Congenital syphilis: why has prevention failed? - abstract

ABSTRACT

The incidence of congenital syphilis reflects the incidence of total and maternal syphilis in the community and syphilitic seroprevalence rates among antenatal attenders. We reviewed notifications of syphilis in Jamaica over the last 20 years as well as 30 cases of congenital syphilis admitted to Bustamante Hospital Children and the University Hospital of the West Indies during 1986 and 1987. Reported syphilis cases were 2611 in 1972, fell to 1367 in 1979, rose to 3070 in 1989 and again declined to 2121 in 1992. Between 1979 and 1985 there were 10 or less reported cases of congenital syphilis annually. Increasing numbers of congenital syphilis were reported in the late 1980s with a high of 60 cases in 1990 which has since fallen to 50 cases in 1992. The antenatal clinic VDRL reactor rate increased from around 7 percent in 1980 to 17 percent in 1990. The increase in congenital syphilis appears to be related to the increase in syphilis throughout the Americas, the decline in the public health services due to economic constraints, the shortage of nurses and laboratory staff and a breakdown in antenatal care, specifically the prompt identification and treatment of pregnant women with syphilis. Measures are being put in place to address these deficiencies and prevent the occurrence of congenital syphilis in Jamaica (AU)