In many countries, syphilis remains a major public health problem for pregnant women. A mother infected with the sexually-transmitted disease can pass it on to her baby in utero. This greatly increases the chance of stillbirth and neonatal death. And many of the babies born with syphilis who survive have congenital birth defects and developmental disabilities.
According to Doctor Bruce Schackman from the Weill Cornell Medical College in New York City, in the past, it's been difficult to treat syphilis in pregnant women, in part because testing involves drawing blood and sending it off to a lab. Results can take days to come back and the mothers often don't return to the clinic for follow up treatment.
Schackman and his Haitian colleagues wanted to find a way to identify and treat more syphilis cases using a new rapid test for the disease. "Our primary goal was to look at what the cost benefit was of adding this new [syphilis] test to the protocols that are being used in Haiti, when pregnant women are tested for HIV," he says, explaining that it is more expensive than the laboratory test.
About 4 percent of pregnant women in Haiti routinely test positive for syphilis. Patients there readily accept HIV testing and were glad to add a quick syphilis test to their prenatal screening, because Schackman says, "if a woman tests positive she could be treated with a shot of penicillin immediately and that shot of penicillin would be very effective in preventing the child from getting sick."
Scaling up this rapid testing to include the whole country could have profound effects. "There would be about 1000 deaths and about 1000 cases of congenital syphilis that would be avoided each year and the cost would be quite low," Schackman estimates. And he says testing women throughout the country would cost only an additional $500,000 per year. That's a small percentage of the international donor money Haiti receives to do HIV testing and treatment.
Schackman says his team is advocating a more integrated approach to prevention of mother-child transmission of HIV. "This should be done in the context of providing better services to pregnant women overall to their health and the health of their children. And including the syphilis test is one component of that and one that was very easy to add and not expensive to add."
Schackman's research is published in the open access online journal Public Library of Science: Medicine.