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Meta-Analysis
. 2011 Apr 13;11 Suppl 3(Suppl 3):S9.
doi: 10.1186/1471-2458-11-S3-S9.

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

Hannah Blencowe  1 , Simon Cousens, Mary Kamb, Stuart Berman, Joy E Lawn
Affiliations
Meta-Analysis

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

Hannah Blencowe et al. BMC Public Health. .

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 2.4 MU 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 2.4 MU 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.

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Figures

Figure 1
Figure 1
The natural history of untreated syphilis in pregnancy
Figure 2
Figure 2
Synthesis of study identification in the review of the effect of at least 2.4MU penicillin on syphilis related adverse pregnancy outcomes
Figure 3
Figure 3
Meta analysis of 8 observational studies showing effect of penicillin on stillbirth in pregnant women with active syphilis
Figure 4
Figure 4
Meta analysis of 5 observational studies showing effect of at least 2.4MU penicillin on all cause neonatal mortality in pregnant women with active syphilis
Figure 5
Figure 5
Meta analysis of 7 observational studies showing effect of at least 2.4MU penicillin on preterm delivery in pregnant women with active syphilis
Figure 6
Figure 6
Meta analysis showing moderate evidence of the effect of at least 2.4MU penicillin treatment on incidence of congenital syphilis in pregnant women with active syphilis
See this image and copyright information in PMC

References

    1. Dennie, C.C., I. Springfield, Charles C. Thomas, editor. A History of Syphilis. 1962.
    1. Schmid GP. et al.The need and plan for global elimination of congenital syphilis. Sexually Transmitted Diseases. 2007;34(7 Suppl):S5–10. doi: 10.1097/01.olq.0000261456.09797.1b. - DOI - PubMed
    1. World Health Organization and Department of Reproductive Health and Research. Investment Case for Eliminating Congenital Syphilis: Promoting Better Maternal and Child Health Outcomes and Stronger Health Systems. WHO Geneva Switzerland; 2010.
    1. Cheng JQ. et al.Syphilis screening and intervention in 500,000 pregnant women in Shenzhen, the People's Republic of China. Sexually Transmitted Infections. 2007;83(5):347–50. doi: 10.1136/sti.2006.023655. - DOI - PMC - PubMed
    1. Tucker JD, Chen XS, Peeling RW. Syphilis and social upheaval in China. N Engl J Med. 2010;362(18):1658–61. doi: 10.1056/NEJMp0911149. - DOI - PubMed

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