AN ANALYSIS OF THE PROTOCOLS FOR SYPHILIS SCREENING IN PREGNANT WOMEN AROUND THE WORLD

Abstract

Syphilis is the second leading cause of preventable stillbirth worldwide, preceded only by malaria (WHO publishes new estimates on congenital syphilis 2019). Maternal syphilis leads to congenital syphilis in over half of affected pregnancies. Congenital syphilis can cause stillbirth, miscarriage, and other complications in pregnancy, yet has been under-diagnosed in pregnant women. Newly developed point-of-care Rapid Syphilis Tests (RST) allow for same-day treatment and have been proven to be more cost-effective in comparison to standard Rapid Plasma Reagin (RPR) testing. Successful introduction of new health technology requires healthcare worker acceptance, effective training, quality monitoring and robust health systems. The objective of this study is to determine if pregnancy clinics around the world are testing and treating for syphilis during pregnancy. These results will then allow us to investigate potential reasons why syphilis may not be diagnosed and treated during pregnancy. Questionnaires were administered through Qualtrics, a secure database to distribute surveys and analyze responses, to pregnancy clinics in various countries around the world. Pregnancy clinics were selected from personal contacts, contacts of Obstetrics and Gynecology department at the University of Arizona, and through an internet search of OB/GYN’s through Doctors without Borders and Medécins Sans Frontières. Using a conceptual framework, we explored syphilis testing and treatment acceptance and usability. Both qualitative and quantitative data were analyzed using descriptive statistics. We hypothesized that diagnosis and treatment of syphilis during pregnancy will be greater in developed countries compared to developing countries due to the latter’s limited financial means, limited training, and limited resources, which are all factors that affect universal healthcare. Limitations to this study include low response rate (possibly due to perceived legal implications ) , technology barriers, and language barriers. A conclusion drawn from this study is that majority of pregnancy clinics around the world test and treat for syphilis during pregnancy. Of the few clinics that do not test for syphilis, reasons were given which could be further analyzed in future studies to close the gap in testing and treatment. 3