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Elimination of mother to child transmission of Syphilis in Papua New Guinea – An opportunity to address the high prevalence of other sexually transmitted infections

Elimination of mother to child transmission of Syphilis in Papua New Guinea – An opportunity to address the high prevalence of other sexually transmitted infections

Introduction: The World Health Organisation (WHO) Initiative for the elimination of mother to child transmission of syphilis (eMTCT ) has identified Papua New Guinea (PNG) as one of 12 priority countries. The most recent national sero-surveillance data indicates a syphilis prevalence of 4.8% in pregnant women. Syphilis diagnosis in antenatal clinics (ANC) relies on rapid point of care (RPOC) tests. These tests are based on detection of anti-treponema pallidum antibodies, and cannot differentiate active syphilis infection, past infection or yaws. Here we provide estimates of active syphilis and other STIs in ANC attendees in PNG.

Methods: Reactive RPOC tests were confirmed using the rapid plasma reagin (RPR) test. According to PNG guidelines, active syphilis was defined as a reactive RPOC test with RPR titre greater than 1/8. Neiserria gonorrhoea, Chlamydia trachomatis and Trichomonas vaginalis were detected using real-time PCR. Provider initiated HIV counselling and testing (PICT ) was offered to all women.

Results: To date, 260 women have been recruited from two ANCs. Of 22 reactive RPOC tests (8.3%), 10 were confirmed, providing an active syphilis prevalence of 3.9%. Uptake of PICT was 77% and HIV prevalence 1.5% (n=3). The prevalence of N. gonorrhoea, C. trachomatis and T. vaginalis was 10.3%, 22.1% and 20.6% respectively.

Conclusion: These data confirm high rates of active syphilis in pregnant women in PNG. However the limitations of using a single RPOC test for syphilis diagnosis in this setting are also demonstrated. Over-diagnosis leading to over-treatment has implications for antibiotic resistance, and social consequences associated with partner notification. This emphasises the need for accurate RPOC diagnostics for active syphilis. The high prevalence of other treatable STIs in this population suggest that broadening the scope of the eMTCT initiative to include interventions for the management of these STIs would also improve maternal and child health.

Conference: ASHM 2013
Areas of Interest / Categories: AIDS 2013

AIDS 2013

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