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Universal antenatal screening for syphilis: is it still justified economically? A 10-year retrospective analysis
Herbert Kiss1, Alexander Widhalm, Alexandra Geusau
1Department of Obstetrics and Gynaecology, University of Vienna, Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria. herbert.kiss@akh-wien.ac.at
Insights
Universal prenatal syphilis screening may not be cost-effective. A reassessment of VDRL screening and a focus on high-seroprevalence areas are recommended for better syphilis control.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- Universal prenatal screening for syphilis has been questioned.
- Syphilis incidence and screening effectiveness require updated analysis.
Purpose of the Study:
- To document syphilis development in Austria.
- To analyze the effectiveness of current antenatal syphilis screening.
Main Methods:
- Analysis of national statistics on syphilis incidence (Statistik Austria, Gesundheitsamt Wien).
- Retrospective analysis of 34,312 maternal sera (1988-1999) using VDRL and TPHA assays.
- Determination of congenital syphilis cases in Vienna (1988-1999).
Main Results:
- Syphilis rates were significantly higher in Vienna (8.1-11.0/100,000) than rural provinces (0.7-0.9/100,000).
- Maternal syphilis seroprevalence at delivery was 2.8/1000 births (TPHA-reactive).
- Three stillbirths and six confirmed congenital syphilis cases occurred in Vienna (1988-1999).
Conclusions:
- Universal syphilis screening may not be economically justified.
- The utility of VDRL-based screening needs reevaluation.
- Screening efforts should target high-seroprevalence regions.
Objective:
Because universal prenatal screening for syphilis has recently been called into question, we documented the development of syphilis in Austria and analysed the effectiveness of current antenatal syphilis screening practices.
Methods:
The development of syphilis in Austria and Vienna was determined based on the data published by the Austrian Bureau of National Statistics (Statistik Austria) and the Vienna Health Authority (Gesundheitsamt Wien, MA15), respectively. The data obtained for Vienna were then compared with those for the remaining eight federal provinces. Also, we retrospectively analysed a total of 34,312 sera obtained between 1988 and 1999 from women screened for syphilis at delivery at the laboratory of the Department of Dermatology, University of Vienna. Serological screening was done with both the Venereal Disease Research Laboratory (VDRL) and the Treponema pallidum haemagglutination (TPHA) assays. Finally, we determined the number of cases of congenital syphilis diagnosed in Vienna between 1988 and 1999.
Results:
In the past 10 years, the annual number of reported syphilis cases has remained fairly constant. In 1999 and 2000, there were 8.1 and 11.0 notifications of syphilis per 100,000 inhabitants in the capital Vienna, compared with 0.7 and 0.9 in the remaining provinces with a mainly rural character. At delivery, there were 96 cases of maternal syphilis that were both TPHA- and fluorescent treponemal absorption (FTA-ABS)-reactive, corresponding to a seroprevalence of 2.8 per 1000 births. Only 24 of the TPHA-reactive sera were VDRL-reactive. In Vienna, there were three stillbirth deliveries due to congenital syphilis and six cases of confirmed congenitally syphilis between 1988 and 1999.
Conclusion:
Universal syphilis screening may no longer be justified economically. The usefulness of VDRL-based syphilis screening should be reassessed. The screening focus should shift to regions with a high seroprevalence of syphilis. Universal syphilis screening does not appear warranted.
