Syphilis in pregnant women in Zambia.

Because of the high incidence of congenital syphilis at the University Teaching Hospital, Lusaka, Zambia, the potential risks of congenital infection and fetal loss due to syphilis were assessed by screening 202 antenatal patients, 340 pregnant women admitted to the hospital whose pregnancies ended in either spontaneous abortion or stillbirth, and 469 consecutive babies delivered at the hospital. Primary serological screening was performed with the rapid plasma reagin test, and reactive sera were confirmed by the Treponema pallidum haemagglutination test. In all cases detailed histories were obtained and patients were examined for clinical signs of syphilis. The TPHA test result was reactive in 12.5% of antenatal patients and in 42% of women who aborted in the later half of pregnancy. Among 469 consecutive babies delivered at the hospital, 30 had reactive results to the TPHA test; of these two were stillborn and four had signs of congenital syphilis at birth. Thus, syphilis appears to affect adversely an appreciably high number of pregnant women in Zambia. For this reason a special campaign to screen adequately and treat pregnant women and neonates is needed.

PIP: Three groups of patients were investigated: 202 pregnant women who attended a suburban antenatal clinic for the first time; 340 pregnant women whose pregnancies resulted in either spontaneous abortion or stillbirth; and 464 pregnant women admitted to the labor ward of the University Teaching Hospital, Lusaka. The socioeconomic background and relevant obstetric and prenatal histories of each patient were recorded; the patients were examined for clinical signs of syphilis. Blood samples were obtained for preliminary serological screening for treponemal antibodies with the rapid plasma reagin (RPR) test and reactive sera were tested by the Treponema pallidum hemagglutination (TPHA) test. The cerebrospinal fluid was examined routinely for the presence of treponemal antibodies. 85% of the women in the antenatal group were 20 or more weeks pregnant. 173 of the 240 spontaneous abortions occurred before the 20th weeks of pregnancy. Seroreactivity in the TPHA test in these two subgroups was 9.8% and 41.8% respectively, In 36 of the 42 seroreactive women who gave birth to stillborn babies, the presence of syphilis was the only recognizable etiological factor. 35 women had premature deliveries; 40 of the babies were macerated at birth. In the 167 cases of fetal loss beyond the 20th week of pregnancy, there were no significant differences in age, marital and economic status, education, and parity between seropositive and seronegative groups. A history of previous abortion or stillbirth and antenatal reactivity to the Venereal Disease Research Laboratory test was significant in the seroreactive group. Among the 30 seroreactive babies, 4 had clinical signs of congenital syphilis at birth (detected by darkfield microscopy of exudate in 3 babies), 2 were stillborn, and 8 more required intensive care because of prematurity, asphyxia, and conjunctivitis. The overall mortality and morbidity rates in babies whose sera were reactive in the TPHA test were significantly higher (p 0.001) than in those whose sera were not reactive.

Penicillin and spectinomycin in treatment of gonococcal urethritis.

In view of the recent discovery of penicillinase-producing strains of Neisseria gonorrhoeae in Zambia, the efficacies of single intramuscular doses of aqueous procaine penicillin G (4.8 x 10(6) units plus 1 g of oral probenecid) and 2 g of spectinomycin were evaluated in an open clinical trial of the treatment of acute gonococcal urethritis in men. The former regimen was given to 123 men; failure of treatment was observed in 9.1% of the 88 men followed for two weeks. Spectinomycin was given to 124 men; treatment failure occurred in 3.8% of the 104 men followed for two weeks. During the trial, 190 unselected isolates of N. gonorrhoeae were screened by rapid iodometric test, and two penicillinase-producing strains were detected. MICs of penicillin and spectinomycin were determined by the agar dilution method for 110 and 98 isolates, respectively. MICs of penicillin of greater than or equal to 0.125 micrograms/ml were observed with 78.2% of the strains, while 83.7% had MICs of spectinomycin of less than or equal to 15.0 micrograms/ml. It was suggested that penicillin be given routinely for treatment of gonorrhea in Zambia and that spectinomycin be reserved for treatment of gonococcal infections not cured by penicillin.

Penicillinase-producing gonococcal strains in Zambia. Observations on treatment failures.

Penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) were detected in nine out of 27 (3.2%) treatment failures in 310 cases of acute gonococcal urethritis in men in Lusaka, Zambia. Minimum inhibitory concentrations of penicillin for 17.2% of 233 gonococcal isolates were less than or equal to 0.05 microgram/ml, for 38.2% between 0.125 and 0.25 microgram/ml, and for 46.6% greater than or equal to 0.5 microgram/ml. At present the prevalence of PPNG in African countries is not known but is likely to increase rapidly unless simplified control schemes are adopted within the existing health care programmes. Endemic pockets of PPNG in a few countries can threaten worldwide efforts to control gonorrhoea.

Sexually transmitted diseases in pregnant women in Lusaka.

The prevalance of sexually transmitted diseases has been known to be high in many African countries and preliminary investigations in Lusaka revealed a similar trend in Zambia. This paper presents an analysis of diagnoses made in 170 symptomatic pregnant women referred to the sexually transmitted diseases clinic and the screening results of 163 pregnant women in a routine antenatal examination. A high prevalance of gonococcal infection as well as syphilis was discovered in pregnant women. The implications of these findings on the possible complications and outcome of pregnancy are discussed and remedial measures suggested.