Effect of a syphilis control programme on pregnancy outcome in Nairobi, Kenya

Objectives: To assess the impact of a syphilis control programme of pregnan t women on pregnancy outcome in Kenya. Method: Women who came to deliver to Pumwani Maternity Hospital (PMH) betwe en April 1997 and March 1998 were tested for syphilis. Reactive rapid plasm a reagin (RPR) tests were titrated and confirmed with treponema haemaggluti nation test (TPHA). Equal numbers of RPR and TPHA negative women were enrol led. Antenatal syphilis screening and treatment history were examined from the antenatal cards. Results: Of 22 466 women giving birth, 12 414 (55%) were tested for syphili s. Out of these, 377 (3%) were RPR reactive of whom 296 were confirmed by T PHA. Syphilis seroreacrive women had a more risky sexual behaviour and coex istent HIV antibody positivity; 26% were HIV seropositive compared with 11% among syphilis negative mothers. The incidence of adverse obstetric outcom e defined as low birth weight and stillbirth, was 9.5%. Syphilis seropositi ve women had a higher risk for adverse obstetric outcome (OR 4.1, 95% CI 2. 4-7.2). Antenatal treatment of RPR reactive women significantly improved pr egnancy outcome but the risk of adverse outcome remained 2.5-fold higher th an the risk observed in uninfected mothers. Conclusions: These data confirm the adverse effect of syphilis on pregnancy outcome. This study also shows the efficacy of antenatal testing and promp t treatment of RPR reactive mothers on pregnancy outcome.