2. Fréquence des formes cliniques de syphilis congénitale d'une série de 53 Nouveau-nés* CHAWLA (13) POURCENTAGENbre DE CAS POURCENTAGENbre DE CAS Faible poids de naissance77%41 Hépatomégalie53%28 Splénomégalie51%27 Hépatosplénomégalie49%26 Ictère47%25 Lésions cutanées38%20 Thrombopénie38%12 Détresse respiratoire19%10 Anasarque6%3 Pseudoparalysie4%2 Corysa4%2 Anémie *50%16 *Les numérations de la formule sanguine n'ont pu être réalisées que pour 32 nouveau-nés.

3. SYPHILIS CONGENITALE (Epidémiologie) AFRIQUE SUBSAHARIENNE = 7 % des femmes enceintes sont séropositives (2 à 17 % selon les statistiques) ROYAUME UNI = 13 CAS regroupés en 4 ANS MOSCOU = 230 CAS RECENSES EN 6 MOIS

8. TABLE 1. Reasons for cases of congenital syphillis,in ATLANTA,GA,USA,1990 -93 REASONNUMBER OF CASES No antenatal care70 (52) (a) Positive test following previous negative test(b) 27 (20) Positive test,but no treatment17 ( 13 ) Therapy failure or reinfection(c)15 (11) No test or delayed test 5 (4) TOTAL134 a - figures in parentheses are percentages b - Thes e could have been either cases of syphilis acquired during pregnancy or the result of an inaccurrate,initial negative test. c -Ten women had a fourfold rise in titre following an initial decline in titre, suggesting reinfection, the remainder had an initial indeterminate response to therapy, suggesting treatment failure.

11. TABLE 2 Results of re-testing ad delivery women who were seronegative earlier in pregnancy, in selected developing countries City YearPrevalence of Syphilis Prevalence among City YearPrevalence of Syphilis Prevalence among at retesting (a) alla ttendees Durban South Africa(54)19935/178(2.8) (b)11,0 % Durban South Africa(54)19959/329 (2.7)9,4 % Nairobi Kenya (47)2000155/12 414 (1.3)3,0 % Three Continents (35)200278/20 320 (0.4)0,9 % Mwanza Tanzania (12)20028/1001 (0.8)7,7 % a-positive by both reaginic and treponemal antibody testing b-figures in parentheses are percentages

12. TABLE 3. Reported obstacles to universal antenatal syphilis screening in sub -Sahara Africa (n=21) Obstacle reported Number of project to be importantmanagers reporting each obstacle Cost to patient of testing10 Organization of services7 Cost to patient of treatment6 Transport costs to testing facility4 Inadequate priority given by ministry of health3 Social/cultural resistance3 Holidays, absence of health workers2 Lack of provider compliance/awareness2

15. REFERENCE M. TEMMERMAN, F. MOHAMED ALI, L.FRANSEN Syphilis prevention in pregnancy : an opportunity to improve reproductive and child health in Kenya. Health planning and policy 8 (2) :122-127.1993 Follow-up:submitted for publication

16. Intervention IMPUTS: Reogarnisation: - No referral for bleeding or treatment - Immediate testing at the place of visit - Quality control and supervision Inclusion of counselling and partner notification. Same inputs as earlier : budget, diagnostics, drugs

17. BASELINE/ INTERVENTION Patients In Sample Blood Taken Screened For Syphilis Mean Seropositivity Treatment Level Partners Notified Partners Treated Baseline 2 54061.50%87%3.80%1/11(+)00 After Intervention 13 628 99.98%99.98%6.80%83.10%85.10%46.80%

18. COSTS (DIRECT and INDIRECT) 2.50 US$ per patient visiting 11 Woman out of 291 tested (540 visiting) were found positive Cost detecting one case:66 US$ (only 1 out of 11 adequate treatment) Cost for preventing one case of congenital syphilis: 730 US$

19. Cost to prevent 1 CASE congenital syphilis BEFORE INTERVENTION730 US$ AFTER INTERVENTION57 US$ Those costs could even decrease further if women visit earlier during pregnancy

20. CONGENITAL SYPHILIS Recommended regimens Early congenital syphilis (up to 2 years of age) Infants with abnormal cerebrospinal fluid: aqueous crystalline benzathine penicillin G 50 000 IU.KG by intramuscular or intravenousi injection,daily in 2 divided doses for a minimum of 10 days. OR aqueous procaine benzathine penicillin G,50 000 IU/KG by intramuscular injection,as a single dailydose for 10 days. Infants with normal cerebrospinal fluid: benzathine penicillin G,50 000 IU/Kg by intramuscular injection, at a single session NOTE: Some experts treat all infants with congenital syphilis as if the cerebrospinal fluid findings were abnormal. Antibiotics other than penicillin (i.e erythromycin) are not indicated for congenital syphilis except in cases of severe allergy to penicillin. Tetracyclines should not be used in young children.