Trends in seroreactivity for syphilis among pregnant Nigerian women

Trends in seroreactivity for syphilis among pregnant Nigerian women Demographic dataSyphilis is an old disease that continues to challenge clinicians, including obstetricians. 1 We present a review of the outcome of routine serological screening for syphilis among pregnant women who received antenatal care at the University of Nigeria teaching hospital in Enugu, eastern Nigeria. MethodsThis was a retrospective review of results of serological tests for syphilis for pregnant women during the period 1 January 1991 to 31 December 1997. ResultsThese are presented in table 1.Owing to the unavailability of the Treponema pallidum haemagglutination assay (TPHA) reagents at certain times and the inability of some women to aVord the cost of screening, only 30 of the 148 VDRL reactive serum samples were subjected to TPHA, with three being positive.Thus, 10% of the VDRL reactive sera were also TPHA reactive.This TPHA/VDRL ratio is similar to the 11.6% observed in an earlier study in our centre.2 Should this ratio be projected for other VDRL reactive sera not subjected to the TPHA test, a total of 15 TPHA reactive sera may be obtained.This will give a VDRL and TPHA reactivity of 0.13%. DiscussionThis study reveals a low prevalence rate of syphilis of 0.13% based on VDRL and TPHA reactivity and is comparable with the 0.15% observed in Amsterdam between 1985 and 1989.3 This indicates a threefold decline from the 0.35% reported from our institution for the period 1979 to 1984.A similar trend has also been observed in Ibadan, a city in western Nigeria.4 5 There the seropositivity rate declined from 2.3% between 1976 and 1985 to 1.55% in the succeeding 10 years.However, these results were based on VDRL only as TPHA was not available.Thus, the rates could have been lower.In our institution, VDRL seroreactivity has similarly declined from 3.06% to 1.3%. 2 The downward trend in seroreactivity in Enugu could be due to greater awareness of pregnant women, created during antenatal classes, about the features and complications of syphilis as well as the availability of cure with prompt medication.The high proportion of booked women not screened (20.6%) gives concern since the impact of syphilis on pregnancy may be grave but preventable.Better education of the women by both doctors and nursing staV, and the introduction of the proposed national health insurance scheme, should lead to an increase in the screening rate.Although the prevalence rate is low we support the continued screening of pregnant women since this will help eliminate the adverse eVects of untreated syphilis.Finally, since the TPHA reagent may not always be available in a developing country such as Nigeria, coupled with the inability of some women to aVord the cost of both VDRL and TPHA tests, we recommend the treatment of all women reactive to the VDRL test.Such a policy should ensure that no cases are missed especially as the drugs used are considered safe in pregnancy.It may also result in a further decline in VDRL and TPHA seroreactivity.In addition, concurrent treatment of partners should be considered.