204824 Maternal and congenital syphilis—a neglected problem

Monday, November 9, 2009: 9:25 AM

Judy Lewis, MPhil , Department of Community Medicine, University of Connecticut, Farmington, CT
Bette Gebrian, MPH PhD , Haitian Health Foundation, Jeremie, Haiti
Chaylah Lomotey, MD, MPH , Department of Community Medicine, University of Connecticut, Farmington, CT
Cheryl Bilinski, BS , Department of Community Medicine, University of Connecticut, New Britain, CT
Stephanie Roberts, BS , Department of Community Medicine, University of Connecticut, Farmington, CT
Juan C. Salazar, MD, MPH , Department of Pediatrics, University of Connecticut, Farmington, CT
Syphilis still affects 12 million people annually, resulting in serious maternal and newborn health problems. Syphilis prevalence in the southwestern region of Haiti is 6%. The Haitian Health Foundation (HHF) provides comprehensive prenatal care to a population of over 200,000 people through urban and rural programs. Syphilis testing (RPR) has been provided to the urban program since 1990, and was expanded to rural areas in 2001 using a rapid treponemal assay (Determine-TP).

HHF and the University of Connecticut have conducted several studies on maternal and congenital syphilis. These have examined access to screening, treatment and follow up for both syphilis+ mothers and babies. A retrospective case study of records of 507 women who delivered 2004-2006 estimated the congenital syphilis rate of 767/100 000. Subsequent research has documented case screening, treatment with two doses of Benzathine Penicillin 2.4 million units IM given 8 days apart, partner notification and testing and newborn screening.

Based on this research, HHF improved screening and treatment protocols for mothers, partners and newborns to ensure RPR and HIV testing follow-up for women in the rural program, improved outreach to and treatment for partners, and newborn assessments, testing and treatment. Unfortunately, Ministry of Public and Population Health (MSPP) stopped the policy of RPR in favor of rapid tests in August 2008; and there has been a total stock out of penicillin since November 2008. This resulted in a temporary cessation of testing based on ethical considerations and will negatively affect mothers and newborns.

Learning Objectives:
1. Describe the global problem of congenital syphilis 2. Identify key strategies for syphilis treatment, partner identification and follow-up. 3. Discuss the role of government policy and supply on program interventions.

Keywords: Syphilis Screening, Maternal Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I supervised all three students and worked with them in the field in Haiti. I collaborated with the two other faculty co-authors
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.