Fréquence des formes cliniques de syphilis Fréquence des formes cliniques de syphilis congénitale d'une série de 53 Nouveau-congénitale d'une série de 53 Nouveau-

nés* CHAWLA (13)nés* CHAWLA (13) POURCENTAGEPOURCENTAGE Nbre DE CASNbre DE CAS

Faible poids de naissanceFaible poids de naissance 77%77% 4141HépatomégalieHépatomégalie 53%53% 2828SplénomégalieSplénomégalie 51%51% 2727HépatosplénomégalieHépatosplénomégalie 49%49% 2626IctèreIctère 47%47% 2525Lésions cutanéesLésions cutanées 38%38% 2020ThrombopénieThrombopénie 38%38% 1212Détresse respiratoireDétresse respiratoire 19%19% 1010AnasarqueAnasarque 6%6% 33PseudoparalysiePseudoparalysie 4%4% 22CorysaCorysa 4%4% 22Anémie *Anémie * 50%50% 1616

*Les numérations de la formule sanguine n'ont pu être réalisées que pour 32 nouveau-nés.

SYPHILIS CONGENITALESYPHILIS CONGENITALE (Epidémiologie) (Epidémiologie)

AFRIQUE SUBSAHARIENNE AFRIQUE SUBSAHARIENNE = 7 % = 7 % des femmes enceintes sont des femmes enceintes sont

séropositives (2 à 17 % selon les statistiques)séropositives (2 à 17 % selon les statistiques)

ROYAUME UNI ROYAUME UNI

= 13 CAS regroupés en 4 ANS = 13 CAS regroupés en 4 ANS

MOSCOU MOSCOU

= 230 CAS RECENSES EN 6 = 230 CAS RECENSES EN 6 MOISMOIS

TABLE 1. Reasons for cases of congenital syphillis TABLE 1. Reasons for cases of congenital syphillis ,in ATLANTA,GA ,USA ,1990 -93,in ATLANTA,GA ,USA ,1990 -93

REASONREASON NUMBER OF CASESNUMBER OF CASES

No antenatal careNo antenatal care 70 (52) 70 (52) (a)(a)Positive test following previous negative test(b) Positive test following previous negative test(b) 27 (20)27 (20)Positive test ,but no treatmentPositive test ,but no treatment 17 17 ( 13 )( 13 )Therapy failure or reinfection(c)Therapy failure or reinfection(c) 15 (11)15 (11)No test or delayed testNo test or delayed test 5 (4)5 (4)

TOTALTOTAL 134134

a - figures in parentheses are percentagesa - figures in parentheses are percentagesb - Thes e could have been either cases of syphilis acquired during pregnancy or the result of an b - Thes e could have been either cases of syphilis acquired during pregnancy or the result of an inaccurrate,initial negative test.inaccurrate,initial negative test.c -Ten women had a fourfold rise in titre following an initial decline in titre, suggesting reinfection, c -Ten women had a fourfold rise in titre following an initial decline in titre, suggesting reinfection, the remainder had an initial indeterminate response to therapy , suggesting treatment failure.the remainder had an initial indeterminate response to therapy , suggesting treatment failure.

TABLE 2 TABLE 2 Results of re-testing ad delivery women who were Results of re-testing ad delivery women who were seronegative earlier in pregnancy, in selected seronegative earlier in pregnancy, in selected developing countriesdeveloping countries

CityCity Year Year Prevalence of Syphilis Prevalence of Syphilis Prevalence amongPrevalence among

at retesting (a)at retesting (a) alla ttendeesalla ttendees

Durban South Africa(54)Durban South Africa(54) 19931993 5/178(2.8) (b)5/178(2.8) (b) 11,0 %11,0 %

Durban South Africa(54)Durban South Africa(54) 19951995 9/329 (2.7)9/329 (2.7) 9,4 %9,4 %

Nairobi Kenya (47)Nairobi Kenya (47) 20002000 155/12 414 (1.3)155/12 414 (1.3) 3,0 %3,0 %

Three Continents (35)Three Continents (35) 20022002 78/20 320 (0.4)78/20 320 (0.4) 0,9 %0,9 %

Mwanza Tanzania (12)Mwanza Tanzania (12) 20022002 ≥8/1001 (≥0.8)≥8/1001 (≥0.8) 7,7 %7,7 %

a-positive by both reaginic and treponemal antibody testingb-figures in parentheses are percentages

TABLE 3 . Reported obstacles to universal TABLE 3 . Reported obstacles to universal antenatal syphilis screening in sub -Sahara Africa antenatal syphilis screening in sub -Sahara Africa

(n=21)(n=21)

Obstacle reported Obstacle reported Number of project Number of project to be importantto be important managers reporting managers reporting

each obstacle each obstacle Cost to patient of testingCost to patient of testing 1010Organization of servicesOrganization of services 77Cost to patient of treatmentCost to patient of treatment 66Transport costs to testing facilityTransport costs to testing facility 44Inadequate priority given Inadequate priority given by ministry of healthby ministry of health 33Social/cultural resistanceSocial/cultural resistance 33Holidays, absence of health workersHolidays, absence of health workers 22Lack of provider compliance/awarenessLack of provider compliance/awareness 22

REFERENCEM. TEMMERMAN, F. MOHAMED ALI,

L .FRANSEN

Syphilis prevention in pregnancy : an opportunity to improve reproductive and child

health in Kenya.

Health planning and policy 8 (2) :122-127.1993Follow-up:submitted for publication

InterventionIntervention

IMPUTS:►Reogarnisation:

- No referral for bleeding or treatment- Immediate testing at the place of

visit- Quality control and supervision

►Inclusion of counselling and partner notification.

Same inputs as earlier : budget, diagnostics, drugs

BASELINE/ INTERVENTIONBASELINE/ INTERVENTION

Patients Patients In SampleIn Sample

Blood Blood TakenTaken

Screened Screened For For SyphilisSyphilis

Mean Mean SeropositivitSeropositivityy

TreatmenTreatment Levelt Level

Partners Partners NotifiedNotified

Partners Partners TreatedTreated

Baseline 2Baseline 2 540540 61.5061.50%%

87%87% 3.80%3.80% 1/11(+)1/11(+) 00 00

After After InterventioInterventionn

13 62813 628 99.9899.98%%

99.98%99.98% 6.80%6.80% 83.10%83.10% 85.10%85.10% 46.80%46.80%

COSTS (DIRECT and INDIRECT)

► 2.50 US$ per patient visiting

► 11 Woman out of 291 tested (540 visiting) were found positive

► Cost detecting one case:66 US$ (only 1 out of 11 adequate treatment)

► Cost for preventing one case of

congenital syphilis: 730 US$

Cost to prevent 1 CASE congenital syphilis

►BEFORE INTERVENTION 730 US$

►AFTER INTERVENTION 57 US$

Those costs could even decrease further if

women visit earlier during pregnancy

CONGENITAL SYPHILISCONGENITAL SYPHILISRecommended regimensRecommended regimens

Early congenital syphilis (up to 2 years of age) Early congenital syphilis (up to 2 years of age)

Infants with abnormal cerebrospinal fluid: Infants with abnormal cerebrospinal fluid:

aqueous crystalline benzathine penicillin G 50 000 IU.KG by aqueous crystalline benzathine penicillin G 50 000 IU.KG by intramuscular or intravenousi injection,daily in 2 divided doses for a intramuscular or intravenousi injection,daily in 2 divided doses for a

minimum of 10 days. minimum of 10 days. OROR

aqueous procaine benzathine penicillin G ,50 000 IU/KG by aqueous procaine benzathine penicillin G ,50 000 IU/KG by intramuscular injection,as a single dailydose for 10 days.intramuscular injection,as a single dailydose for 10 days.

Infants with normal cerebrospinal fluid:Infants with normal cerebrospinal fluid:

benzathine penicillin G ,50 000 IU/Kg by intramuscular injection, at a benzathine penicillin G ,50 000 IU/Kg by intramuscular injection, at a single sessionsingle session

NOTE: Some experts treat all infants with congenital syphilis as if the cerebrospinal fluid NOTE: Some experts treat all infants with congenital syphilis as if the cerebrospinal fluid findings were abnormal. Antibiotics other than penicillin (i.e erythromycin) are not findings were abnormal. Antibiotics other than penicillin (i.e erythromycin) are not indicated for congenital syphilis except in cases of severe allergy to penicillin. indicated for congenital syphilis except in cases of severe allergy to penicillin. Tetracyclines should not be used in young childrenTetracyclines should not be used in young children..