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Global burden of maternal and congenital syphilis and associated adverse birth outcomes—Estimates for 2016 and progress since 2012

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Korenromp, Eline L., Rowley, Jane, Alonso, Monica, Mello, Maeve B., Wijesooriya, N. Saman, Mahiané, S. Guy, Ishikawa, Naoko, Le, Linh-Vi +6 more·2019·PLOS ONE
DOI 10.1371/journal.pone.0211720PMC PMC6611667
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Abstract

BACKGROUND: In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. METHODS: Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. RESULTS: The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57-0.81%) resulting in a global CS rate of 473 (385-561) per 100,000 live births and 661,000 (538,000-784,000) total CS cases, including 355,000 (290,000-419,000) adverse birth outcomes (ABO) and 306,000 (249,000-363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs- 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63-0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000-432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. CONCLUSIONS: Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.

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  • During the assessment, several health workers reported concerns about adverse reactions to benzathine penicillin as a reason for not treating pregnant women who tested positive for syphilis.

    “During the assessment, several health workers reported concerns about adverse reactions to benzathine penicillin as a reason for not treating pregnant women who tested positive for syphilis [19].”

    From Expanding Syphilis Screening Among Pregnant Women in Indonesia Using Dual Human Immunodeficiency Virus HIV/Syphilis Testing in Indonesia (2026) · cites this paper as [19]

    The Discussion (page unavailable in our copy) says providers sometimes prescribed penicillin substitutes because of misperceptions about the likelihood of adverse outcomes. It does not say that several health workers reported this during an assessment, or that their concerns led them to withhold treatment from pregnant women who tested positive. (LLM, conf=0.82)

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Research works printed but not linked: 4

  1. [3]3. Darville T. Syphilis. Pediatr Rev. 1999; 20(5):160-4, quiz 5. PMID: 10233174
  2. [11]11. UNICEF East Asia and Pacific Regional Office, World Health Organization Western Pacific regional office, UNAIDS. Elimination of Parent-to-Child Transmission of HIV and Syphilis in Asia and the Pacific in 2015 and Beyond Progress Review and Roadmap. Bangkok: 2016 August. Report No.
  3. [27]27. Waheed U, Khan H, Satti HS, Ansari MA, Malik MA, Zaheer HA. Prevalence of transfusion transmitted infections among blood donors of a teaching hospital in Islamabad. Ann Pak Inst Med Sci. 2012; 8 (4):236-9.
  4. [47]47. Rowley J, Korenromp EL. A pilot application of the Spectrum-STI model in a low-prevalence setting: Estimation of STI prevalence and incidence trends in Georgia. Technical Report, based on a workshop in Tbilisi, Georgia, August 23-24th 2017. London: 2017 13 December. https://spectrummodel.zendesk. com/hc/en-us/articles/115003492452-Georgia-Spectrum-STI-estimation-2017-final-report.

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Authors
Korenromp, E. L., Rowley, J., Alonso, M., Mello, M. B., Wijesooriya, N. S., Mahiané, S. G., Ishikawa, N., Le, L.-V., Newman-Owiredu, M., Nagelkerke, N., Newman, L., Kamb, M., Broutet, N., & Taylor, M. M.
Affiliations
  • Avenir Health (US)
  • World Health Organization Regional Office for the Americas (US)
  • World Health Organization Regional Office for the Western Pacific (PH)
  • Centers for Disease Control and Prevention (US)
Corresponding author
Korenromp, Eline L.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-02-27
Volume
14
Issue
2
Pages
e0211720
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0211720
PMC
PMC6611667
OpenAlex
W2917519553
Cited by
478
References
37
Citations by year
2026: 46 · 2025: 36 · 2024: 78 · 2023: 90 · 2022: 77 · 2021: 74 · 2020: 55 · 2019: 21 · 2018: 1
FWCI
38.91
Type
journal article
Language
en
Update notices
correction (2019-07-05)
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
World Health Organization, Dept. of Reproductive Health and Research
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
congenital syphilis, maternal syphilis, mother-to-child transmission, adverse birth outcomes, stillbirth, neonatal death, low birth weight, preterm birth, elimination targets
MeSH terms
Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Syphilis, Syphilis, Congenital, Global Health, Prevalence, Cost of Illness, Infectious Disease Transmission, Vertical, Stillbirth

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