SYPHILIS CONTROL AMONG PREGNANT-WOMEN - AN EVALUATION AT DELIVERY IN KINGSTON, JAMAICA

This paper evaluates syphilis seroprevalence among women at the time o f delivery and aims to identify weaknesses in antenatal syphilis contr ol. In a cross-sectional study, ail mothers delivering at the largest maternity in Kingston between 13 March 1996 and 3 April 1996 were eval uated using a questionnaire and antenatal records. Maternal sera as we ll as sera from infants born to syphilis seroreactive mothers were tes ted with Toluidine Red Unheated Serum Test (TRUST). Maternal TRUST-rea ctive sera were tested with Microhemagglutination for Treponema pallid um (MHA-TP). Of the 504 women evaluated, 482 (95.6%) had received ante natal care (ANC); 34 (6.7%) were syphilis seroreactive at delivery: 14 (77.8%) of 18 women found sero(+) during pregnancy; four (1.4%) of 283 women with negative antenatal syphilis serology; and 16 (7.9%) of 203 women who had no antenatal syphilis result. Five (27.8%) of the 18 wo men who were found sero(+) during pregnancy had received three benzath ine penicillin injections before delivery, six (33.3%) women had recei ved no antenatal treatment. Syphilis seroreactivity was 22.7% in women who had not received ANC versus 6.0% among women who had (OR: 4.6, p= .01). Syphilis seroreactivity at delivery was associated with a histor y of stillbirth (p=.02). Of 37 newborns with syphilis seroreactive mot hers, 21 (56.7%) were TRUST(+). Both pregnant women and ANC providers must be made aware of the need for improved antenatal syphilis control . Results of syphilis screening should be available before the mother leaves the ANC clinic to avoid poor follow-up, the first injection sho uld be given the same day to seroreactors. Free testing should be offe red when required. Women should be tested early in pregnancy and again before delivery.