Forum for Nordic Dermato-Venereology Nr 4, 2019 | Page 11

Dermatology Abroad
Progress Towards the Elimination of Mother to Child Trans-
mission of Syphilis in Ukraine
L udmyla D erevyanko , MD
Department of Dermatology and Venereology, Kyiv Medical University, Ukraine. E-mail: dludmyla@
gmail.com
Syphilis is one of the most common sexually transmitted in-
fections (STIs) worldwide, with approximately 6 million new
cases each year. If a pregnant woman who is infected with
syphilis does not receive early and effective treatment, she can
transmit the infection to her unborn infant. New estimates
published by the World Health Organization (WHO) show
that there were approximately 661,000 cases of congenital
syphilis worldwide in 2016, resulting in more than 200,000
stillbirths and neonatal deaths (1).
In 2007 the WHO launched an initiative for the global elim-
ination of congenital syphilis, setting country targets, as
described in “The global elimination of congenital syphilis:
rationale and strategy for action” (2).
The term “congenital syphilis” has traditionally been used to
describe the adverse outcomes of syphilis infection in preg-
nancy. However, expert consensus from a global consultation
in 2012 suggested that, whenever possible, the term “mother-
to-child transmission of syphilis” should be used in place of
“congenital syphilis” in order to increase awareness of the full
spectrum of adverse outcomes, including stillbirths, neonatal
deaths, premature and low-birth-weight infants, as well as
deformities at birth (3).
The global community has committed itself to eliminating
mother-to-child transmission (MTCT) of HIV and syphilis as
a public health priority, as exemplified in the 2014 “WHO
global guidance on criteria and processes for validation” (4).
Elimination is defined as a reduction to zero of the incidence of
a disease or infection in a defined geographical area. However,
because both HIV and syphilis remain public health issues,
and prevention of MTCT measures are highly, but not 100%,
effective, it is currently not possible to reduce the incidence
of either infection to zero. Therefore, the goal for elimination
of MTCT initiatives is to reduce MTCT of HIV and syphilis to
a very low level.
The WHO has announced elimination of MTCT of HIV and
syphilis in Cuba, Thailand, Belarus, Republic of Moldova
(syphilis only), Armenia (HIV only), Anguilla, Montserrat,
Malaysia, Cayman Islands, Bermuda, Antigua and Barbuda, St
Forum for Nord Derm Ven 2019, Vol. 24, No. 4
Christopher Nevis, and Maldives (5). While other countries are
on the way to achieving those targets, a recent report from the
European Center for Disease Control and Prevention (CDC)
highlighted an alarming rate of MTCT of syphilis among
infants in the USA (6). The CDC found that rates of CS and
syphilis among women in Eastern Europe have decreased
since 2005. However, it expressed concerns over the probably
under-reporting of congenital syphilis in several member states
and increasing syphilis rates among women in some western
EU/EEA countries (7).
The objective of this study was to analyse cases of MTCT of
syphilis in Ukraine in order to describe potential risk factors;
knowledge that will help in working to eliminate this infection
according to the WHO target and indicators.
M ethods
Study design and study population
This retrospective study is based on a survey of the number
of MTCT cases of syphilis from 14 regions of Ukraine and
Kyiv, the city capital of Ukraine, during the period 2002
to 2007. The survey included epidemiological, sociodemo-
graphic, clinical and serological data for infants with MTCT
of syphilis and their mothers. The survey was completed by
dermatovenereo­logists, who diagnosed the cases of MTCT of
syphilis and submitted the notification forms. The survey was
approved by order of the Ministry of Health in 2002 (order
number 14, from 17 Jan 2002) when the incidence of cases of
MTCT, as well as syphilis in general, in Ukraine was high. The
Wassermann test and the cardiolipin-based microprecipitation
assay (MPR) were used as screening tests for pregnant women
with syphilis, while rapid plasma reagin (RPR) and Venereal
Disease Research Laboratory (VDRL), the WHO-recommended
tests, are not in routine use. To confirm the diagnosis, samples
found to be reactive on non-treponemal tests were subsequent-
ly tested with assays that detect treponemal antibodies, such
as fluorescent treponemal antibody (FTA) or enzyme-linked
immunosorbent assay (ELISA).
The assessment of laboratory services, human rights and com-
munity participation were not part of this work.
121