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Cited by 32Syphilis Diagnosis and TreatmentReproductive tract infections researchHIV/AIDS Research and Interventions

Strategies of testing for syphilis during pregnancy

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Shahrook, Sadequa, Mori, Rintaro, Ochirbat, Tumendemberel, Gomi, Harumi·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd010385.pub2PMC PMC11126892
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Abstract

BACKGROUND: Each year about two million pregnant women are infected with preventable syphilis infection, mostly in developing countries. Despite the expansion of antenatal syphilis screening programmes over the past few decades, syphilis continues to be a major public health concern in developing countries. Point-of-care syphilis testing may be a useful strategy to substantially prevent syphilis-associated perinatal mortality and other negative consequences in resource-poor settings. However, the evidence on effectiveness has been generated mostly from observational study designs or has been reported as a mixed-intervention effect. OBJECTIVES: To assess the effectiveness of antenatal syphilis screening in improving the uptake of screening tests and treatment, and reducing perinatal mortality. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and the reference lists of retrieved studies. SELECTION CRITERIA: Randomised (individual and cluster) controlled trials comparing different screening tests conducted during routine antenatal check-ups versus no screening test. Cross-over trials and quasi-randomised experimental study designs were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. MAIN RESULTS: We included two cluster-randomised controlled trials (three reports). Both trials assessed point-of-care syphilis testing with conventional testing methods and together involved a total of 8493 pregnant women. Data from these trials were not amenable to meta-analysis as the measure of effectiveness was assessed in a non-comparable way.One trial randomised 14 antenatal clinics (including 7700 pregnant women) and was carried out at in Ulaanbaatar, Mongolia. The trial assessed one-stop syphilis testing using a rapid treponemal test, and was judged to have unclear methods of random sequence generation, allocation concealment, selective reporting, and other bias and low risk of bias for incomplete outcome data. Blinding was not reported and was assessed as high risk. The point-of-care testing provided screening, test results and treatment within the same day. The trial appears to have adjusted their results to account for clustering. We entered the data into RevMan using the generic inverse variance method. The incidence of congenital syphilis was lower in the clusters receiving on-site screening (adjusted odds ratio (AOR) 0.09, 95% confidence interval (CI) 0.01 to 0.71) and the proportion of women tested for syphilis was higher in the clusters receiving on-site screening at both the first antenatal visit and at the third trimester visit (OR 989.80, 95% CI 16.27 to 60233.05; OR 617.88, 95% CI 13.44 to 28399.01). Adequate treatment and partner treatment was higher with the on-site screening (AOR 10.44, 95% CI 1.00 to 108.99; AOR 18.17, 95% CI 3.23 to 101.20) and more syphilis cases were detected at first and third trimester visits with the on-site screening (AOR 2.45, 95% CI 1.44 to 4.18; AOR 6.27, 95% CI 1.47 to 26.69). Perinatal mortality, incidence of HIV/AIDS, obstacles in uptake of screening, any other adverse effects, or healthcare resource usage were not reported in this trial.The second trial divided clinics into seven matched pairs (including 7618 pregnant women, although results were only presented for the positive cases (793 women)), and within each pair one clinic was randomised to receive the on-site screening and the other to continue routine laboratory testing. The trial was conducted in primary healthcare clinics in KwaZulu-Natal, South Africa. Random sequence generation were judged to be at low risk of bias, but allocation concealment and incomplete outcome data were judged to be high risk. Other bias and selective reporting bias remain unclear. Blinding was not reported and was assessed as high risk of bias. This trial assessed the primary outcome of this review (perinatal mortality) and the secondary outcomes (adverse outcomes; adequate treatment; syphilis prevalence) in the subset of women (793 women) who tested positive for syphilis. Only one outcome, adequate treatment, was adjusted to account for cluster design. However, not enough information was provided to include this in an analysis using the generic inverse variance method. Where possible, results have therefore been presented in forest plots (perinatal mortality; adequate treatment), as if the data are from a parallel randomised controlled trial. These results should therefore be interpreted with caution.The trial reported on perinatal mortality in women with positive test results and showed that on-site screening using a rapid plasma reagin test had no clear evidence of an effect on perinatal mortality reduction (odds ratio (OR) 0.63; 95% CI 0.27 to 1.48; 18/549 (3.3%) versus 8/157 (5.1%)). After loss to follow up, 396/618 (64.1%) women with positive test

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  • La probabilidad de afectación fetal ocurre en mujeres con infección activa por sífilis, con infección inadecuada o no tratada adquirida en los cinco años anteriores al embarazo.

    “La probabilidad de afectación fetal ocurre en mujeres con infección activa por sífilis, con infección inadecuada o no tratada adquirida en los cinco años anteriores al embarazo.”

    From Syphilis and pregnancy. Treatment Guidelines (2022) · cites this paper as [2]

  • Syphilis, with a lower prevalence than HIV, is likely to have a higher rate of false positive POC tests.

    “Syphilis, with a lower prevalence than HIV, is likely to have a higher rate of false positive POC tests and for this reason have not been introduced 36.”

    From Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study (2015) · cites this paper as [36]

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2 of the 46 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
  2. Rotchford K, Lombard C, Zuma K, Wilkinson D. Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial. Tropical Medicine & International Health 2000;5(11):800‐4. [DOI] [PubMed] [Google Scholar]
  3. Shafii T, Radolf JD, Sanchez PJ, Schulz KF, Murphy FK. Congenital syphilis. Sexually Transmitted Diseases. Fourth. New York: McGraw Hill Medical, 2008:1577‐612. [Google Scholar]

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Authors
Shahrook, S., Mori, R., Ochirbat, T., & Gomi, H.
Affiliations
  • National Center For Child Health and Development (JP)
  • The University of Tokyo (JP)
  • University of Tsukuba (JP)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-10-29
Volume
2014
Issue
10
Pages
CD010385-CD010385
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd010385.pub2
PMC
PMC11126892
OpenAlex
W1481116442
Cited by
32
References
46
Citations by year
2023: 1 · 2022: 7 · 2021: 3 · 2020: 2 · 2019: 5 · 2018: 5 · 2017: 2 · 2016: 2 · 2015: 3 · 2012: 1
FWCI
0.27
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
syphilis, prenatal screening, point-of-care testing, congenital syphilis, perinatal mortality, resource-limited settings, developing countries, Mongolia, Ulaanbaatar
MeSH terms
Female, Humans, Pregnancy, Pregnancy Complications, Infectious, Prenatal Diagnosis, Syphilis, Syphilis, Congenital, Randomized Controlled Trials as Topic, Point-of-Care Systems

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