphilis-related pregnancy complications, the result was still found statistically very significant in favour of the study treatment. After stratifying the expectant mothers for the number of ANC visits attended throughout their pregnancy, the trend was again found statistically significant. CONCLUSION: Based on this promising preliminary results, a drug-based prophylactic approach may offer better protection to pregnant women in resource-limited clinical settings where sophisticated diagnostic essays are not readily available.