Born free of HIV but dying from the “silent killer”: The crisis of syphilis

By on .

McGillScience Speaks staff writer and Global Health Policy Research Coordinator Rabita Aziz is attending and writing from the McGill University Summer Institute in Infectious Diseases and Global Health this week.

MONTREAL —  In Haiti, activities to prevent mother to child transmission were working, Rosanna Peeling of the London School of Hygiene and Tropical Medicine was heartened to see. Women infected with HIV were giving birth to children free of the virus. But within months, those children were dying from another disease that would have taken less than a dollar to prevent: congenital syphilis.

Over two million pregnant women are infected with syphilis every year, and half of those women pass it on to their children during pregnancy. A third of those children will be born syphilis free, while one third will be stillborn. The last third will be born with congenital syphilis and a high risk of premature death. Up to one million stillbirths and newborn deaths are estimated to occur each year globally because of congenital syphilis, Peeling said here this week.

Over 400,000 stillbirths and newborn deaths occur in Africa alone. It’s not coincidental that syphilis prevalence is high in the same places and populations that see high HIV prevalence. Like the synergistic nature of HIV and TB coinfection, syphilis facilitates HIV infection while HIV drives syphilis infection. More than 10 percent of people infected with HIV are also infected with syphilis. And pregnant women infected with both HIV and syphilis are twice as likely to pass HIV on to their babies than women who are only infected with HIV, according to the Elizabeth Glaser Pediatric AIDS Foundation.

While almost every country has policies in place to screen pregnant women for syphilis, only a fraction of pregnant women are tested, and receive treatment if they’re found to be infected, Peeling said. Many pregnant women don’t have access to antenatal care to begin with, she said, and among those who do have access during early pregnancy, 25 percent receive a syphilis test and 18 percent are given test results. In the end, only 15 percent of pregnant women with syphilis are tested and treated, she said.

“In Haiti, for 50 cents we could have screened a woman for syphilis, and for pennies we could have treated her with penicillin,” Peeling said.

Peeling went to the Global Fund to Fight AIDS, TB and Malaria to advocate for a syphilis testing and treatment program to save the lives of children born to women coinfected with HIV and syphilis, but was told that “the money was only for HIV.”

That’s when she and colleagues from LSHTM partnered with EGPAF and other organizations to develop and distribute a rapid test for syphilis, which unlike conventional syphilis tests, can be done without laboratory equipment, cold storage or electricity, and requires minimal training.

The rapid test was deployed in several low- and middle-income countries in a study to see if it made a difference in reducing stillbirths and infant deaths, and the initial results were so successful, several countries quickly adopted the use of rapid tests in their policies before the research was published, Peeling said.

Uganda and Zambia now include the syphilis rapid test in their standard  prevention of mother-to-child-transmission services while Brazil has prioritized using the rapid test to reach remote populations, within its national HIV prevention program.

Peeling wants to see more integration of HIV and syphilis care and treatment. “Dual elimination of mother-to-child-transmission of HIV and syphilis is possible,” she said.

The World Health Organization now has new syphilis targets: 95 percent of pregnant women getting access to antenatal care, 95 percent of those getting tested for HIV and syphilis, and 95 percent of them getting treated.

Follow Rabita on Twitter at @AzR86. 

Leave a Comment

Your email address will not be published. Required fields are marked *