Treating Syphilis to Reduce Infant Mortality in Africa
Approximately 2.1 million pregnant women worldwide have an active syphilis infection. Without proper treatment, 69% of these pregnancies will result in either stillbirth or early death of the infant. With the discovery of penicillin in 1928, syphilis went from being a highly prevalent sexually transmitted disease to an easily treatable infection. However, in the Third World, syphilis remains a silent scourge, as pregnant women without economic means suffer adverse birth events as a result of this highly treatable disease.
According to the World Health Organization, syphilis is responsible for approximately 500 000 perinatal deaths each year in sub-Saharan Africa. Of the approximately 2 million pregnant women with an active syphilis infection, 1.2 million cases of syphilis are transmitted to unborn babies. The result of prenatal syphilis exposure may be stillbirth, premature birth, low birth weight or congenital malformation.
Syphilis is an infection caused by the bacterium treponema palladum. It is transmitted through sexual intercourse, blood transfusions, mother to fetus, and through direct contact with open, infected lesions. Syphilis has been called “the great impostor” because its symptoms mimic those of other infections. Typically patients present with a solitary lesion called a chancre, which may appear reddened and slightly painful, but will resolve without treatment in approximately four weeks. Left untreated, syphilis progresses to a secondary infection with more widespread symptoms including body rash, fever, malaise,, body aches, nausea and neck stiffness. Treatment of both primary and secondary syphilis infection consists of a single injection of penicillin, injected intramuscularly. In North America, pregnant women are routinely screened for syphilis, so mother to fetus transmission of this infection is relatively uncommon.
In a recent article published in the medical journal The Lancet, European medical researchers did a meta-analysis of studies which examined the role of prenatal care, syphilis testing, and syphilis treatment on women in Africa. It was found that these interventions could reduce the rate of infant mortality by approximately 50%. It is worth noting that syphilis testing and antibiotic treatment of the infection is extremely inexpensive, costing only a few dollars. With a relatively modest investment in testing, treatment and education of pregnant women with respect to syphilis infection, the result would be a major reduction in infant mortality in Africa.