Guidance on Syphilis Testing in Latin America and the Caribbean: Improving Uptake, Interpretation, and Quality of Testing in Different Clinical Settings

Abstract

[Background]: In 2007, the World Health Organization (WHO), in collaboration with global partners, launched a global initiative for the elimination of congenital syphilis as a public health problem. Congenital syphilis occurs when a pregnant woman with syphilis transmits the infection to her fetus during pregnancy or delivery, also referred to as mother-to-child transmission (MTCT). Congenital syphilis can lead to stillbirth or neonatal death, low birth weight or premature infants, as well as disorders in surviving infants such as blindness, deafness, other neurologic impairment, and bone deformities. It can be prevented by early detection and treatment of the maternal infection with parenteral penicillin. The ongoing initiative to combat this condition is based on four pillars: (i) ensuring sustained political commitment and advocacy for the elimination effort; (ii) increasing access to and quality of maternal and newborn health services; (iii) screening all pregnant women for syphilis and promptly treating those who are positive; and (iv) having adequate surveillance, monitoring and evaluation procedures in place – ideally integrated within or building upon existing health care and health information systems. While strong antenatal programs can identify and treat individual cases to prevent congenital syphilis, the syndrome cannot be eliminated without addressing syphilis prevalence among all reproductive-aged women in the community. Thus, to be most effective, a country response would work to reduce sexual transmission of syphilis within the community through prompt identification and treatment of early infections, as well as identification and treatment of all sexual partners. The Pan American Health Organization (PAHO) and its Member States undertook congenital syphilis prevention efforts more than a decade before the launch of the WHO global initiative. With this long experience, the Region of the Americas helped to lead the global effort through its initial development and implementation of action plans and standards, which included the adoption of recommended standard case definitions and practical program targets and outcome measures. More recently, PAHO has helped to link efforts to eliminate congenital syphilis with those to eliminate perinatal HIV, as well as to lead the development of standards on validating country-level elimination of MTCT of both infections.