PAHO warns against increasing cases of syphilis

WASHINGTON, DC, United States (CMC) — The Pan American Health Organization (PAHO) is urging countries and health professionals, including those in the Caribbean, to step up the fight against syphilis and congenital syphilis which, though preventable and curable, affect thousands of people each year.

According to the Epidemiological Review of Syphilis in the Americas, launched last month by PAHO, an estimated 4.6 million people have syphillis in the region.

In 2020, countries reported 29,147 cases of congenital syphilis, and preliminary figures reported to PAHO for 2021 indicate more than 30,000 infections transmitted via mother to child.

"The number of people affected remains unacceptably high for a disease that should no longer exist," Dr Marcos Espinal, acting assistant director of PAHO, said.

"We must redouble our efforts to stop the chains of transmission and syphillis from spreading, both in vulnerable populations and in pregnant women and newborn children. Treatment is available and affordable."

Syphilis is a sexually transmitted disease that can cause neurological, cardiovascular, and dermatological disorders in adults. It can also be transmitted from mother to child during pregnancy, and can cause miscarriage, foetal death, prematurity, or severe disabilities in newborns.

In 2016 countries around the world pledged at the World Health Assembly to reduce new cases of syphillis by 90 per cent between 2018 and 2030, and to reduce new cases of congenital syphillis to less than 50 per 100,000 live births. Currently, the incidence of congenital syphilis in the region of the Americas is 200 per 100,000 — well above the target required to achieve elimination.

In 2017 PAHO launched the ETMI-PLUS framework to help countries end mother-to-child transmission of syphilis, HIV, hepatitis B, and Chagas disease, integrating efforts for diagnosis and treatment for pregnant women during prenatal care. And in 2019 it launched an initiative to eliminate more than 30 infectious diseases by 2030, including syphillis and congenital syphillis.

"We must test all women at the first prenatal visit, before week 20, and in the third trimester of pregnancy, and immediately treat those positive — as well as their babies — with penicillin to prevent transmission," said Rodolfo Gómez Ponce de León, PAHO regional advisor for sexual and reproductive health

"If the test has not been done during pregnancy, it should be done at delivery," he said, adding "To avoid reinfection it is also necessary to treat partners."

Increasing testing availability is key to controlling the disease. PAHO's Epidemiological Review of Syphilis shows that in Latin America, only 59 per cent of pregnant women were offered a syphillis test in 2020.

PAHO/WHO recommends using rapid point-of-care tests, including those that detect HIV and syphilis at the same time, to improve opportunities for diagnosis and treatment, but only seven countries in the Americas currently use them.

Countries should also implement awareness and education strategies for health-care workers and the population, and to combat stigma and discrimination against the populations most disproportionately affected — such as sex workers and men who have sex with men — barreiers in accessing prevention and care should be removed.

In order to support countries' efforts towards the elimination of congenital syphillis, PAHO and its Latin American Center for Perinatology, Women's Health and Reproductive Health (CLAP) last week presented a course aimed at primary health-care workers, which will be launched in August.

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