14 DAY TRIAL // Congenital syphilis is extremely severe: it frequently induces stillbirths or neonatal death and children who survive are usually disabled.
Syphilis is often undiagnosed or untreated in pregnant women, even when mothers are involved in anti-HIV programs.
A new approach from Weill Cornell Medical College and the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) has revealed that a new rapid syphilis test incorporated into prenatal HIV testing programs can impede many stillbirth, neonatal death or congenital syphilis cases, over 2,000 just in Haiti.
There are three strategies used for detecting syphilis: the standard in rural Haitian areas, lacking access to syphilis laboratory testing, is determining the symptoms; the standard in urban areas is blood analysis for the syphilis bacterium, which requires one-week waiting and the rapid testing allowing immediate diagnosis and treatment initiation in just one clinic visit.
Over 20 rapid syphilis tests are commercially available. Four were evaluated during this field test in Haiti and proved to be simple to administer, coming with a result in 30 minutes; they are cheap and can be applied also in other poor countries, like Africa.
Haiti is one example of those cases when pregnant women infection with untreated syphilis is as frequent as infection with HIV.
"Relying on the appearance of symptoms allows for many syphilis cases to be missed. And for most rural women, making even one repeat visit to a clinic to learn the results of a test and be treated is too much of a personal burden. Requiring only one clinic visit, rapid testing followed by immediate treatment proved to be definitely the best strategy," said coauthor Dr. Jean W. Pape, founder and director of GHESKIO and professor of medicine in the Division of International Medicine and Infectious Diseases at Weill Cornell Medical College.
GHESKIO efforts led to a decrease by 50 % of infant mortality and HIV cases in Haiti.
The cost-effectiveness of the strategy was calculated in "disability-adjusted life years" (DALYs), the period of healthy life lost due to congenital syphilis among newborn babies, the number of stillbirths and the number of neonatal deaths.
Rapid testing may be more costly than other methods, but its value compared to standard syphilis screening in both rural and urban areas appeared to be by cost-effectiveness ratios of $7-10 per DALY, a better result than in the case of programs aimed at mother-to-child transmission of HIV in Africa.
"If immediate syphilis testing were provided as part of HIV-testing programs for all pregnant women in Haiti who currently have access to prenatal care, over 1,000 cases would be avoided each year, along with over 1,000 stillbirths and neonatal deaths, at a very reasonable additional cost of slightly more than half a million dollars," said senior author Dr. Daniel W. Fitzgerald, assistant professor of medicine at Weill Cornell Medical College and assistant attending physician at New York-Presbyterian Hospital/Weill Cornell Medical Center.