Abstract

PIP: Qolohe and colleagues conducted a study at a hospital in Natal, South Africa to assess the prevalence of syphilis, human immunodeficiency virus (HIV) infection, and hepatitis B virus (HBV) infection in umbilical cord blood samples at the time of delivery, and to determine the seroconversion rates of syphilis and HIV infections from initial visit to delivery. 418 women were enrolled; 39 (9.3%) had reactive syphilis serology (RPR positive, TPHA positive) at delivery. 9 of the 329 booked women who were initially seronegative for syphilis seroconverted at delivery (a seroconversion rate of 2.7%). The seroprevalence rate was significantly higher for the unbooked group of women (18.2%) than for the booked group of women (8.4%). 18 women with reactive sera at the initial visit became nonreactive after 4-17 weeks. Another 50 patients showed evidence of past treponemal infection (RPR negative, TPHA positive). Overall, 32 (7.2% of 418) women were positive for HIV at delivery. 4 of the 178 (2.2%) in the booked group seroconverted. Hepatitis B surface antigen was detected in 2 women. In view of these findings, the authors recommend screening for syphilis and HIV at the time of delivery in the Natal-Kwazulu region where these diseases are endemic. Since congenital syphilis is preventable with treatment, and knowledge of HIV status affects counseling about safe sex practices, pregnancy termination, follow-up care of the infant, and breast feeding, this author recommends screening for syphilis and HIV during pregnancy and at delivery in areas of high prevalence of these two diseases.