TABLE 16.

Antenatal Syphilis Screening and Treatment

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Patel et al330South Africa; urban hospital setting; QT5 nurses were trained by a laboratory technician to perform and read the RPR card test. The result of on-site RPR testing (n = 513 women) was compared with RPR test results reported by the laboratory.Sensitivity for the onsite test was 50%, specificity was 91%, positive predictive value was 33% and negative predictive value was 95%.
Osman et al329Mozambique; urban hospital setting; QTBefore the intervention, nurses referred patients (n = 918) to an STD doctor. The intervention trained the nurses to be autonomous in diagnosis and treatment of syphilis with benzathine penicillin.Perinatal mortality was significantly higher in the control group (P = .03; 98.7% of the neonates were alive on the seventh day of life in the intervention group, vs 95.8% in the control group).
Temmerman et al332Kenya; urban hospital setting; CCSOf the 22 466 neonates born to women giving birth in the hospital, 12 414 were tested for syphilis. Cases were defined as mothers whose babies were stillborn or LBW.Syphilis treatment during pregnancy reduced the rate of adverse outcome significantly from 26% to 15%.Women who were seropositive and untreated were 4 times more likely to have adverse pregnancy outcomes, including a stillbirth (OR: 3.34, P < .03) or LBW baby (OR: 4.01, P < .0001).
Hira et al328Zambia; periurban setting; QTStaff was trained in methods of health education, clinical evaluation, on-site RPR serological testing for syphilis and on-site treatment. Number of patients was 3005. Prior to the intervention, the study center had 491 patients and the control center had 434. Post-intervention, the study center had 806 patients and the control center had 1274.Adverse pregnancy outcomes (abortion, stillbirth, preterm birth, LBW and congenital syphilis) were evaluated as a combined entity. Adverse outcomes were significantly lower in the study area (28%) compared to the control area (72%) (P < .001).
Guinness et al316Swaziland; rural setting; QTNurses performed the RPR test for 283 deliveries and the women who were positive were treated in this community-based screening and treatment protocol.Screening averted 35% of congenital syphilis but missed the remaining 65%.