Screening for syphilis during pregnancy in Ghana: the role of new rapid point-of-care diagnostic tests

Background Untreated maternal syphilis caused by infection with the bacterium Treponema pallidum is responsible for an estimated annual 360,000 foetal and perinatal deaths worldwide. A further 270,000 babies suffer serious permanent defects because of congenital syphilis. This annual mortality level is greater than that for HIV/AIDS among children (age <15 years). In addition, syphilis is associated with increased transmission of HIV to sexual partners. Adverse pregnancy outcomes due to syphilis would be entirely preventable if pregnant women were screened and treated with the cheapest available antibiotic, penicillin. This would contribute to addressing the Millennium Development Goals (MDGs) 4, 5, and 6. Among pregnant women in developing countries, between 1% and 19% test positive for syphilis. In Ghana, the National HIV/STI Sentinel Surveillance has reported a dramatic increase in mean syphilis seroprevalence from 0.4% in 2003 to 6.5% in 2008, with site prevalence ranging from 0% to 30.5% across 40 clinics involving 18,366 antenatal attenders. This large increase in maternal syphilis prevalence is worrying and may be due to an unfolding epidemic of venereal syphilis or the resurgence of yaws (endemic syphilis) in parts of Ghana or could have been artificially caused by a recent change in the surveillance testing algorithms.