London School of Hygiene & Tropical Medicine

"Syphilis is one of the major reasons hundreds of thousands of babies die in their first four weeks of life - but we can so easily stop this. Syphilis is invisible: if you don't test for it you don't find it. If countries could integrate syphilis screening with HIV screening, it would be more cost-effective and prevent babies dying of syphilis.”

Professor Peter Piot, Director, London School of Hygiene & Tropical Medicine

Simple, low cost interventions to increase the coverage of screening and treatment of syphilis during pregnancy could prevent more than half of newborn deaths and stillbirths related to the disease, which is responsible for nearly 500, 000 perinatal deaths every year in sub-Saharan Africa alone. The findings, published Online First in The Lancet Infectious Diseases, show that syphilis remains a major cause of infant death in many low-income and middle-income countries and that antenatal syphilis screening is one of the most cost-effective health interventions for preventing adverse pregnancy outcomes and improving newborn and child survival.

More than two million pregnant women are infected with syphilis every year. Screening of pregnant women for syphilis is recommended in nearly all countries but is not widely implemented, and fewer than one in eight pregnant women is screened. Without screening and treatment, up to 69% of women will experience an adverse pregnancy outcome such as stillbirth, low birthweight, or disability of an infant. Yet adverse outcomes caused by syphilis are entirely preventable.*

In a related commentary David Mabey, Professor of Infectious Diseases at the London School of Hygiene & Tropical Medicine, and Rosanna Peeling, Professor of Diagnostic Research, note that this is a timely reminder that syphilis has not gone away, and remains a major, though entirely preventable, cause of death in newborn babies.

Prof Mabey remarks: "It is heartening to see the word syphilis in print. Syphilis has not gone away and cannot be ignored. There is a simple and cost-effective solution to save the hundreds of thousands of babies' lives lost from syphilis every year. In the context of campaigns like Save the Children's No Child Born to Die, now is the time to act upon this and integrate syphilis screening into routine antenatal care alongside HIV."

Both Prof Mabey and Prof Peeling point out: “The perception among many public health experts, programme managers, and policy makers that syphilis has disappeared has probably been the greatest barrier to preventing syphilis deaths in babies. If you don’t test for it you don’t find it, which reinforces the impression that it is no longer an issue.”

They add: “If all pregnant women were screened, and those who tested positive were treated with one dose of benzathine penicillin before 28 weeks’ gestation, no stillbirths or neonatal deaths would be due to syphilis.”