Forthcoming Issue 1 2024 Resurgence of congenital syphilis: a profile of symptomatic newborns with congenital syphilis requiring admission to the nursery at a peri-urban regional hospital in Kwa-Zulu Natal (KZN).

Abstract

Background. Congenital syphilis should by now be a medical rarity. However, there has been a recent global resurgence despite preventative measures and effective treatment. This has significant impact on the health system with existing data on the burden of congenital syphilis and preventable factors coming mainly from developed countries.

Objectives. To describe maternal and newborn demographic characteristics of babies admitted with symptomatic congenital syphilis, their spectrum of disease, as well as outline their clinical outcomes and identify modifiable factors that led to the development of the syphilis infection.

Methods. A retrospective chart review of 46 mothers and their 47 newborns admitted to the nursery at Prince Mshiyeni Memorial Hospital (PMMH) between January 2018 to March 2021 with symptomatic congenital syphilis.

Results. Of the 47 symptomatic babies, 12 (26%) died – 50% within 24 hours of birth. Factors associated with death were hydrops foetalis, seizures, low APGAR scores and need for resuscitation at birth. Hepatosplenomegaly, the characteristic rash and pallor were the 3 most common presenting signs. Average length of stay was 19.7 days. Nineteen neonates required admission to ICU for invasive ventilation (40%). Thirteen babies (28%) required non-invasive ventilation. Fourteen newborns (30%) required inotropic support. Red cell transfusion was required in 26 newborns (55%) and platelet transfusion in 4 babies (9%). Most mothers accessed antenatal care (83%) with 71% testing negative for syphilis at booking. Inadequate treatment of the partner, untreated and inadequately treated maternal syphilis, lack of follow up testing plans with absent repeat testing at 32 – 34 weeks gestation were the main modifiable factors.

Conclusion. Despite good antenatal attendance and early maternal syphilis testing, 47 newborns were admitted to a regional nursery in KZN with congenital syphilis over a period of 39 months. This study highlighted the burden of disease in the neonatal population as reflected by the need for intensive care, a prolonged hospital stay and predictors of mortality. The health system failures are related to maternal testing, treatment and tracing. Strengthening of existing programmes together with novel measures such as extended re-testing protocols and mass treatment of sexually active adults need to be explored in order to curb the rise of congenital syphilis.