Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 17, Number 11—November 2011
Letter

Congenital Syphilis, Réunion Island, 2010

On This Page
Tables
Article Metrics
4
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Syphilis, caused by the bacterium Treponema pallidum, is primarily a sexually transmitted infection, but T. pallidum can also be transmitted by infected pregnant women to their children. Every year, at least 500,000 children are born with congenital syphilis (CS); maternal syphilis causes another half million stillbirths and abortions, usually in countries with limited resources (1). However, CS has been recently found in industrialized countries such as the United States, where the CS rate increased by 23% during 2005–2008, after a 38% increase in the syphilis rate among US women and girls during an earlier period (2004–2007) (2).

Réunion Island, a French overseas territory with 810,000 inhabitants, has a health care system similar to that in continental France. Neither syphilis infection, CS, nor other trepanomatosis (yaws) is notifiable. Since 2006, an increase in early syphilis was documented, first in men who have sex with men infected with HIV and second in the general population.

In 2009, we conducted a retrospective study by using data from 2004–2009 to document the situation of CS on the island. Data from all public (n = 4) and private (n = 2) hospitals on the island with neonatology and obstetrical departments were investigated. Birth deliveries at home were not included. Inclusion criteria were positive specific (T. pallidum hemagglutination assay) and nonspecific (Venereal Disease Research Laboratory [VDRL]) test results for Treponema spp. among children <2 years of age during 2004–2009. Additionally, hospitalized children coded as having congenital syphilis (International Classification of Diseases [ICD] 10 codes A50.0 to A50.9) in the French national hospital database were included. After reviewing medical files of mothers and their children, cases were classified as confirmed or probable CS according to the case definition of the Centers for Disease Control and Prevention (2).

Eighteen children had positive syphilis serologic results by T. pallidum hemagglutination assay and VDRL tests, according to the selection criteria. Among these 18 test results, 7 were classified as probable CS (late treatment for mother or symptoms linked to CS), 3 in 2008 and 4 in 2009 (Table). The male:female sex ratio was 0.75. Five case-patients were preterm newborns; 3 of the most premature babies had signs linked to CS, such as hepatosplenomegaly, cutaneous mucosal signs, neurologic signs, radiographic signs of CS in long bones, edema, and biologic anomalies. All were screened for T. pallidum–specific IgM by using fluorescent treponemal antibody absorption or IgM capture ELISA from immediately after birth to 15 days old. Two case-patients had positive results; 1 was symptomatic. Six of the 7 children who had probable CS received appropriate penicillin G treatment, except for 1 asymptomatic baby for whom long-term medical supervision was recommended by the pediatrician. Survival rates at 3 months of age reached 100%.

Median age of mothers at delivery was 22 years. All mothers were natives of Réunion Island except 1 who was born in Madagascar and received no antenatal follow-up. Medical history indicated previous genital herpes for 3 women. Social difficulties or alcohol consumption were reported for 3 women. The mean age of gestation at which the first syphilis screening was conducted was 23 weeks (5–33 weeks). Two mothers were symptomatic. Syphilis was diagnosed after delivery for 3 mothers; seroconversion occurred during the pregnancy. Except for missing data on 1 mother, all mothers were HIV negative.

In Réunion Island, in our retrospective review, we found 7 CS cases during 2008–2009 but none during 2004–2007. The incidence rate of probable CS cases was estimated to be 28 cases per 100,000 live births during 2009. However, results may have been underestimated because not all parturients with a positive syphilis test result and fetal deaths were investigated. Meanwhile, a fetal death at 30 weeks was reported during the investigation but not included in the selection criteria. The Centers for Disease Control and Prevention definition of CS based on maternal status can also lead to an overestimation. Late screening of syphilis in mothers, lack of antenatal follow-up, higher VDRL titer, or unknown stage of the disease at time of diagnosis have already been described in other studies (35).

Our report highlights an alarming situation in Réunion Island. Reemergence of CS after the increase of early syphilis in women of childbearing age must be considered as a public health alert, especially in countries where health care is supposed to be efficient. CS is easy to prevent with adequate screening of the mother and good follow-up of seropositive parturients.

The results of our study permitted reinforcement of the syphilis mass screening and awareness campaign regarding this sexually transmitted infection in the general population and medical corps. Although it is unrealistic to expect complete eradication of primary and secondary syphilis in communities, a minimal increase of CS rates should trigger reinforcement of these prevention policies.

Top

Acknowledgment

We thank the staff of all pediatric, gynecology, laboratory, and medical information departments who participated in this study.

Top

Juliana Ramiandrisoa, Lydéric Aubert, Emilie Boidin Lespine, Jean-Luc Alessandri, Pierre-Yves Robillard, Marc Bertsch, Anne Gallay, Véronique Goulet, and Eric D’OrtenzioComments to Author 
Author affiliations: Regional Office of French Institute for Public Health Surveillance in the Indian Ocean, Saint-Denis, Réunion Island, France (J. Ramiandrisoa, L. Aubert, E.B. Lespine, E. D’Ortenzio); Regional Hospital, Saint-Denis (J.-L. Alessandri, P.-Y. Robillard); Centre Hospitalier Gabriel Martin, Saint-Paul, Réunion Island (M. Bertsch); French Institute for Public Health Surveillance, Saint-Maurice, France (A. Gallay, V. Goulet)

Top

References

  1. World Health Organization. The global elimination of congenital syphilis: rationale and strategy for action. Geneva: The Organization; 2007.
  2. Centers for Disease Control and Prevention. Congenital syphilis—United States, 2003–2008. MMWR Morb Mortal Wkly Rep. 2010;59:4137.PubMedGoogle Scholar
  3. McFarlin  BL, Bottoms  SF, Dock  BS, Isada  NB. Epidemic syphilis: maternal factors associated with congenital infection. Am J Obstet Gynecol. 1994;170:53540.PubMedGoogle Scholar
  4. Sheffield  JS, Sanchez  PJ, Morris  G, Maberry  M, Zeray  F, McIntire  DD, Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol. 2002;186:56973. DOIPubMedGoogle Scholar
  5. Tikhonova  L, Salakhov  E, Southwick  K, Shakarishvili  A, Ryan  C, Hillis  S. Congenital syphilis in the Russian Federation: magnitude, determinants, and consequences. Sex Transm Infect. 2003;79:10610. DOIPubMedGoogle Scholar

Top

Table

Top

Cite This Article

DOI: 10.3201/eid1711.101925

Related Links

Top

Table of Contents – Volume 17, Number 11—November 2011

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Eric D’Ortenzio, Institut Pasteur de Nouvelle-Calédonie, 9-11 Ave Paul Doumer, BP 61 98845 Nouméa Cedex, New Caledonia, France

Send To

10000 character(s) remaining.

Top

Page created: October 24, 2011
Page updated: October 24, 2011
Page reviewed: October 24, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external