Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 154 No. 11 (2024)

Syphilis in pregnant women and congenital syphilis from 2012 to 2021 in Switzerland: a multicentre, retrospective study

DOI
https://doi.org/10.57187/s.3678
Cite this as:
Swiss Med Wkly. 2024;154:3678
Published
01.11.2024

Summary

BACKGROUND AND AIMS OF THE STUDY: Congenital syphilis is a rare complication of syphilis in pregnant women. Vertical transmission may occur at any time during pregnancy. The incidence of congenital syphilis has been increasing worldwide. Congenital syphilis has been a notifiable disease for many years in Switzerland but reporting does not include maternal features associated with syphilis in pregnancy or infantʼs subsequent development. We described syphilis cases among pregnant women screened over a 10-year period in Switzerland and subsequent cases of congenital syphilis, in order to identify maternal risk profiles and to optimise prevention. Second, we compared the characteristics of pregnant women screened early (1st trimester) vs late in pregnancy (2nd or 3rd trimester). Finally, we assessed the risk factors for premature birth among these women with syphilis.

METHODS: A multicentre retrospective study conducted in Swiss hospitals from 2012 to 2021, including pregnant women who screened positive for syphilis (Treponema pallidum haemagglutination assay [TPHA] / T. pallidum particle agglutination assay [TPPA ] ≥1:80) and newborns exposed to T. pallidum in utero and/or congenitally infected and with a positive syphilis serology at birth. Data were collected from medical records.

RESULTS: A total of 147 syphilis-positive pregnant women and 102 infants were included. A history of treated syphilis was known for 44% (65/147) of the mothers corresponding to a serological scar and the remaining 56% (82/147) were newly identified syphilis cases. Syphilis screening was done during the first trimester in 54%, second trimester in 29% and third trimester in 13% of cases. Two babies were diagnosed with congenital syphilis (1.96%). Several potential factors that could contribute to women’s risk of syphilis during pregnancy were identified such as a foreign origin (93% of mothers), lack of healthcare insurance (25%), no employment status (37%), drug use (5%), co-infection with other sexually transmitted infections (24%) and a late first antenatal consultation (42%). The number of pregnant women without insurance was higher in women diagnosed in the second or third trimester than in those diagnosed in the first trimester (odds ratio 0.41; 95% CI 0.19–0.89; p = 0.024). Syphilis diagnosed in the second or third trimester was associated with a late first antenatal consultation (odds ratio 77.82; 95% CI 9.81–617.21; p <0.001). A high rate of intrauterine growth retardation and of preterm birth was observed in newborns (18% versus 6% in Switzerland in 2022).

CONCLUSION: Congenital syphilis remains rare in Switzerland. However, we found potential maternal factors associated with a positive syphilis serology during pregnancy, which can help to improve future prevention measures.

The study protocol was registered on ClinicalTrials.gov (ID NCT05975502).

References

  1. World Health Organization. The global elimination of congenital syphilis: rationale and strategy for action. Geneva, Switzerland: WHO, 2007. Available at: http://apps.who.int/iris/bitstream/10665/43782/1/9789241595858_eng.pdf. Accessed 29 November 2023.
  2. De Santis M, De Luca C, Mappa I, Spagnuolo T, Licameli A, Straface G, et al. Syphilis Infection during pregnancy: fetal risks and clinical management. Infect Dis Obstet Gynecol. 2012;2012:430585. doi: https://doi.org/10.1155/2012/430585 DOI: https://doi.org/10.1155/2012/430585
  3. World Health Organisation - Governance guidance for the validation of elimination of mother-to-child transmission of HIV and syphilis - 2020 Jun - Available at: https://www.who.int/publications-detail-redirect/governance-guidance-for-validation-of-emtct-syphilis-hiv
  4. Worls Health Organization. The global health observatory. Data on syphilis. Available at: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/data-on-syphilis
  5. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2021. National Overview of STDs, 2021. Available at: https://www.cdc.gov/std/statistics/2021/overview.htm#Syphilis
  6. Centers for Disease Control and Prevention. U.S. Syphilis Cases in Newborns Continue to Increase: A 10-Times Increase Over a Decade. 2023,11. Available at: https://www.cdc.gov/nchhstp/newsroom/2023/syphilis-cases-in-newborns.html
  7. Dai Y, Zhai G, Zhang S, Chen C, Li Z, Shi W. The Clinical Characteristics and Serological Outcomes of Infants With Confirmed or Suspected Congenital Syphilis in Shanghai, China: A Hospital-Based Study. Front Pediatr. 2022 Feb;10:802071. doi: https://doi.org/10.3389/fped.2022.802071 DOI: https://doi.org/10.3389/fped.2022.802071
  8. Wang Y, Wu M, Gong X, Zhao L, Zhao J, Zhu C, et al. Risk Factors for Congenital Syphilis Transmitted from Mother to Infant - Suzhou, China, 2011-2014. MMWR Morb Mortal Wkly Rep. 2019 Mar;68(10):247–50. doi: https://doi.org/10.15585/mmwr.mm6810a4 DOI: https://doi.org/10.15585/mmwr.mm6810a4
  9. Kanai M, Arima Y, Shimada T, Hori N, Yamagishi T, Sunagawa T, et al. Increase in congenital syphilis cases and challenges in prevention in Japan, 2016-2017. Sex Health. 2021 May;18(2):197–9. doi: https://doi.org/10.1071/SH21004 DOI: https://doi.org/10.1071/SH21004
  10. Gilmour LS, Best EJ, Duncanson MJ, Wheeler BJ, Sherwood J, Thirkell CE, et al. High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study. Pediatr Infect Dis J. 2022 Jan;41(1):66–71. doi: https://doi.org/10.1097/INF.0000000000003233 DOI: https://doi.org/10.1097/INF.0000000000003233
  11. Heringer AL, Kawa H, Fonseca SC, Brignol SM, Zarpellon LA, Reis AC. [Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016Desigualdades en la tendencia de sífilis congénita en la ciudad de Niterói, Brasil, 2007-2016]. Rev Panam Salud Publica. 2020 Feb;44:e3. DOI: https://doi.org/10.26633/RPSP.2020.8
  12. Office fédéral de la santé publique - Bulletin 45/2022 Available at: https://www.bag.admin.ch/bag/fr/home/das-bag/publikationen/periodika/bag-bulletin.html
  13. Office fédéral de la santé publique OFSP. Chiffres Maladies Infectieuses 2023. Available at: https://www.bag.admin.ch/bag/fr/home/zahlen-und-statistiken/zahlen-zu-infektionskrankheiten.html
  14. Wolff H, Epiney M, Lourenco AP, Costanza MC, Delieutraz-Marchand J, Andreoli N, et al. Undocumented migrants lack access to pregnancy care and prevention. BMC Public Health. 2008 Mar;8(1):93. doi: https://doi.org/10.1186/1471-2458-8-93 DOI: https://doi.org/10.1186/1471-2458-8-93
  15. Meyer Sauteur PM, Trück J, Bosshard PP, Tomaske M, Morán Cadenas F, Lautenschlager S, et al. Congenital syphilis in Switzerland: gone, forgotten, on the return. Swiss Med Wkly. 2012 Jan;141(102):w13325. doi: https://doi.org/10.4414/smw.2012.13325 DOI: https://doi.org/10.4414/smw.2012.13325
  16. Nicolay N, Gallay A, Michel A, Nicolau J, Desenclos JC, Semaille C. Reported cases of congenital syphilis in the French national hospital database. Euro Surveill. 2008 Dec;13(50):19062. doi: https://doi.org/10.2807/ese.13.50.19062-en DOI: https://doi.org/10.2807/ese.13.50.19062-en
  17. Chan EY, Smullin C, Clavijo S, Papp-Green M, Park E, Nelson M, et al. A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California. PLoS One. 2021 Apr;16(4):e0249419. doi: https://doi.org/10.1371/journal.pone.0249419 DOI: https://doi.org/10.1371/journal.pone.0249419
  18. Tridapalli E, Capretti MG, Sambri V, Marangoni A, Moroni A, D’Antuono A, et al. Prenatal syphilis infection is a possible cause of preterm delivery among immigrant women from eastern Europe. Sex Transm Infect. 2007 Apr;83(2):102–5. doi: https://doi.org/10.1136/sti.2006.021352 DOI: https://doi.org/10.1136/sti.2006.021352
  19. Wolff H, Stalder H, Epiney M, Walder A, Irion O, Morabia A. Health care and illegality: a survey of undocumented pregnant immigrants in Geneva. Soc Sci Med. 2005 May;60(9):2149–54. doi: https://doi.org/10.1016/j.socscimed.2004.12.007 DOI: https://doi.org/10.1016/j.socscimed.2004.12.007
  20. Trepka MJ, Bloom SA, Zhang G, Kim S, Nobles RE. Inadequate syphilis screening among women with prenatal care in a community with a high syphilis incidence. Sex Transm Dis. 2006 Nov;33(11):670–4. doi: https://doi.org/10.1097/01.olq.0000216032.52731.ea DOI: https://doi.org/10.1097/01.olq.0000216032.52731.ea
  21. Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017 Oct;3(1):17073. doi: https://doi.org/10.1038/nrdp.2017.73 DOI: https://doi.org/10.1038/nrdp.2017.73
  22. Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021 Mar;35(3):574–88. doi: https://doi.org/10.1111/jdv.16946 DOI: https://doi.org/10.1111/jdv.16946
  23. Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. Available at: https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm
  24. Scherler G, Tomaske M, Cannizzaro V, Steppacher A, Zucol F, Theiler M, et al. Congenital syphilis in Switzerland: a retrospective cohort study, 2010 to 2019. Swiss Med Wkly. 2023 Nov;153(11):40121. doi: https://doi.org/10.57187/smw.2023.40121 DOI: https://doi.org/10.57187/smw.2023.40121
  25. Office fédéral de la statistique. Comparaisons internationales. Available at: https://www.bfs.admin.ch/bfs/fr/home/statistiques/population/familles/comparaisons-internationales.html
  26. David A, Posfay-Barbe KM, Aguiar Nogueira C, Toutous Trellu L. Congenital syphilis in Switzerland: a marker of inequality? A mini-review. Front Public Health. 2023 Sep;11:1265725. doi: https://doi.org/10.3389/fpubh.2023.1265725 DOI: https://doi.org/10.3389/fpubh.2023.1265725
  27. Visser M, van der Ploeg CP, Smit C, Hukkelhoven CW, Abbink F, van Benthem BH, et al. Evaluating progress towards triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B in the Netherlands. BMC Public Health. 2019 Mar;19(1):353. doi: https://doi.org/10.1186/s12889-019-6668-6 DOI: https://doi.org/10.1186/s12889-019-6668-6
  28. Keuning MW, Kamp GA, Schonenberg-Meinema D, Dorigo-Zetsma JW, van Zuiden JM, Pajkrt D. Congenital syphilis, the great imitator-case report and review. Lancet Infect Dis. 2020 Jul;20(7):e173–9. doi: https://doi.org/10.1016/S1473-3099(20)30268-1 DOI: https://doi.org/10.1016/S1473-3099(20)30268-1
  29. Matthias JM, Rahman MM, Newman DR, Peterman TA. Effectiveness of Prenatal Screening and Treatment to Prevent Congenital Syphilis, Louisiana and Florida, 2013-2014. Sex Transm Dis. 2017 Aug;44(8):498–502. doi: https://doi.org/10.1097/OLQ.0000000000000638 DOI: https://doi.org/10.1097/OLQ.0000000000000638
  30. Office fédéral de la statistique. Santé des nouveaux-nés. Available at: https://www.bfs.admin.ch/bfs/fr/home/statistiques/sante/etat-sante/sante-nouveau-nes.html
  31. Aebi-Popp K, Kahlert C, Rauch A, Mosimann B, Baud D, Low N, et al. Heterogeneity in testing practices for infections during pregnancy: national survey across Switzerland. Swiss Med Wkly. 2016 Jul;146:w14325. doi: https://doi.org/10.4414/smw.2016.14325 DOI: https://doi.org/10.4414/smw.2016.14325
  32. European Center for Disease Prevention and Control. Syphilis and congenital syphilis in Europe - A review of epidemiological trends (2007–2018) and options for response. 2019. Available at: https://www.ecdc.europa.eu/en/publications-data/syphilis-and-congenital-syphilis-europe-review-epidemiological-trends-2007-2018

Most read articles by the same author(s)

<< < 1 2