Demographics And Outcomes Of Syphilis Seropositive Pregnant Women And Infants In Three Irish Maternity Hospitals

Untreated syphilis results in significant fetal/neonatal morbidity and death. Increases in infectious syphilis rates worldwide, in particular in the United States, UK and Ireland, necessitates continued diligence in antenatal management. Universal antenatal screening is standard care worldwide. In Ireland management follows the ‘Prevention of Perinatal Transmission’ guidelines. A retrospective cohort study of T.Pallidum seropositive antenatal patients attending three tertiary maternity hospitals in Dublin, Ireland from 01/August/2015 to 31/August/2018 was completed . Ethical approval was granted. Data included demographics, syphilis serology, co-infections, treatment, infant follow-up and adherence to national guidelines. 98 seropositive women with 104 pregnancies were identified, representing 0.14% of livebirths in the study period (n≈66700). 87.5%(n=91) did not speak English as their first language, and 36%(n=37) reported no prior treatment. 91% (n=95) attended a syphilis specialist. Baseline RPR was positive in 31 pregnancies (neat=17, 1:2=6, 1:4=5, 1:16=1, 1:32=2). Treatment was indicated in 40 pregnancies: 85%(n=34) completed Benzathine Penicillin-G (BPG) treatment >4 weeks before delivery; two did not complete BPG treatment; two initiated BPG treatment late in pregnancy and two received Erythromycin. There were 98(94%) liveborn infants, 4 miscarriages and 2 terminations. 28 infants received stat dose BPG on day 1 of life. Two infants received a ten-day course of penicillin. One case of congenital syphilis was identified, with neurological and radiological findings of syphilis infection. Minority ethnic groups comprised the majority in this study. For most, treatment was completed prior to delivery. One in 10 requiring treatment either failed to attend or initiated treatment very late in pregnancy. We highlight a need for continued cohesive multidisciplinary care, focussing on supporting women from minority ethnic communities to access comprehensive maternal and infant care.