Syphilis in pregnant women and their children in the United Kingdom: results from national clinician reporting surveys 1994-7.

Abstract

Objective To measure the incidence of syphilis detected in pregnancy and congenital syphilis in the United Kingdom.

Design Surveys through consultants in genitourinary medicine and paediatricians with active surveillance.

Setting United Kingdom, 1994-7.

Subjects Women treated for syphilis in pregnancy, and children with early congenital syphilis born in the United Kingdom.

Results Over 3 years 139 women were diagnosed with and treated for syphilis in pregnancy; 121 were detected through antenatal screening. Thirty one had confirmed or probable congenitally transmissible syphilis, putting their pregnancies at risk. These were minimum figures but are compatible with the 90 to 100 women newly diagnosed annually as having infectious or early latent syphilis. A universal screening policy would require 18 600 and 55 700 women (maximum numbers) to be screened, respectively, to detect one woman needing treatment and to prevent one case of congenital syphilis. Nine presumptive cases of children with congenital syphilis born in the United Kingdom were reported. Mothers requiring treatment for syphilis were found in almost every health region but were more prevalent in London and the south east. Being born abroad and belonging to an ethnic minority group were strong risk factors, but 14% (19 of 121) of cases treated and six of 31 definite or probably transmissible cases occurred in white women born in the United Kingdom.

Conclusions Congenitally transmissible syphilis continues to occur among pregnant women in the United Kingdom. Cases would be missed and stillbirths and congenitally infected babies would occur if antenatal screening was abandoned.

Introduction

Infectious syphilis in a pregnant woman usually results in miscarriage, stillbirth, or a congenitally infected baby.[1] Risk of transmission diminishes as maternal syphilis advances, but in early latent (asymptomatic) syphilis the risk of vertical transmission remains about 30% to 60%.[2] Maternal infection is, however, detectable by serological screening and entirely treatable with penicillin, which also prevents vertical transmission.[3] Although screening in the United Kingdom is routine,[2] there is no stated policy and the numbers of maternal cases detected are unknown.[4]

The number of cases of adult syphilis and childhood congenital syphilis seen at genitourinary medicine clinics in the United Kingdom diminished after …