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Congenital syphilis in Russia: The value of counting epidemiologic
cases and clinical cases.
Sexually Transmitted Diseases 2004;31(2):127-132.
Salakhov E, Tikhonova L, Southwick K, Shakarishvili A, Ryan C, Hillis
S, for the Congenital Syphilis Investigation Team.
Abstract
BACKGROUND: Congenital syphilis (CS) reports in Russia increased 26-fold from
1991 to 1999. Case reports included only infants who were clinical cases,
had persistent serologic changes, or confirmed syphilitic stillbirth. Although
not reported, policies stipulate that infants of inadequately treated or
untreated mothers receive preventive penicillin treatment. GOAL: We examined
whether risk factors and consequences for epidemiologic cases of CS (infants
of inadequately treated mothers) resembled those of clinical cases and differed
from those of noncases (infants of adequately treated mothers). STUDY DESIGN:
A retrospective record review from Maternity Houses in 5 sites identified
715 syphilis-infected women who gave birth. RESULTS: Among women with maternal
syphilis, 11% (n = 81) of infants were clinical cases, 56% (n = 402) were
epidemiologic cases, and 33% (n = 232) were noncases of CS. Compared with
noncases, maternal risk factors for epidemiologic cases included nonresidence
(P <0.01), late syphilis (P <0.01), unemployment (P <0.01), no prenatal
care (P <0.01), and syphilis testing at >/=28 weeks (P <0.01). Each
of these was also significant for being a clinical case. Associated consequences
of CS for the epidemiologic cases included increases in stillbirth (P <0.01),
preterm birth (P <0.01), low birth weight (P <0.01), transfer to a
pediatric hospital (P <0.01), and abandonment (P <0.05). Each of these
except stillbirth was significantly elevated among clinical cases. Nearly
half of the epidemiologic cases had no record of any penicillin treatment
for the infant. Epidemiologic cases were significantly more likely than noncases
to have no clinical or laboratory follow up. CONCLUSION: In Russia, maternal
risk factors and perinatal consequences for epidemiologic cases of CS resembled
those of clinical cases. Expanding national reporting to include epidemiologic
cases would strengthen CS prevention and monitoring.
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