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Free Content Treatment of maternal syphilis in rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss

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Abstract:

Summary Objectives 

Despite few data, the treatment of syphilis in pregnant women using a single dose of benzathine penicillin is the standard of care in many resource-poor settings. We examined the effect of various doses of benzathine penicillin on pregnancy loss among women with a positive Rapid Plasma Reagin (RPR) test result in a rural South African district. Methods 

All pregnant women making their first antenatal care visit during pregnancy were screened for syphilis using the RPR test. Those testing positive were counselled to receive three weekly doses of benzathine penicillin, and received a partner notification card. Pregnancy outcomes were determined from facility records or home visits where necessary. Results 

Of 8917 women screened, 1043 (12%) had reactive syphilis serology; of those with titre data available, 30% had titres of 1:8 or greater. While 41% (n = 430) of women received all three doses as counselled, 30% (n = 312) received only one dose, and 20% (n = 207) did not return to the clinic to receive treatment. Among the 947 women with pregnancy outcome data available, there were 17 miscarriages and 48 perinatal deaths observed. There was a strong trend towards reduced risk of pregnancy loss among women receiving multiple doses of penicillin (adjusted OR for perinatal mortality for each additional dose received, 0.63; 95% CI, 0.48–0.84). Conclusions 

While this association requires further investigation, these results suggest that there may be substantial benefit to providing multiple doses of benzathine penicillin to treat maternal syphilis in this setting.

Keywords: Rapid Plasma Reagin test; South Africa; miscarriage; perinatal mortality; pregnancy; syphilis; treatment efficacy

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2004.01330.x

Affiliations: 1: School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa 2: Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South Africa 3: Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa 4: School of Medicine, University of Queensland, Brisbane, Australia

Publication date: November 1, 2004

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